Table of Contents
The opioid-related overdose deaths epidemic persists across the U.S., and people released from jail and prisons are at particular risk.
While the benefits of life-saving medications for opioid use disorder (MOUD) – like methadone, buprenorphine, and extended-release (XR) naltrexone — has been documented across hospitals and treatment centers, its uptake has been extremely limited in United States prisons and jail settings.
Access to MOUD in Prisons
In new research published in the International Journal of Drug Policy on July 22, researchers from the Brown University School of Public Health led by Alexandria Macmadu, a doctoral candidate in epidemiology, found that expanding access to all three MOUD in prisons and jails can lower overdose deaths by 31.6% in certain circumstances.
The researchers developed a microsimulation model — a computer program that mimics the operation of government programs and demographic processes on individual members of a population — to simulate a population of 55,000 individuals at risk of opioid-related overdose death in Rhode Island.
The key calibration targets for the model were the observed overdose mortality rates in Rhode Island in 2015.
The model proceeds in two-week time-steps; thus, incarceration was defined as being incarcerated in Rhode Island’s unified prison and jail system for a period of at least two weeks.
They then studied the potential impacts of providing access to all three MOUD in a combined prison and jail setting to at-risk people in Rhode Island over eight years and compared that to an XR-naltrexone-only intervention and the standard of care.
In the standard of care scenario, which accounts for limited or no access to MOUD, the model predicted 2,385 opioid-related overdose fatalities between 2017 and 2024.
An XR-naltrexone intervention prevented 103 deaths, for a 4.3% reduction, and access to all three MOUD averted 139 deaths, for a 5.8% reduction.
Among those with prior-year incarceration, those numbers increased to 22.8% and 31.6%, respectively.
According to previous studies, the first two weeks following release from incarceration are associated with a 129-fold increase in overdose risk relative to the general populace.
During confinement, tolerance to opioids is diminished or lost, which — combined with disrupted social support networks, limited access to MOUD, medical comorbidities and various other socioeconomic conditions — places people at a much higher risk for overdose upon release.
The findings align with similar studies conducted in other countries like the United Kingdom and Australia that found that increased access to MOUD in prisons and jails is associated with a lower overdose rate.
The researchers say that the Rhode Island outcomes suggest that other states would see similarly large mortality reductions with increased access to MOUD.
Nevertheless, Rhode Island stands out from other states when it comes to prisons.
First, Rhode Island has one of the lowest incarceration rates in the United States.
It also implemented diversion programming, which offers the dismissal of criminal charges to those with nonviolent crimes through participation in drug treatment and mental health programs.
Provision of Methadone for Tapering
Lastly, the pre-2016 standard of care in Rhode Island allowed for the provision of methadone on a 30-day taper protocol among those who were prescribed methadone prior to incarceration — the majority of prisons and jails in America offer MOUD only to women who are pregnant.
These characteristics likely underestimate the potential reduction in overdose mortality that would be observed if all three MOUD were implemented in correctional centers elsewhere.
“As it stands, most prisons and jails that provide any access to treatment only offer extended-release naltrexone,” Macmadu said.
“Our findings suggest that if all prisons and jails in the United States expanded access to MOUD to all persons who are indicated for treatment, overdose mortality in this highly vulnerable population would plummet.”
Get Started Today!
An attempt to detox unattended will almost always fail as you may give in to the unforgiving withdrawal symptoms and take Naltrexone to relieve them. Instead, contact the United Recovery Project for help with detox, treatment and rehabilitation. The goal of the program is to help our patients go through medically assisted detox to ensure their safety, teach them to adopt and maintain a sober lifestyle and finally ensure they don’t relapse using our alumni programs. We offer a variety of services like inpatient recovery programs, partial hospitalization, and outpatient programs. Our tried and tested programs aim to heal patients physically and emotionally too. We are confident we can help you rehabilitate.