Continuing Methadone Treatment During Incarceration Decreases Overdose Risk After Release

While there are high rates of substance use disorder among incarcerated individuals in the US, less than 1% receive medications for opioid use disorder (MOUD) while in custody. This retrospective observational study examined post-release outcomes for men with OUD who were receiving methadone prior to incarceration at 2 high-security facilities in Connecticut. The treatment group (n=660) consisted of men who continued to receive methadone while incarcerated. The comparison population (n=904) were men who did not continue methadone while incarcerated, either due to personal preference or limited treatment capacity.

• Individuals who continued to receive methadone during incarceration were less likely to experience a non-fatal overdose after release (odds ratio [OR], 0.57) and had a longer time to non-fatal overdose (hazard ratio [HR], 1.78), compared with those who did not receive methadone during incarceration.
• Incarcerated individuals who continued to receive methadone also had an increased likelihood of return to community-based methadone treatment (OR, 2.84), compared with the control group.
• Individuals who resumed methadone after release from jail (in either group) were significantly less likely to experience a fatal overdose (OR, 0.26).

Comments: The benefits of MOUD for incarcerated populations are clear. These findings suggest that methadone reduces the risk for overdose and increases the likelihood of engagement with care post-release. For all participants in the study, return to community-based methadone treatment was found to be protective, reinforcing the importance of post-release linkage services.

Lea Selitsky, MD* and Darius A. Rastegar, MD

*Contributing editorial intern and Addiction Medicine Fellow, Johns Hopkins University.

Reference: Haas A, Viera A, Doernberg M, et al. Post-incarceration outcomes for individuals who continued methadone treatment while in Connecticut jails, 2014–2018. Drug Alcohol Depend. 2021;227:108937.