Part I: When OTP Patients Leave Lockup
They’ve served their sentences, and now it’s time to leave.
Many look forward to a new start in life, but they may be woefully unprepared for the challenges they’ll face.
When the lucky ones step outside, family will greet them, hug them, take them home for a good meal and a comfy bed.
The less fortunate will find themselves dumped at the prison exit, no money in their pockets, no way to get a meal or take a bus; no friends or family to connect with; no one to ask for help.
Some of the less fortunate will spend the night curled up on a park bench. When morning comes and they realize that nothing has changed and it’s unlikely that anything will, returning to a life with drugs may look like the best solution—or the only one.
But their bodies are no longer used to drugs. So some will overdose, some will die.
A team of ten authors from the Yale School of Medicine and other institutions has written one of the few published studies investigating what happens during the crucial first 24 hours when people with opioid use disorder (OUD) leave jail or prison. In their study, appearing in Addiction Science & Clinical Practice, the authors describe the re-entry period as one of “economic uncertainty, fractured social and family relationships, and housing instability.” Re-entry is never easy; for those with OUD it is especially difficult. .
|Study Highlights 42 participants, 19 women, 23 men, in opioid treatment programs (OTPs) Recruitment through flyers and clinicians’ recommendationsParticipants’ self-reported incarcerations: 1 to 60 (median, 4)Interviews: semi-structured, qualitative Interview period: January to December 2017Site: the APT Foundation, Inc., affiliated with Yale School of MedicineType of opioid treatment programs (OTPs): not-for-profit, low-barrier The authors studied the transcribed interviews using a Thematic Analysis approach.|
Aim of the Study: “to investigate the re-entry planning experience, perceived levels of preparation to return to life after incarceration, and the challenges faced during the re-entry period among people in an OTP with a history of incarceration.
An effective way to capture the opinions of study participants is to see how they describe what they’re thinking and feeling. So we include below, in italics, comments from participants.
Participants viewed the initial 24 hours as “a tenuous period” when many lacked basic resources such as shelter or money. They also saw it as a period of risk for returning to substance use—or as an opportunity to engage with OUD treatment.
Dumped at the prison door
A newly released ex-prisoner described his experiences:
My first day when I got released, they dropped me off in front of the courthouse at 5:30 in the morning and handed me my stuff and said there ya go… You don’t get money to get released. Family has to meet you at the bus stop…if I didn’t have money, I wasn’t getting home… there’s no help…. they say they help you, but they don’t. They just leave you to fend for yourself.
Dilemma—seek substances, or seek treatment?
First day after release… freedom! [laughing] But also… you have to make a decision whether you’re gonna use or not…
Some chose substances, or “a balance”…
. . . And I chose this time, I chose to use… so it was like none of that jail time never even happened.
It’s good to get out, you wanna celebrate… but you don’t wanna party too hard I guess because if you go back to jail it’s just gonna be worse than last time. Every time you go, it’s a little longer usually because your record builds up.
I did a little partying but I wasn’t gonna run wild and run back to what I used to do. I was gonna do better.
And some—about one in three—chose treatment
I got released, the minute I came running to the program, tell them what happened, they gave me my dose, I still had a bottle in my house, and whoop, I was happy.
Survival comes first. It’s no surprise that without structured support—through family, medication for opioid use disorder (MOUD), or other resources—survival needs took priority over treatment-seeking and other needs. When strong support did occur, usually it was through families.
I remember everyone came. My family picked me up. I got to see my daughter right away. It was nice… it
felt like a homecoming.
They got me right at the YWCA and the next thing we went to motor vehicles to get my IDs—if it wasn’t for that program, I’d have been… probably right back in jail within a week. They took me shopping for clothes… they got me . . . a bus pass . . . signed me up for my doctors.
Familiar people and places evoked a desire to return to substance use.
. . . when you go back out and shit is around you, and if you’re around the same people again you know it like they all the same- people, places, and things. Cause if nothing changes, nothing changes.
Ex-prisoners also had to contend with mental and behavioral barriers.
. . ..you have to speak an entirely different language in prison. And sometimes people carry that out when they get out and it takes them a while to learn how to actually socialize normal again.
Most respondents reported motivation to shift their mindsets and habits to avoid returning to substance use:
Fighting addiction…Trying to find steady employment……Fighting…just fighting for my life to stay alive.
—Reestablishing trust within the family
Getting my family to trust me was the hardest thing…Trust me again and forgive me.
—Finding a job
You know you need to find a job and hope that your record doesn’t affect that.
But indeed, background checks were “a death sentence.”
. . . they say when you’re on parole you have to get a job or you’re going back to prison, but places don’t wanna hire felons.
Participants tried to avoid homelessness by staying in halfway houses, shelters, residential programs, or sober living facilities, or by calling upon family and friends. A participant described the situation as going “couch to couch, hotel to hotel.”
—Trying to cope with lack of education and training
It’s been very difficult [to find work]. Not only is my criminal record an issue, I have no education.
Even the better educated have difficulties:
I got two years of college in human services but seems everything changed. You gotta know computers all that stuff, I don’t know computers, it’s hard for me to get a job, now that I’m old.
Many participants felt unprepared for release from incarceration. Their concerns were realistic, for many encountered overwhelming barriers.
(Part II in this two-part series will share participants’ suggestions for a smoother transition from prison OTP to the outside world.)
Hoffman KA, Thompson E, Gaeta Gazzola M, et al. “Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories. Addict Sci Clin Pract. 2023;18(1):16. Published 2023 Mar 21. doi:10.1186/s13722-023-00377-y