Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes

Area of Science:

• Public Health
• Addiction Medicine
• Criminal Justice Health

Background:

• Medications for opioid use disorder (MOUD), such as buprenorphine and methadone, can reduce overdose risk after release from carceral settings but are rarely offered.
• The Massachusetts Department of Correction (MADOC) began offering buprenorphine in April 2019, alongside existing injectable naltrexone, to incarcerated individuals.

Purpose of the Study:

• To evaluate the impact of implementing buprenorphine during incarceration on postrelease outcomes.
• To assess changes in medication for opioid use disorder receipt, opioid overdose rates, and all-cause mortality following buprenorphine availability.

Main Methods:

• A cohort study with interrupted time-series analysis utilized linked statewide data from January 2014 to November 2020 (males) and January 2015 to October 2019 (females).
• The study included 15,225 individuals released from MADOC facilities, stratified by sex.
• Segmented linear regression was used to analyze changes in outcome rates before and after buprenorphine implementation in April 2019.

Main Results:

• Postrelease buprenorphine receipt significantly increased for both males (21.2% vs 10.6%) and females (31.6% vs 9.5%) after implementation.
• Naltrexone receipt decreased among males (1.0% vs 6.0%) and females (3.4% vs 7.2%).
• While not statistically significant, all-cause mortality showed a decreasing trend for males (1.9% vs 2.8%) and remained stable for females (1.6%). Opioid overdose rates did not significantly change.

Conclusions:

• Buprenorphine availability during incarceration led to increased postrelease receipt of this medication and decreased naltrexone use.
• The study suggests that providing buprenorphine in carceral settings can improve continuity of care for opioid use disorder.
• Further research is needed to confirm impacts on overdose and mortality rates, particularly for females.