Incarceration-Related Withdrawal from Methadone Leads to Aversion to Opioid Agonist Treatment

Up to 25% of incarcerated people meet criteria for opioid use disorder (OUD), but few jails and prisons offer opioid agonist treatment (OAT), and some limit it to certain populations (i.e., pregnant women). This qualitative study explored attitudes toward medications for treatment of OUD among 21 former inmates (defined as ≥1 day of incarceration in the previous 5 years) with OUD. Interviews were one hour in length and were conducted by a trained research assistant. An interview guide was used to elicit participants’ experiences with treatment for OUD, incarceration, community reentry, and attitudes toward methadone and buprenorphine.

• The median age of the sample was 49 years; all were African American or Hispanic; 18 were male. Participants were incarcerated for a median of 16 years (interquartile range 5.5–26 years) and prison or jail release was a median of 7.5 months prior to the interview (median 10 days to 4 years).
• 20 out of 21 participants received non-pharmacologic treatment for OUD while incarcerated; at the time of the interview 6 were receiving buprenorphine and 3 were receiving methadone.
• Participants who received methadone treatment immediately prior to an incarceration episode reported severe and prolonged withdrawal symptoms from rapid dose reductions or disruption of their methadone treatment during incarceration, leading to a subsequent aversion to reengagement in OAT post release.

Comments:

Although the sample is drawn from a single region, the results of this study underscore the negative effect that OAT disruption can have on retention in care and should inform policy change with regard to medication administration during incarceration.

Jeanette M. Tetrault, MD

Reference:

Maradiaga JA, Nahvi S, Cunningham CO, et al. “I kicked the hard way. I got incarcerated.” Withdrawal from methadone during incarceration and subsequent aversion to medication assisted treatments. J Subst Abuse Treat. 2016;62:49–54.