Barriers to Continuing Medication for Opioid Use Disorder Post-incarceration in Rhode Island

In 2016, the Rhode Island Department of Corrections introduced the first state-wide correctional system-based medication for opioid use disorder (MOUD) program in the US. Between February 2017 and August 2018, researchers conducted telephone interviews with 214 individuals* post-release to ascertain whether they had been linked to community treatment and to identify any barriers.

• Overall, 54% of participants continued MOUD and 34% initiated MOUD while incarcerated; 12% received MOUD just prior to release.
• Participants received methadone (56%), buprenorphine (43%), and injectable naltrexone (1%).
• On average, surveys were conducted 29 days post-release with most participants (84%) either on probation or parole.
• Post-release, 82% of participants continued MOUD through: an opioid treatment program (74%); an office-based provider (20%); a residential treatment facility (1%); or an unclassifiable location (5%).
• Reasons for not continuing MOUD post-release included: transportation issues (23%); lack of a desire to continue (21%); perceiving treatment as a hassle (8%); time-lapse between release and connecting with an MOUD provider (8%); side effects (5%); cost (5%); and pressure from family/friends not to continue (3%).

* N=227, but 13 participants were re-incarcerated during the study period. Participants were majority white and male, with an average age of 37.

Comments: With a large majority of program participants continuing to receive MOUD approximately one month post-release, these results emphasize the potential role of universal access to MOUD in correctional settings. To improve retention, interventions should focus on minimizing the delay between release from a correctional facility and contact with a community MOUD provider, as well as addressing transportation challenges.

Seonaid Nolan, MD

Reference: Martin RA, Gresko SA, Brinkley-Rubinstein L, et al. Post-release treatment uptake among participants of the Rhode Island Department of Corrections comprehensive medication assisted treatment program. Prev Med. 2019;128:1057666.