Practice Patterns in Prescribing Buprenorphine in the New Jersey Department of Corrections

Inmates have high rates of opioid use disorder and are at risk for morbidity and mortality both during incarceration and after release. We conducted a retrospective chart review to assess prescribers' fidelity to the New Jersey Department of Corrections practice guideline for prescribing maintenance or prerelease buprenorphine. We compared the entire group of inmates prescribed buprenorphine at the conclusion of 2019 (n = 875) with a sample of inmates diagnosed with opioid use disorder (OUD) but not prescribed buprenorphine (n = 396) and a sample of inmates not diagnosed with OUD (n = 367). Inmates on buprenorphine were more likely to be male, White, in treatment for a mental illness, have higher scores on the Texas Christian University Drug Screen, be closer to release, have multiple substance use disorder comorbidities, and have more substance-related disciplinary charges. They were most often prescribed buprenorphine-naloxone strips, with doses ranging from 2 mg to 12 mg, and a median dose of 8 mg. Racial disparities in prescribing were observed, though the reasons for this are likely multifactorial, and research from the community has shown similar findings. We propose strategies to reduce these differences, including staff education, patient education, and quality improvement initiatives.