Providing Buprenorphine During Incarceration Reduces Re-engagement With the Criminal-legal System

Incarcerated individuals with opioid use disorder (OUD) are at high risk for adverse outcomes after release. Previous studies have found improved outcomes associated with provision of medications for OUD (MOUD), but primarily examined the effects of methadone and naltrexone in urban settings. Researchers compared two adjacent rural Massachusetts counties, one of which (Franklin) offered buprenorphine to incarcerated individuals with OUD, while the other (Hampshire) did not.

  • During the 2015–2019 study period, there were 469 adults with OUD released from jail in Franklin County and 272 from Hampshire.
  • During the study period, 93% of individuals with OUD received MOUD while incarcerated in Franklin; most (86%) received buprenorphine. None of the individuals with OUD incarcerated at Hampshire received MOUD.
  • Re-engagement with the criminal-legal system overall (i.e., re-incarceration, arraignment, or probation violation) was lower among individuals incarcerated at Franklin compared with Hampshire (48% versus 63%, respectively; adjusted odds ratio [aOR], 0.51), as was re-incarceration specifically (21% versus 39%; aOR, 0.37).

Comments: This study suggests that providing buprenorphine and other MOUD during incarceration reduces re-engagement with the criminal-legal system, adding to the many benefits of MOUD for people with OUD. Incarceration is an opportunity to engage individuals with OUD in treatment; MOUD should be the standard of care.

Darius A. Rastegar, MD

Reference: Evans EA, Wilson D, Friedmann PD. Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug Alcohol Depend. 2022;231:109254.

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