Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study

Martin, Rosemarie A.; Alexander‐Scott, Nicole; Carpenter, Ryan W.; Kang, Aram; Hoadley, Ariel; Kaplowitz, Eliana; Hurley, Linda; Rich, Josiah D.; Clarke, Jennifer G.

doi:10.1016/j.lana.2022.100419

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…Regression analysis showed that use of MOUD during incarceration was positively associated with already being on MOUD at intake. Results are consistent with recent evidence on the Rhode Island Department of Corrections MOUD program indicating that most MOUD participants, 61%, were continued on MOUD from the community 21 . We also found differences by site, with receipt of MOUD during incarceration associated with the site that had offered buprenorphine for more years and had lower barriers to use of medications, for example by offering inductions at entry and not only prerelease, providing methadone on-site, and engaging with pretrial individuals in addition to sentenced individuals.…”

Section: Discussionsupporting

confidence: 88%

“…Results are consistent with recent evidence on the Rhode Island Department of Corrections MOUD program indicating that most MOUD participants, 61%, were continued on MOUD from the community. 21 We also found differences by site, with receipt of MOUD during incarceration associated with the site that had offered buprenorphine for more years and had lower barriers to use of medications, for example by offering inductions at entry and not only prerelease, providing methadone on-site, and engaging with pretrial individuals in addition to sentenced individuals. Future research should examine the extent to which specific aspects of MOUD programming and operation are associated with MOUD use and other related patient outcomes.…”

Section: Discussionmentioning

confidence: 75%

“…Taken together, findings suggest that jails in rural communities can continue and initiate these life-saving medications and thereby play a critical role in expanding access to and use of MOUD. Use of MOUD during incarceration has been associated with continuity of MOUD 12-month postrelease, 21,27 suggesting that program benefits may continue after community re-entry. Although it will be necessary to research whether MOUD continuity postrelease differs in communities with more barriers to MOUD access and utilization, such as rural communities.…”

Section: Discussionmentioning

confidence: 99%

“…20 Recent literature suggests that Black and Hispanic individuals are less likely to enter carceral facilities with a MOUD prescription and are more likely to be inducted on buprenorphine while incarcerated, compared with White individuals. 21 In addition, individuals may not receive MOUD while incarcerated because of patient preferences, a lack of patient knowledge about MOUD, and MOUD-related social stigma. 22 Taken together, the evidence suggests that there are contextual-and individual-level factors that can impact receipt of MOUD, including whether individuals start, stop, or maintain MOUD while incarcerated or receive a type of MOUD during incarceration that is different from what was being taken while residing in the community.…”

mentioning

confidence: 99%

“…At the individual level, incarcerated women may be more likely than men to receive MOUD, for example, due to policies that prioritize provision of MOUD to pregnant women, 9 while a significant proportion of incarcerated women have co-occurring mental illnesses and do not receive treatment 20 . Recent literature suggests that Black and Hispanic individuals are less likely to enter carceral facilities with a MOUD prescription and are more likely to be inducted on buprenorphine while incarcerated, compared with White individuals 21 . In addition, individuals may not receive MOUD while incarcerated because of patient preferences, a lack of patient knowledge about MOUD, and MOUD-related social stigma 22 …”

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confidence: 99%

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Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail

2023

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Objectives: Little is known about the correlates of use of medications to treat opioid use disorder (MOUD, ie, buprenorphine, methadone, naltrexone) offered in jails. We evaluated the implementation and outcomes of a MOUD program offered by 2 of the first jails nationwide to provide access to such care. Methods: We examined use of MOUD among adults with opioid use disorder (n = 347) incarcerated by 2 rural jails in Massachusetts (2018Massachusetts ( -2021. We examined MOUD transitions from intake to during incarceration. Using logistic regression, we examined factors associated with in-jail use of MOUD. Results: At jail entry, 48.7% of individuals with opioid use disorder were being treated with MOUD. During incarceration, 65.1% received MOUD, attributable to a 9.2% increase in use of methadone (from 15.9% to 25.1%) and a 10.1% increase in use of buprenorphine (from 28.5% to 38.6%). During incarceration, 32.3% of individuals were continued on the same MOUD from the community, 25.4% were started, 8.9% stopped, and 7.5% switched type. A total of 25.9% entered jail not on any MOUD and were not started on it. Use of MOUD during incarceration was positively associated with having received MOUD in the community (odds ratio, 12.2; 95% confidence interval, 5.8-25.5) and incarceration at site 1 compared with site 2 (OR, 24.6; 95% CI, 10.9-54.4). Conclusions: Expanded access to MOUD in jails can engage an at-risk population with treatment. Understanding factors related to this population's use of MOUD may aid efforts to optimize care during incarceration and after community re-entry.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail

2023

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Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes

Bovell-Ammon,

Yan,

Dunn

et al. 2024

JAMA Netw Open

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ImportanceAgonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone.ObjectiveTo evaluate postrelease outcomes after buprenorphine implementation.Design, Setting, and ParticipantsThis cohort study with interrupted time-series analysis used linked data across multiple statewide data sets in the Massachusetts Public Health Data Warehouse stratified by sex due to differences in carceral systems. Eligible participants were individuals sentenced and released from a MADOC facility to the community. The study period for the male sample was January 2014 to November 2020; for the female sample, January 2015 to October 2019. Data were analyzed between February 2022 and January 2024.ExposureApril 2019 implementation of buprenorphine during incarceration.Main Outcomes and MeasuresReceipt of MOUD within 4 weeks after release, opioid overdose, and all-cause mortality within 8 weeks after release, each measured as a percentage of monthly releases who experienced the outcome. Segmented linear regression analyzed changes in outcome rates after implementation.ResultsA total of 15 225 individuals were included. In the male sample there were 14 582 releases among 12 688 individuals (mean [SD] age, 35.0 [10.8] years; 133 Asian and Pacific Islander [0.9%], 4079 Black [28.0%], 4208 Hispanic [28.9%], 6117 White [41.9%]), a rate of 175.7 releases per month; the female sample included 3269 releases among 2537 individuals (mean [SD] age, 34.9 [9.8] years; 328 Black [10.0%], 225 Hispanic [6.9%], 2545 White [77.9%]), a rate of 56.4 releases per month. Among male participants at 20 months postimplementation, the monthly rate of postrelease buprenorphine receipt was higher than would have been expected under baseline trends (21.2% vs 10.6% of monthly releases; 18.6 additional releases per month). Naltrexone receipt was lower than expected (1.0% vs 6.0%; 8.8 fewer releases per month). Monthly rates of methadone receipt (1.4%) and opioid overdose (1.8%) were not significantly different than expected. All-cause mortality was lower than expected (1.9% vs 2.8%; 1.5 fewer deaths per month). Among female participants at 7 months postimplementation, buprenorphine receipt was higher than expected (31.6% vs 9.5%; 12.4 additional releases per month). Naltrexone receipt was lower than expected (3.4% vs 7.2%) but not statistically significantly different. Monthly rates of methadone receipt (1.1%), opioid overdose (4.8%), and all-cause mortality (1.6%) were not significantly different than expected.Conclusions and RelevanceIn this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.

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Incarceration and health: An overview of conditions and solutions

Cullins,

Behne,

Macmadu

et al. 2024

Reference Module in Biomedical Sciences

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Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study

Cited by 11 publications

References 18 publications

Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail

Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail

Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes

Incarceration and health: An overview of conditions and solutions

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