Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study

Area of Science:

• Public Health
• Addiction Medicine
• Criminal Justice Health

Background:

• Opioid overdoses are rising, yet medications for opioid use disorder (MOUD) are underutilized.
• Individuals in the criminal justice system have disproportionately high rates of opioid use disorder (OUD) and mortality.
• MOUD is infrequently provided in correctional facilities, despite this high-risk population.

Purpose of the Study:

• To evaluate the impact of MOUD provided during incarceration on post-release outcomes.
• To assess treatment engagement, retention, overdose mortality, and recidivism.
• To examine the effectiveness of the Rhode Island Department of Corrections' statewide MOUD program.

Main Methods:

• Retrospective cohort study of 1600 individuals released from the Rhode Island Department of Corrections between December 2016 and December 2018.
• Analysis of MOUD prescriptions (methadone, buprenorphine, naltrexone) during incarceration and post-release.
• Tracking of 12-month post-release treatment engagement, retention, overdose deaths, and reincarceration rates.

Main Results:

• High post-release MOUD treatment engagement: 73% at 30 days and 86% at 12 months.
• Individuals continuing MOUD from community-based treatment showed higher engagement than those newly inducted in jail.
• Reincarceration rates were comparable to the general correctional population; overdose deaths were low, especially in the immediate post-release period.

Conclusions:

• Implementing MOUD within correctional facilities is a critical, life-saving strategy.
• Seamless linkage to community-based MOUD care post-release is essential for sustained engagement and improved outcomes.
• Expanding MOUD in correctional settings can significantly reduce overdose mortality and improve public health.