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Addiction treatment in prison reduces postincarceration overdose mortality
Study findings demonstrated that implementation of a medications for addiction treatment program in a Rhode Island correctional facility resulted in a 60% reduction in postincarceration deaths from overdose among inmates.
“As the epidemic of opioid use in the United States continues to shift from prescription opioids to illicit drugs, more people living with opioid use disorder are encountering the criminal justice system,” Traci C. Green, PhD, MSc, of The Warren Alpert Medical School of Brown University and Brown University School of Public Health, and colleagues wrote in JAMA Psychiatry. “Most U.S. correctional facilities do not continue or initiate medications for addiction treatment [MAT]. This is especially unfortunate given the higher rates of opioid overdose immediately after release from incarceration.”
In 2016, a new model of screening and treatment with MAT was launched at the Rhode Island Department of Corrections that allowed incoming inmates who were receiving MAT to maintain their medication. A system of Centers of Excellence in MAT was then established to help released inmates transition back into society and refer them to health care professionals. Using data from the Rhode Island Office of State Medical Examiners between Jan. 1 to June 20, 2016 and Jan. 1 to June 30, 2017, researchers conducted a retrospective cohort analysis to examine the association of the MAT program with overall overdose fatalities and deaths from overdose among inmates postincarceration.
They examined data on demographics, the status of incarceration and the number of fentanyl-related overdoses along with aggregate data of inmates released from the Department of Corrections, counts of naloxone provided to inmates postrelease and the monthly receipt of MAT. They compared the proportion of decedents, defined as people who died within 12 months of release, in 2017 with those incarcerated in 2016 to examine the risk difference in the number needed to treat between the two periods.
Analysis showed that postincarceration overdose deaths dropped 12.3% between the two periods after the implementation of an MAT program, with 179 overdose deaths occurring from Jan. 1, 2016, to June 30, 2016, and 157 during the same period in 2017. Of 179 individuals in the 2016 group, 26 (14.5%) who died of an overdose were recently incarcerated compared with nine of 157 individuals (5.7%) in the 2017 group, indicating a 60.5% drop in mortality (RR = 0.4; 95% CI, 18.4-80.9). Although more deaths from overdose were due to fentanyl, the observed reduction in mortality occurred concurrently during the fentanyl-driven overdose epidemic, according to the researchers.
Researchers observed 11 people who needed treatment to prevent a death from overdose (95% CI, 7-43). The overall number of admissions and releases from prison were similar over time, but the act of providing naloxone to inmates postincarceration fell while the monthly receipt of MAT after release rose. Demographically, those in the 2017 group were slightly older and less likely to be white.
“People may say, well, Rhode Island is a small state and that's why they were able to implement this, but there are state and county correctional systems all over the country that are the same size as Rhode Island's. They could all be doing this, and this study tells us that they should be,” Green said in a press release. “Not only do we see that a statewide program treating people using medications for addiction treatment is possible and reduces deaths, but also this approach intervenes on the opioid epidemic at its most lethal and socially disrupting point — incarceration — to give hope and heal communities.” – by Savannah Demko
Disclosures: Green reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.