Buprenorphine Induction in a Rural Maryland Detention Center During COVID-19: Implementation and Preliminary Outcomes of a Novel Telemedicine Treatment Program for Incarcerated Individuals With Opioid Use Disorder

Abstract

Over 10 million individuals pass through U.S. detention centers on an annual basis, with nearly two-thirds meeting criteria for drug dependence/abuse. Despite proven efficacy, treatment with medications for opioid use disorder (MOUD) is underutilized in jail settings—a gap that could be addressed using telemedicine. Here we describe a new program of telemedicine-based clinical provision of new/continuing buprenorphine treatment for individuals detained in a rural jail. Implementation objectives were completed between January and August 2020, and patient encounters were conducted between August 2020 and February 2021. We established (i) telemedicine hardware/software capability; (ii) a screening process; (iii) buprenorphine administration methods; (iv) necessary medical release procedures; (v) telemedicine encounter coordination and medication prescription procedures; and (vi) a research platform. Seven incarcerated patients have been treated, two of whom were referred from community treatment. Patients were mostly male (71%), non-Hispanic White (86%), and averaged 33 years old. All patients tested positive for an opioid upon intake and began/continued buprenorphine treatment in the jail. Average time to first MOUD appointment was 9 days and patients were maintained in treatment an average 21 days. Referrals for continuing community treatment were offered to all patients prior to discharge. We report successful implementation of telemedicine MOUD in a rural detention center, with treatment engagement and initiation occurring prior to the high-risk period of discharge. The fact that this program was launched during the height of the pandemic highlights the flexibility of telemedicine-based buprenorphine treatment. Challenges and obstacles to implementation of buprenorphine treatment in a correctional system are discussed.

Pandemic telehealth flexibilities for buprenorphine treatment: a synthesis of evidence and policy implications for expanding opioid use disorder care in the United States

“… 62 A program located in a jail described having staff monitor buprenorphine intake for patients who met with a prescriber via telehealth. 64 Programs also used check-in calls to support patients in the transition to telehealth and with other difficulties during the pandemic. 43 , 44 Others offered patients the option to access remote technologies from a clinic to communicate with a prescriber if they did not have access to personal technologies for telehealth visits.…”

Facilitators and barriers to adopting or expanding medications for opioid use disorder provision in rural Colorado jails: a qualitative analysis

“…Rhode Island was the first state to implement a comprehensive program for OUD in a correctional system in 2016 and had statewide decreases in overdose deaths and post-incarceration overdose deaths after the program was in place (Clarke et al, 2018 ). Following the lessons learned from Rhode Island (Brinkley-Rubinstein, 2019 ), Massachusetts (Evans et al, 2021 ), and Maryland jails (Belcher et al, 2021 ) other states could identify ways to implement substance use screening, counseling and treatment with MOUD during incarceration, and coordination with MOUD providers post-release. In addition, lessons learned from other state’s jail programs can help with overcoming barriers like the perceived risk of diversion.…”

Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy

“…As part of this program, providers travel to one local jail to provide care on site, and other jails transport pregnant patients on BUP to the health system outpatient OBGYN clinic approximately monthly for OUD treatment follow-up while incarcerated during pregnancy ( 12 ). Recently, due to the COVID-19 pandemic, some jails and prisons have implemented telemedicine to provide further flexibility for MOUD ( 18 ). While we found high rates of BUP continuation at delivery for incarcerated patients, it is important that this finding not be interpreted as a recommendation for incarceration as an addiction treatment modality.…”