Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder

Abstract

BackgroundThe United States has the highest rate of incarceration in the world (937 per 100,000 adults). Approximately one-third of heroin users pass through correctional facilities annually. Few receive medication assisted treatment (MAT; either methadone or buprenorphine) for opioid use disorder during incarceration, and nearly three-quarters relapse to heroin use within 3 months of release. This qualitative study investigated barriers to and facilitators of buprenorphine maintenance treatment (BMT) following release from incarceration (“re-entry”).MethodsWe conducted 21 semistructured interviews of former inmates with opioid use disorder recruited from addiction treatment settings. Interviews were audio-recorded, transcribed, and analyzed using a grounded theory approach. Themes that emerged upon iterative readings of transcripts were discussed by the research team.ResultsParticipants reported adverse re-entry conditions, including persistent exposure to drug use and stressful life events, which were perceived to contribute to opioid relapse and affected addiction treatment decisions during re-entry. Themes that emerged relating to BMT included: 1) reliance on willpower; 2) fear of dependency on medications; 3) variable exposure to buprenorphine; and 4) acceptability of BMT following relapse. Willpower was perceived to be more important for recovery than medications. Many participants experienced painful withdrawal from methadone during incarceration and were fearful that using MAT would lead to opioid tolerance and painful withdrawal again in the future. Participants reported both positive and negative experiences taking illicit buprenorphine, which affected interest in BMT. Overall, BMT was perceived to be a good treatment option for opioid use disorder that could reduce the risk of re-incarceration.ConclusionsBMT was perceived to be acceptable, but former inmates with opioid use disorder may be reluctant to utilize BMT upon re-entry. Factors limiting utilization of BMT could be mitigated though policy change or interventions. Policies of the criminal justice system (e.g., forced detoxification) may be dissuading former inmates from utilizing effective treatments for opioid use disorder. Interventions that improve education and access to BMT for former inmates with opioid use disorder could facilitate entrance into treatment. Both policy changes and interventions are urgently needed to reduce the negative consequences of opioid relapse following re-entry.

Triggers of Substance Abuse Slip and Relapse During Outpatient Treatment in Methadone/Buprenorphine Maintenance Therapy Clinics: A Predictive Model with Emphasis on Treatment-Related Factors

“…In these centers, the agonists of opioids, which act on µ receptor as same as natural opioids, are prescribed for substance abuse treatment. These medications include Methadone (2,17) as pure agonist of µ receptor, Buprenorphine (2,17) as partial agonist of µ receptor and k receptor and tincture of opium.…”

Extended-release naltrexone opioid treatment at jail reentry (XOR)

“…NYC jails are an exception, and offer methadone detoxification (13,532 persons, 2014) and methadone maintenance (3086 persons, 2014) as routine standards of care [11,17,18]. However, most detainees receiving methadone detoxification will not transition to methadone maintenance due to various logistic, regulatory, and patient-centered factors [19,20]. Thus, among heroin users out-of-treatment at arrest, most leave NYC jails detoxed but still out-of-treatment, alongside a much smaller number newly enrolled in methadone maintenance.…”

NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale

“…11 Many patients believe that they can “go it alone” following detoxification, or otherwise reject agonist maintenance due to stigma, side effects and inconvenience. 12,13 Clinicians, treatment programs, and patients often espouse a strong tradition of “drug-free,” abstinence-oriented treatment, and maintenance on an opioid agonist is often not considered abstinence. 14 There are concerns about agonist diversion.…”