Incarceration & Opioid Use Disorder

FDA-approved agonist-based medications are the best available treatment for individuals with opioid use disorder (OUD); however, few people who are incarcerated have access to these life saving medications. Luckily, this trend is changing as there are a growing number of jurisdictions offering medications for opioid use disorder (MOUD) to incarcerated individuals.

Additionally, there is increasing evidence demonstrating and comparing the effectiveness of the three FDA-approved medications approved to treat OUD: methadone, buprenorphine, and extended-release naltrexone. Because these medications vary in terms of effectiveness, costs, routes of administration, formulations, required length of time of detoxification prior to initiation, and other factors, it is critical that all three types of medications are offered to people with OUD. Rhode Island was the first state in the U.S. to provide all three FDA-approved medications in its unified correctional system. This resulted in a 61% decrease in overdose deaths following incarceration within the first year of the program’s implementation.

In the News: MOUD and Corrections

Rockingham County jail to be second in nation with methadone clinic. (2020, April 24). Elizabeth Dinan. Seacost Online

Maine prisons will expand use of ‘gold standard’ treatment for inmates with opioid addiction. (2020, March 12).  Lauren Abbate. Bangor Daily News.

Maine Expands Treatment for Inmates With Opioid Addiction. (2020, March 12). U.S. News & World Reports.

Boone County Jail becomes first in state to administer suboxone for addiction treatment (2020, March 3). Kelly Reinke. Fox 59.

Prison agrees to provide addiction medications for inmates. (2020, March 3). Gloucester Times.

3 Men Will Continue To Receive Addiction Medication In Prison Under Settlement With ACLU. (2020, February 28). Walter Wuthmann. WBUR News.

This State Has Figured Out How to Treat Drug-Addicted Inmates. (2020, February 26). Christine Vestal. PEW Stateline.

For some opioid users in NC, jail doesn’t mean detox. (2020, February 25). Taylor Knopf. North Carolina Health News.

Opioid-replacement treatment available for Montgomery County prisoners. (2020, February 11). Jo Ciavaglia. Bucks County Courier Times.

County plans to offer inmates in San Antonio new treatment option to fight deadly opioid epidemic.(2020, February 11). Emilie Eaton. San Antonio Express-News.

County jails awarded government funding. (2020, February 10). The Tribune-Democrat.

Washington Tackles Opioid Use Disorder in its Jails.(2019, October 25). Casey Leins. US News.

The push to get addiction medication treatment into Maine jails is underway. (2019, July 4). Callie Ferguson. Bangor Daily News.

Setting Precedent, A Federal Court Rules Jail Must Give Inmate Addiction Treatment. (2019, May 4). Willis R. Arnold. NPR.

How the Smallest State is Defeating America’s Biggest Addiction Crisis. (2018, August 25). Erick Trickey. Politico Magazine.

Comparative Effectiveness and Other Studies

Hyatt, J. M. & Lobmaier, P. P. (2020). Medication assisted treatment (MAT) in criminal justice settings as a double-edged sword: balancing novel addiction treatments and voluntary participation. Health & Justice. doi: 10.1186/s40352-020-0106-9

“Medication-Assisted Treatment (MAT) provides an opportunity to address opioid addiction among justice-involved individuals, an often difficult to reach population. This potential has been increasingly recognized by agencies, policymakers and pharmaceutical companies. The result has been a marked increase in the number of drug courts, prisons and agencies in which MAT, notably with long-acting injectable medications, is offered. While this is a positive development, ensuring that vulnerable individuals are in a position voluntarily participation within the complex criminal justice environment is necessary. The unequal authority and agency inherent in the nature of these environments should be recognized. Therefore, rigorous protections, mirroring the goals of the consent processes required for medical or sociobehavorial research, should be employed when MAT is offered to protect individual autonomy.”

Wakeman, S. E., Larochelle, M. R., Ameli, O., Chaisson, C. E., McPheeters, J. T., Crown, W. H., Azocar, F., & Sanghavi, D. M. (2020). Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Network Open, 3(2), e1920622.

