“Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

Abstract

Background During the period of community re-entry immediately following release from jail or prison, individuals with opioid use disorder (OUD) face structural barriers to successful re-entry and high risk of overdose. Few published studies investigate experiences in the immediate period (i.e., first 24 h) of re-entry among people with OUD. Aim To understand the barriers and facilitators to treatment and reintegration of people with OUD during the initial transition from carceral settings back into the community. Methods From January–December 2017, we conducted 42 semi-structured qualitative interviews with patients with a history of incarceration who were receiving methadone at a not-for-profit, low-barrier opioid treatment program. Interviews probed participants’ community re-entry experiences immediately following incarceration. Interviews were transcribed and analyzed using a Thematic Analysis approach. Results The main themes described the experiences during the 24 h following release, reacclimating and navigating re-entry barriers, and re-entry preparedness and planning. Participants noted the initial 24 h to be a period of risk for returning to substance use or an opportunity to engage with OUD treatment as well as a tenuous period where many lacked basic resources such as shelter or money. When discussing the subsequent re-entry period, participants noted social challenges and persistent barriers to stable housing and employment. Participants overall described feeling unprepared for release and suggested improvements including formal transition programs, improved education, and support to combat the risk of overdose and return to substance use after incarceration. Conclusions In this study that qualitatively examines the experiences of people with incarceration histories and OUD enrolled in methadone treatment, we found that participants faced many barriers to community re-entry, particularly surrounding basic resources and treatment engagement. Participants reported feeling unprepared for release but made concrete suggestions for interventions that might improve the barriers they encountered. Future work should examine the incorporation of these perspectives of people with lived experience into the development of transition programs or re-entry classes.

Medicaid Inmate Exclusion Policy and Infectious Diseases Care for Justice-Involved Populations

“…Another barrier, with its own set of challenges, is data sharing between correctional and community healthcare systems (30). Virus eradication (hepatitis C virus) and virus suppression (HIV) are needed to end the hepatitis C and HIV infection epidemics, yet persons who leave jail and prisons with those infections often encounter administrative, geographic, and financial hurdles blocking access to treatment, further complicated by competing priorities of housing, food insecurity, and unemployment (31)(32)(33)(34)(35). Persons with untreated HIV infection (36), viral hepatitis (37), and substance use disorder (38) are particularly at risk for disjointed care when transitioning to the community.…”

HIV Risk and Interest in Preexposure Prophylaxis in Justice-Involved Population

“…I n 2021, 6.7 million persons cycled through United States jails (1), 443,700 persons were released from state and federal prisons (2), and 3.7 million persons were on probation or parole (3). During this transition and while under community supervision, those persons are disproportionately affected by health threats such as drug overdose and increased risk for acquiring HIV, sexually transmitted infections (STIs), and hepatitis C (4)(5)(6)(7)(8)(9). Despite successful interventions focused on medications for opioid use disorder (10,11), implementation of integrated, evidence-based interventions that include HIV prevention has been limited.…”