Benefits of in-jail buprenorphine treatment for opioid use disorder touted in new study
“This is a critical outcome to be aware of as jails nationwide consider whether to offer this type of healthcare,” said the study's lead author
By Ray Kelly
SPRINGFIELD — A new study by Baystate Medical Center and the University of Massachusetts Amherst strengthens the case for using buprenorphine to treat inmates with opioid use disorder.
The study, published last week in Drug and Alcohol Dependence, was funded by the National Institute on Drug Abuse, part of the National Institutes of Health. It was part of the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative, and its Justice Community Opioid Innovation Network.
With a grant to Dr. Peter Friedmann, chief research officer at Baystate Health and associate dean for research at UMass Chan Medical School – Baystate, researchers found a 32% reduction in recidivism — including probation violation, reincarceration or court charges — when a jail offered buprenorphine to prisoners, compared to when it did not.
“These results show convincingly that on top of their positive health effects, providing these medications to treat opioid use disorder in jail can break the repressive cycle of arrest, reconviction, and reincarceration,” Friedmann said.
According to lead author Elizabeth Evans, associate professor in the UMass Amherst School of Public Health and Health Sciences, “When jails offer buprenorphine and other evidence-based medications to treat opioid use disorder, it can improve public safety.”
“This is a critical outcome to be aware of as jails nationwide consider whether to offer this type of healthcare,” she said.
In addition to reducing recidivism, opioid agonist medications, including buprenorphine and methadone, show great promise to stem overdose and drug use in correctional populations. The challenge is that their implementation is not standard-of-care in U.S. jails. The few correctional facilities that do offer medications to treat opioid use disorder are large urban jails in New York, San Francisco and Albuquerque, or are part of unified state systems.
The study, part of a national effort to address the opioid crisis in criminal justice settings, is one of the first to evaluate the impact on recidivism of providing buprenorphine to people who are incarcerated.
Co-lead investigators Evans and Friedmann recognized an opportunity to assess this research gap when jails in two neighboring rural counties — the Franklin County Sheriff’s Office and the Hampshire County House of Corrections — both began to offer buprenorphine to adults in jail, but at different times. Franklin County was one of the first rural jails in the nation to offer buprenorphine — in addition to naltrexone — beginning in February 2016. Hampshire County began providing buprenorphine in May 2019.
The researchers followed 469 adults who were incarcerated and had opioid use disorder — 197 individuals in Franklin County and 272 in Hampshire County — and who exited one of the jails between Jan. 1, 2015, and April 30, 2019. During this time, Franklin County jail began offering buprenorphine while the Hampshire County facility did not. Most of the observed individuals were male, white and in their mid-30s.
The difference in buprenorphine availability across two jails in adjacent counties presented the authors with a “natural experiment” to determine whether post-release recidivism was different between individuals who did and did not have the opportunity to receive buprenorphine while in jail. Prior research on post-release outcomes found beneficial effects of methadone and buprenorphine on drug use, injection risk behaviors associated with HIV, and overdoses.
“Less established is the impact of buprenorphine in jails on post-release recidivism, a crucial outcome to convince lawmakers and public safety officials of its value in correctional settings,” Friedmann said.
Evans added, “Most people convicted of crimes carry out short-term sentences in jails, not prisons, so it was important for us to study our research question in jails.”
The authors hypothesized that outcomes would be better among those who exited the Franklin County jail and were offered buprenorphine pre-release than among those who exited the Hampshire County jail who were not offered buprenorphine pre-release.
Using statistical models to analyze data from each jail’s electronic booking system, the researchers found that 48% of individuals from the Franklin County jail recidivated, compared to 63% of individuals in Hampshire County. As well, 36% of the people who were incarcerated in Franklin County faced new criminal charges in court, compared to 47% of people in Hampshire County. The rate of re-incarceration in the Franklin County group was 21%, compared to 39% in the Hampshire County group.
Further analyses found that recidivism related to property crime was reduced, in keeping with the idea that medication treatment effectively managed the opioid use disorder, and thus reduced property crime to support drug use. Analyses also found no differences in violations of parole or probation, suggesting that differing rates of re-arrest for technical violations and variation in community correctional practices did not explain the findings.
“We were correct in our assumptions,” Friedmann said.
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