Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes.

Journal: JAMA network open

Volume: 7

Issue: 3

Year of Publication: 2024

Affiliated Institutions:  Departments of Medicine and of Healthcare Delivery and Population Sciences, Baystate Health, Springfield, Massachusetts. Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts. Massachusetts Department of Public Health, Boston, Massachusetts. Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health & Health Sciences, Amherst. Office of Research and Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, Springfield.

Abstract summary 

Agonist 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.To evaluate postrelease outcomes after buprenorphine implementation.This 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.April 2019 implementation of buprenorphine during incarceration.Receipt 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.A 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.In this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.

Authors & Co-authors:  Bovell-Ammon Yan Dunn Evans Friedmann Walley LaRochelle

Study Outcome 

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Statistics
Citations :  O’Connor AW, Sears JM, Fulton-Kehoe D. Overdose and substance-related mortality after release from prison in Washington State: 2014-2019. Drug Alcohol Depend. 2022;241:109655. doi:10.1016/j.drugalcdep.2022.109655
Authors :  7
Identifiers
Doi : e242732
SSN : 2574-3805
Study Population
Male,Female
Mesh Terms
Female
Other Terms
Study Design
Cohort Study
Study Approach
Country of Study
Publication Country
United States