Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review

Abstract

This study examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Randomized controlled trials (RCTs) and quasi-experimental studies published through December 2017 that examined induction to or maintenance on methadone (n=18 studies), buprenorphine (n=3 studies), or naltrexone (n=3 studies) in correctional settings were identified from PsycINFO and PubMed databases. There were a sufficient number of methadone RCTs to meta-analyze; there were too few buprenorphine or naltrexone studies. All quasi-experimental studies were systematically reviewed. 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.

Evaluating the implementation of a prisoner re-entry initiative for individuals with opioid use and mental health disorders: Application of the consolidated framework for implementation research in a cross-system initiative

“…A recent meta-analysis examining the effectiveness of MAT delivered in prisons and jails found promising results with methadone treatment (Moore et al, 2019). There were not enough studies of buprenorphine or naltrexone to meta-analyze, but data from trials in which methadone was provided during incarceration demonstrated increased community treatment engagement and reduction in illicit opioid and injection drug use (Moore et al, 2019). In a randomized control trial of individuals recently released from prison, XR-NTX plus counseling showed improved relapse outcomes compared to counseling or treatment referrals alone (Lee et al, 2016).…”

Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine

“…1,2 Treatment with methadone or buprenorphine can mitigate adverse consequences and decrease mortality. [3][4][5][6][7] Despite the strong evidence and clinical guidelines supporting use of these medications, [8][9][10] as many as 80% of patients do not receive such potentially life-saving treatments. 7,11 To address this treatment gap, the emergency department (ED) has emerged as an important location to identify patients with OUD and initiate buprenorphine with referral for ongoing treatment.…”

Trends in Substance Use by Gender Among Participants in a Jail‐Based Substance Use Disorder Treatment Program: 1998–2016

“…While jail-and prison-based treatment programs in the US are slowly shifting to align their services with evidence-based approaches (30)(31)(32), the uptake of MAT in prison and jail systems has been limited (33,34). In addition, the research supporting MAT in corrections settings is largely focused on prison-based or integrated jail-prison systems rather than on jail-based programs (35). In the Choices program, clients are now eligible to receive a long-acting opioid antagonist, naltrexone (brand name Vivitrol).…”