Part II: What OTP Patients Say They Need on Re-Entry
Part I of our two-part series appeared here in May. The source study (see citation at the end of this article) discusses events during the crucial first 24 hours when prisoners with opioid use disorder (OUD) leave jail or prison. Here, in Part II, we share participants’ recommendations for improving re-entry, based on their lived experience.
Kim Hoffman, PHD
Structural and Logistical Barriers
Release from imprisonment should be a happy event, yet for the vulnerable it’s often a time of abandonment; for some, even danger.
Departing prisoners with OUD face many barriers to community re-entry. These may include problems accessing methadone programs, arranging shelter and employment, and managing social relationships.
Preparedness to Leave Confinement
Participants varied widely in how ready they were to re-enter the outside world (see box). After re-entry, drawing on their lived experience, they offered concrete suggestions for interventions; steps prisoners and others could take to help overcome barriers.
| Ex-Prisoners’ Preparedness To Leave Confinement The “fortunate”; those who have family or friends waiting to help. The “well prepared”; those who have received support from halfway houses or social programs while incarcerated. Some, the very well prepared, were enrolled in a MOUD (medication for opioid use disorder) treatment program, usually with methadone. The “unprepared”; those without structured support, and no money, no sources of food and shelter. |
Those who have gone through re-entry say that many challenges ex-prisoners face can be avoided, if prisoners:
-Know when they will be released, and have time to prepare
-Know how to access necessary information, and the items they will need
-Can obtain what they need immediately after release
Recommendations
Below are ex-inmates’ observations and suggestions, as reported in the published study. Italicized sections indicate direct quotes.
| 1. Help the newly released meet common challenges—transportation, shelter, employment |
Counselors can help locate local mutual support meetings and sponsors. For those in methadone programs or other MOUD programs, counselors can arrange to restart treatment as soon as prisoners are released.
. . . because without the treatment … there’s a lot of people that are gonna be dyin’ . . .
Counselors can also help ex-prisoners find employment—
. . . so you don’t return to the same thing you were doing. If you just get released and you got nothing to do, you’re just gonna do the same thing.
| 2. Help the newly released access transitional programs— especially those offering health services |
. . . So when you come home you’re insured, you’re capable of going out and getting all the things you need. Going to the doctor, going to the clinic, whatever you need instead of having to go home and then wait however long it takes . . .
| 3. Give them advance notice of the release date |
When participants were asked what they wished they’d known before their re-entry, most specified release date. With enough notice, they said, prisoners could “prepare logistically and emotionally” for re-entry.
A participant:
. . . before release, they need to talk to people about housing. And programs . . . [So they] might not get high. If they came right here [to a treatment program] and did what they’re supposed to do to get on the program.
| 4. Help them meet probation requirements |
Participants said they were released with “no help and no resources,” unable to meet “impossible” probation requirements. And not meeting them would mean going back behind bars.
Here’s how a participant described it:
. . . with no resources, no money, nowhere to go, yet expected on the conditions of your probation to have a job and have somewhere to live and have a phone number and be able to have transportation to parole and probation . . . Basically, it’s an impossible situation. And that’s why . . . 85% of people end up [back in jail or prison].
| 5. Help them become involved in MOUD treatment post-release |
The authors consider engagement in outpatient MOUD treatment a “critical element to successful re-entry.” A participant who was receiving methadone treatment in prison told of keeping in contact with others in his program after their release:
. . . and they helped me to facilitate my release as far as what I need to do from day one, going to [OTP clinic location]. . . the other things I would need to do as far as . . . getting medicated as soon as I was released which kept me from relapsing.
Some participants—a small number—were reticent toward MOUD, although they stayed in treatment. One complained about lifelong treatment; another wondered if treatment was just a “revolving door.” Some who wanted to continue treatment after release couldn’t because there were no programs nearby.
Conclusions
Participants faced many barriers to community re-entry, and many felt unprepared for release. The authors discuss difficulties occurring in the first hours: problems accessing methadone treatment programs, shelter, and employment; and trouble managing social relationships.
The authors suggest that future investigations consider looking into the feasibility of widespread transitional program implementation, focusing on education about the overdose crisis within jails and prisons. Also important: supporting and maintaining relationships during and post-incarceration.
Declan Barry, PHD
Lastly, the authors propose linkage to outpatient MOUD programs as interventions to reduce mortality during re-entry. In his work as director of Pain Treatment Services and Research at the APT Foundation, Declan Barry, PhD, senior author on the study, has found these programs helpful in enabling people with OUD to return safely to the community. Dr. Barry told AT Forum, “Reducing barriers so that people who were incarcerated can access evidence-based treatment for OUD benefits not only the individuals themselves, but the community at large as well.” Dr. Barry is an associate professor in the Department of Psychiatry, Yale School of Medicine.
Reference
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