Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

Abstract

BackgroundWorldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration.Methods and findingsWe systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273–131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27–960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15–1,557) and 44 (range 27–382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36–55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research.ConclusionsIn this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional prev...

Readiness to try extended-released buprenorphine and related factors of interest: comparison between incarcerated and non-incarcerated subjects with opioid use disorder.

“…For these subjects, incarceration can constitute an opportunity to initiate an OAT [10]. Compared with the incarcerated subjects with OUD who are untreated, those who receive an OAT show signi cant reductions in their overall opioid use during incarceration, as well as in their injection behaviors, prison infractions, and suicide and overall mortality risk in prison [11,12]. Moreover, the treated subjects are less likely to experience an overdose after prison release.…”

“…Moreover, the treated subjects are less likely to experience an overdose after prison release. Consequently, it has been deemed crucial to scale up OUD treatment and prevention strategies within a continuum of initiatives before, during, and after incarceration [12]. Despite this overall statement, the access to OATs remains globally insu cient in prison.…”

Substance Use and Overdose Risk: Documenting the Perspectives of Formerly Incarcerated Persons in the Fraser East Region of BC

“…Within Canada, both in provincial and federal correctional settings, injection drug use prior to incarceration was commonly reported, with 2/3 of federal inmates reporting a history of substance use problems 8 . Several studies have found that in the rst weeks following release from prison, risk of non-fatal overdose and overdose death is markedly increased, and overdose is one of the leading causes of death related to correctional institutions both during and after incarceration 3,4,5 . In Canada, there have been fewer studies relating overdose death and incarceration history.…”

“…As far as protective factors, many studies have identi ed the availability of harm reduction during incarceration as having a protective effect on overdose deaths post-release. A 2019 systematic review found that opioid agonist treatment (OAT) provided to incarcerated people with opioid use disorder (OUD) reduces overdose incidence and mortality and improved retention rates in treatment services post-release 5 . It also recommended that OAT as well as other harm reduction strategies, including naloxone training and provision, be available before, during and after incarceration to reduce risk of overdose 5 .…”

“…A 2019 systematic review found that opioid agonist treatment (OAT) provided to incarcerated people with opioid use disorder (OUD) reduces overdose incidence and mortality and improved retention rates in treatment services post-release 5 . It also recommended that OAT as well as other harm reduction strategies, including naloxone training and provision, be available before, during and after incarceration to reduce risk of overdose 5 . Although these quantitative analyses certainly inform our understanding of opioid overdose risk following incarceration, the existing knowledge base requires qualitative studies to better understand the intersecting individualized and systemic factors affecting substance use and risk of overdose post-release.…”