By Alison Knopf
Medication-assisted treatment (MAT) for opioid use disorder provided to incarcerated individuals sharply reduced overdose deaths after the inmates were released, researchers in Rhode Island have found. The reduction was so large that it contributed to a greater than 12% overall population-level decline in overdose fatalities in the state, according to the study, which is published as a Research Letter in the April issue of JAMA Psychiatry.
The results are consistent with other studies of MAT provided during incarceration. However, the results are especially significant considering that they “occurred in the face of a devastating, illicit, fentanyl-driven overdose epidemic,” the researchers, who were headed by senior author Josiah Rich, MD, wrote.
In July 2016, the Rhode Island Department of Corrections (RIDOC), a unified prison/jail, launched a new screening and protocoled treatment with MAT (including methadone, buprenorphine, or naltrexone) along with an opioid treatment program (OTP), which agreed to provide MAT after release. All sites were fully operational, providing treatment, by January 2017. Individuals who went to RIDOC already on MAT were maintained on their medications without tapering or discontinuation.
For the retrospective cohort study, researchers used data from the Rhode Island Office of State Medical Examiners for all unintentional deaths from overdose, and linked it to data from RIDOC. They compared data from January-June 2016 with data from January-June 2017. Monthly receipt of MAT, counts of naloxone provided to inmates after release, and aggregated data of inmates released were reported.
There were 179 overdose deaths in Rhode Island from January 1, 2016, to June 30, 2016, compared with 157 overdose deaths during the same period in 2017, a reduction of 12.3%. Most deaths were fentanyl-related.
“Identification and treatment of opioid use disorder in criminal justice settings with a linkage to medication and supportive care after release from incarceration is a promising strategy to rapidly address the high rates of overdose and opioid use disorder in the community,” the researchers concluded.
In an interview with AT Forum, Dr. Rich explained that 100 incarcerated individuals a month are leaving the system on one of the medications—more than 1,000 people, so far. “About a dozen” take naltrexone; the rest are evenly divided between methadone and buprenorphine treatment.
Green TC, Clarke J, Brinkley-Rubinstein L, et al. Postincarceration fatal overdoses after implementing medications for addiction treatment in a statewide correctional system [Epub ahead of print February 14, 2018]. JAMA Psychiatry. Research Letter. 2018;75(4):405-407. doi: 10.1001/jamapsychiatry.2017.4614.