“In this comparative effectiveness research study of 40,885 adults with opioid use disorder that compared 6 different treatment pathways, only treatment with buprenorphine or methadone was associated with reduced risk of overdose and serious opioid-related acute care use compared with no treatment during 3 and 12 months of follow-up.”

Moore, K. E., Roberts, W., Reid, H. H., Smith, K. M. Z., Oberleitner, L. M. S., & McKee, S. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32-43.

“Data from RCTs involving 807 inmates (treatment n = 407, control n = 400) showed that methadone provided during incarceration increased community treatment engagement (n = 3 studies; OR = 8.69, 95% CI = 2.46; 30.75), reduced illicit opioid use (n = 4 studies; OR = 0.22, 95% CI = 0.15; 0.32) and injection drug use (n = 3 studies; OR = 0.26, 95% CI = 0.12; 0.56), but did not reduce recidivism (n = 4 studies; OR = 0.93, 95% CI = 0.51; 1.68). Data from observational studies of methadone showed consistent findings. Individual review of buprenorphine and naltrexone studies showed these medications were either superior to methadone or to placebo, or were as effective as methadone in reducing illicit opioid use post-release. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use; additional work is needed to understand the reduction of recidivism and other health risk behaviors.”

Malta, M., Varatharajan, T., Russell, C., Pang, M., Bonato, S., & Fischer, B. (2019). Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systemic review. PLOS Medicine, 16(12), e1003002.

“In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.”

Brinkley-Rubinstein, L., Peterson, M., Clarke, J., Macmadu, A., Truong, Pognon, K. . . . Rich, J. D. (2019). The benefits and implementation challenges of the first state-wide comprehensive medication for addictions program in a unified jail and prison setting. (2019). Drug and Alcohol Dependence, 205, 107514.

“The prevalence of opioid use disorders among people who are incarcerated is high. People who are released from incarceration are at increased risk for overdose. The current study details the first year of implementation of a state-wide medications for addiction treatment (MAT) program in a unified jail and prison setting at the Rhode Island Department of Corrections in Cranston, Rhode Island. We conducted 40 semi-structured, qualitative interviews with people who were incarcerated and concurrently enrolled in the MAT program. Analysis employed a general, inductive approach in NVivo 12. We found that a majority of participants discussed program benefits such as reduced withdrawal symptoms, decreased prevalence of illicit drug use in the facility, improved general environment at the RIDOC, and increased post-release intentions to continue MAT. Suggested areas of improvement include reducing delays to first dose, increasing access to other recovery services in combination with MAT, improving staff training on stigma, and earlier access to medical discharge planning information prior to release. Our findings suggest that correctional MAT programs are acceptable to targeted populations and are a feasible intervention that may be transferable to other states.”

Jarvis, B. P., Holtyn, A. F., Subramaniams, S. Tompkins, D. A., Oga, E. A., Bigelow, G. E., & Silverman, K. (2018). Extended-release injectable naltrexone for opioid use disorder: a systematic review. Addiction, 113(7), 1188-1209.

“We identified and included 34 studies. Pooled estimates showed that XR-NTX induction success was lower in studies that included individuals that required opioid detoxification [62.6%, 95% confidence interval (CI) = 54.5-70.0%] compared with studies that included individuals already detoxified from opioids (85.0%, 95% CI = 78.0-90.1%); 44.2% (95% CI = 33.1-55.9%) of individuals took all scheduled injections of XR-NTX, which were usually six or fewer. Adherence was higher in prospective investigational studies (i.e. studies conducted in a research context according to a study protocol) compared to retrospective studies of medical records taken from routine care (6-month rates: 46.7%, 95% CI = 34.5-59.2% versus 10.5%, 95% CI = 4.6-22.4%, respectively). Compared with referral to treatment, XR-NTX reduced opioid use in adults under criminal justice supervision and when administered to inmates before release. XR-NTX reduced opioid use compared with placebo in Russian adults, but this effect was confounded by differential retention between study groups. XR-NTX showed similar efficacy to buprenorphine when randomization occurred after detoxification, but was inferior to buprenorphine when randomization occurred prior to detoxification.”