In a study of 6,400 patients with probable opioid use disorder released from 7 Massachusetts county jails between 2019 and 2020, researchers found that receiving medications for opioid use disorder during incarceration was associated with lower risks of death, overdose, and reincarceration following release. Buprenorphine was the most common medication both in jail and in the community, followed by methadone and naltrexone. Outcomes were tracked through 2021.
Among patients who received medications for opioid use disorder (MOUD) in jail, 60% started treatment in the community within 30 days of release, compared with 18% of those untreated. At jail entry, 74% of patients who went on to receive MOUD had already been prescribed community-based medications, compared with 17% of those who did not receive MOUD during incarceration. Half of the MOUD group engaged in treatment for at least three-quarters of the first 90 days after release, compared with 12% of the non-MOUD group. At 180 days, 58% of the MOUD group remained in treatment, compared with 23% of those untreated.
Deaths from any cause occurred in 4% of the MOUD group compared with 5% of the untreated group. Fatal overdoses were reported in 3% of patients who received MOUD in jail and 4% of those who did not. Nonfatal overdoses were also decreased. Reincarceration occurred in 44% of the MOUD group and 50% of the untreated group. Overall, 83% of patients who received MOUD in jail initiated treatment at some point after release compared with 52% of those who did not.
The researchers noted that delivery of MOUD was lower among Black non-Hispanic and Hispanic patients, a finding which was reflected in baseline data which showed that 75% of patients in the MOUD group were White non-Hispanic compared with 58% of those untreated. “Given the overrepresentation of Black non-Hispanic and Hispanic persons in the carceral population," wrote lead author Peter D. Friedmann, MD, MPH, of Baystate Health and the University of Massachusetts Chan Medical School–Baystate, with colleagues, "jails may have the opportunity to improve community equity in access to MOUD by offering MOUD induction to all new intakes who meet criteria for OUD, regardless of previous treatment, and linking them to postrelease community treatment."
Researchers linked mortality, overdose, hospitalization, and correctional data from jail medical and administrative records with statewide health records. Eligible patients were identified as having probable opioid use disorder and were released by June 2021 with at least 180 days of follow-up. Of the 6,400 patients, 2,711 received MOUD in jail and 3,689 did not. Propensity score weighting was used to balance differences between groups. Median follow-up was about 620 days for those treated in jail and 650 days for those untreated. The study was conducted under Chapter 208 of the Acts of 2018, which mandated that five county jails in Massachusetts pilot-test the provision of all FDA-approved forms of MOUD; two additional county jails opted in.
The study had several limitations. It was limited to 7 Massachusetts county jails and may not reflect practices in other states. Identification of opioid use disorder varied across facilities. Some events, such as overdoses outside Massachusetts or reincarceration in federal facilities, were not captured. Data were collected during the COVID-19 pandemic, which may have influenced access to treatment and outcomes. The use of observational data also means that unmeasured confounding factors cannot be excluded.
“These findings provide the impetus for the majority of jails in the United States and internationally that do not provide agonist pharmacotherapy for OUD to implement these effective medications to reduce the risks of opioid overdose, death from any cause, and reincarceration when jailed persons reenter the community," the authors concluded. They added, "Modeled estimates indicate that overdose deaths among formerly incarcerated persons may account for 47% of community overdose deaths. Carceral facilities thus have opportunities for public health and clinical interventions to treat OUD and prevent opioid overdose deaths."
Full disclosures can be found in the study.
Source: NEJM
