Receipt of Medication for Opioid Use Disorder While Incarcerated Improves Post-release Treatment Outcomes

Compared with the general population, the prevalence of opioid use disorder (OUD) is high among criminal justice-involved populations. Without treatment, individuals are at increased risk for overdose and recidivism post-release. Individual studies have demonstrated the efficacy of medication for OUD (MOUD; i.e., methadone, buprenorphine, and naltrexone) for incarcerated individuals, but no quantitative summary of this research currently exists. Researchers conducted the first meta-analysis on the effectiveness of MOUD in correctional settings with respect to post-release substance use treatment engagement, opioid use, criminal behavior/recidivism, and health risk behaviors.

• Only methadone had a sufficient number of studies (n=18) to meta-analyze.
• Data from randomized controlled trials (RCTs) involving 807 inmates demonstrated that methadone provided during incarceration was significantly associated with post-release: community treatment engagement (odds ratio [OR], 8.69), reduction in illicit opioid use (OR, 0.22), and reduction in injection drug use (OR, 0.26), but not with recidivism (OR, 0.93).
• Individual buprenorphine or naltrexone studies showed these medications to be either superior to methadone or placebo, or as effective as methadone in reducing illicit opioid use post-release.

Comments: Though limited by heterogeneity and a small number of RCTs, these results demonstrate that MOUD increases community treatment engagement and reduces illicit opioid use and injection drug use in the post-release period. Future research should accurately test for moderation by methadone dose, continuation versus induction, or type of correctional facility. Studies demonstrating the efficacy of buprenorphine or naltrexone treatment among incarcerated individuals are also needed.

Seonaid Nolan, MD

Reference: Moore KE, Roberts W, Reid HH, et al. Effectiveness of medication assisted treatment for opioid use in prison and jail settings: a meta-analysis and systematic review. J Subst Abuse Treat. 2019;99:32–43.