Treatment preference for opioid use disorder among people who are incarcerated

Kaplowitz, Eliana; Truong, Ashley; Martin, Rosemarie A.; Clarke, Jennifer G.; Wieck, Morgan; Rich, Josiah D.; Brinkley-Rubenstein, Lauren

doi:10.1016/j.jsat.2021.108690

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…Our study found that being CLS involved was strongly associated with being diagnosed with a stimulant use disorder. Despite the high prevalence of methamphetamine use among CLS-involved older adults in general,3 most research on SUD interventions for CLS populations focuses on alcohol or opioid use disorders 17–20. Meanwhile, the prevalence of co-occurring opioid and methamphetamine use disorder is increasing sharply among veterans,21 and methamphetamine use itself is associated with multimorbidity 22.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the high prevalence of methamphetamine use among CLS-involved older adults in general, 3 most research on SUD interventions for CLS populations focuses on alcohol or opioid use disorders. [17][18][19][20] Meanwhile, the prevalence of co-occurring opioid and methamphetamine use disorder is increasing sharply among veterans, 21 and methamphetamine use itself is associated with multimorbidity. 22 Proper screening of older CLS-involved veterans for SUDs is critical in linking patients to treatment, including contingency management.…”

Section: Discussionmentioning

confidence: 99%

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Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

et al. 2023

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Background: Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. Objectives: To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. Research Design: Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. Subjects: Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). Methods: Mental illness, SUD, medical multimorbidity. Results: An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35–5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04–2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01–1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35–2.49). Conclusions: Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

et al. 2023

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“…Study methods have been described in detail previously 22,23 . Briefly, between June and August 2018, 40 semistructured, qualitative interviews were conducted with persons who were incarcerated and enrolled in the RIDOC MOUD program.…”

Section: Methodsmentioning

confidence: 99%

“…Study methods have been described in detail previously. 22,23 Briefly, between June and August 2018, 40 semistructured, qualitative interviews were conducted with persons who were incarcerated and enrolled in the RIDOC MOUD program. Patients were recruited during group sessions, where study participants were able to confidentially sign up and later had an hourlong interview.…”

Section: Setting and Participantsmentioning

confidence: 99%

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Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration

Kaplowitz

Truong

Macmadu

et al. 2022

Journal of Addiction Medicine

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BackgroundAlthough the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist.MethodsWe conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12.ResultsParticipants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release.ConclusionOur findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.

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Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes

Bovell-Ammon,

Yan,

Dunn

et al. 2024

JAMA Netw Open

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ImportanceAgonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone.ObjectiveTo evaluate postrelease outcomes after buprenorphine implementation.Design, Setting, and ParticipantsThis cohort study with interrupted time-series analysis used linked data across multiple statewide data sets in the Massachusetts Public Health Data Warehouse stratified by sex due to differences in carceral systems. Eligible participants were individuals sentenced and released from a MADOC facility to the community. The study period for the male sample was January 2014 to November 2020; for the female sample, January 2015 to October 2019. Data were analyzed between February 2022 and January 2024.ExposureApril 2019 implementation of buprenorphine during incarceration.Main Outcomes and MeasuresReceipt of MOUD within 4 weeks after release, opioid overdose, and all-cause mortality within 8 weeks after release, each measured as a percentage of monthly releases who experienced the outcome. Segmented linear regression analyzed changes in outcome rates after implementation.ResultsA total of 15 225 individuals were included. In the male sample there were 14 582 releases among 12 688 individuals (mean [SD] age, 35.0 [10.8] years; 133 Asian and Pacific Islander [0.9%], 4079 Black [28.0%], 4208 Hispanic [28.9%], 6117 White [41.9%]), a rate of 175.7 releases per month; the female sample included 3269 releases among 2537 individuals (mean [SD] age, 34.9 [9.8] years; 328 Black [10.0%], 225 Hispanic [6.9%], 2545 White [77.9%]), a rate of 56.4 releases per month. Among male participants at 20 months postimplementation, the monthly rate of postrelease buprenorphine receipt was higher than would have been expected under baseline trends (21.2% vs 10.6% of monthly releases; 18.6 additional releases per month). Naltrexone receipt was lower than expected (1.0% vs 6.0%; 8.8 fewer releases per month). Monthly rates of methadone receipt (1.4%) and opioid overdose (1.8%) were not significantly different than expected. All-cause mortality was lower than expected (1.9% vs 2.8%; 1.5 fewer deaths per month). Among female participants at 7 months postimplementation, buprenorphine receipt was higher than expected (31.6% vs 9.5%; 12.4 additional releases per month). Naltrexone receipt was lower than expected (3.4% vs 7.2%) but not statistically significantly different. Monthly rates of methadone receipt (1.1%), opioid overdose (4.8%), and all-cause mortality (1.6%) were not significantly different than expected.Conclusions and RelevanceIn this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.

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Treatment preference for opioid use disorder among people who are incarcerated

Cited by 15 publications

References 35 publications

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration

Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes

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