Retention on Buprenorphine for Opioid Use Disorder in Justice-Involved Individuals: A Retrospective Cohort Study

Area of Science:

• Addiction Medicine
• Public Health
• Criminal Justice Research

Background:

• Criminal justice system (CJS) involvement is prevalent among individuals with opioid use disorder (OUD).
• Limited research exists on medication for opioid use disorder (MOUD) retention within community settings for justice-involved individuals.
• Understanding factors influencing MOUD retention is crucial for improving treatment outcomes and reducing recidivism.

Purpose of the Study:

• To assess if CJS involvement predicts retention in buprenorphine/naloxone treatment.
• To explore demographic and clinical factors associated with MOUD retention in a justice-involved population.
• To evaluate the impact of low-barrier, comprehensive services on treatment retention.

Main Methods:

• Retrospective cohort study of 367 adults in a low-barrier outpatient MOUD program in Texas (January 2022-April 2024).
• CJS involvement identified from program records; retention measured by continuous days of buprenorphine/naloxone prescription.
• Statistical analyses included univariate tests, logistic regression, and nonparametric kernel regression.

Main Results:

• 24.8% of participants had CJS involvement.
• 180-day retention rates were similar between CJS-involved (38%) and non-CJS groups (38%).
• CJS participants reported earlier substance initiation and higher heroin/injection drug use.
• Behavioral health sessions correlated with CJS involvement (OR=1.10) and longer retention (β=10.81 days/session).

Conclusions:

• Individuals with CJS involvement achieved comparable MOUD retention to non-CJS peers in a low-barrier program.
• Early and consistent engagement in behavioral health services is a key predictor of MOUD retention.
• Comprehensive, low-barrier services can enhance treatment outcomes and promote equity for justice-involved populations.