Buprenorphine treatment in prison for opioid use disorder may reduce re-arrests and reconvictions

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A study in two rural Massachusetts prisons found that people with opioid use disorder who were incarcerated and given a drug approved to treat opioid use disorder, known as buprenorphine, were less likely to be re-arrested and convicted after release than those who had not. medication. After adjusting the data for baseline characteristics such as history with the criminal justice system, the study found a 32% reduction in rates of probation violations, return to custody, or court charges when the facility offered buprenorphine to people in prison compared to when it did not. The findings were published in Drug and alcohol addiction.

The study was conducted by the Justice Community Opioid Innovation Network (JCOIN), a program aimed at increasing high-quality care for people with opioid abuse and opioid use disorders in the legal communities and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, through the long-term Helping to End Addiction, or NIH HEAL Initiative.

Studies like this provide much-needed evidence and momentum for jails and prisons to better enable the treatment, education and support systems that people with opioid use disorder need. to help them recover and prevent incarceration. Failing to offer treatment to people with opioid use disorder in jails and prisons can have devastating consequences, including a return to use and an increased risk of overdose and death after release. »

Nora D. Volkow, MD, director of NIDA

A growing body of evidence suggests that drugs used to treat opioid use disorder, including buprenorphine, methadone and naltrexone, have great potential to improve outcomes in individuals after release. However, offering these evidence-based treatments to people with opioid use disorders who go through the justice system is currently not the standard of care in US jails and prisons, and most prisons that offer them are found in major urban centres.

While previous studies have investigated the impact of buprenorphine provision on overdose rates, risk of infectious disease, and other health effects related to opioid use in incarcerated individuals, this study is one of the first to assess the impact specifically on recidivism, defined as additional probation violations, reincarcerations or prosecutions. Researchers recognized an opportunity to assess this research gap when the Franklin County Sheriff’s Office and the Hampshire County Reformatory, jails in two neighboring rural Massachusetts counties, both began offering buprenorphine to adults in prison, but at different times. Franklin County was one of the first rural prisons in the country to offer buprenorphine, in addition to naltrexone, beginning in February 2016. Hampshire County began providing buprenorphine in May 2019.

“There was a sort of ‘natural experiment’ where two rural county jails within 23 miles of each other had very similar populations and different approaches to the same problem,” said the study author Elizabeth Evans, Ph.D., of the University of Massachusetts-Amherst. “Most people convicted of crimes serve short sentences in prison, not prisons, so it was important for us to investigate our research question in prisons.”

The researchers looked at the outcomes of 469 adults, 197 people in Franklin County and 272 in Hampshire County, who were incarcerated and had opioid use disorder, and who were released from one of the two participating prisons between January 1, 2015, and April 30, 2019. During this time, Franklin County Jail began offering buprenorphine, while the Hampshire County facility did not. Most individuals observed were male, Caucasian, and approximately 34-35 years old.

Using statistical models to analyze data from each jail’s electronic booking system, the researchers found that 48% of people in the Franklin County jail had reoffended, compared with 63% of people in Hampshire County. Additionally, 36% of people incarcerated in Franklin County faced new criminal charges in court, compared to 47% of people in Hampshire County. The reincarceration rate in the Franklin County group was 21%, compared to 39% in the Hampshire County group.

Further analysis showed that the decrease in property crime charges appeared to have fueled the 32% reduction in overall recidivism.

The Massachusetts JCOIN Project, led by Dr. Evans and lead author Peter Friedmann, MD, of Baystate Health, is conducting further research on medications for opioid use disorder in urban and rural prisons in more diverse populations, including women and people of color. Investigators are examining the comparative effectiveness of U.S. Food and Drug Administration-approved drugs for opioid use disorder in prison populations, and the challenges prisons face in implementing them.

“Abundant evidence already shows that offering medication for opioid use disorder to people in prison can prevent overdoses, withdrawal and other adverse health effects after the individual is released. “, said Dr. Friedmann. “Although this study was carried out with a small sample, the results convincingly show that in addition to these positive health effects, the provision of these drugs in prison can break the repressive cycle of arrest, reconviction and of re-incarceration that occurs in the absence of adequate support and resources.

The Helping to End Addiction Long Term Initiative and the NIH HEAL Initiative are registered service marks of the US Department of Health and Human Services.

Source:

National Institutes of Health

Journal reference:

Evans, EA, et al. (2022) Recidivism and mortality after buprenorphine treatment in prison for opioid use disorder. Addiction to drugs and alcohol. doi.org/10.1016/j.drugalcdep.2021.109254.

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