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According to recent findings by Boston Medical Center, providing medications for opioid addiction within correctional facilities results in a reduction in overdose fatalities. The study, published in JAMA Network Open, further revealed that treating opioid addiction during incarceration is not only effective in terms of healthcare and incarceration expenses, but also prevents deaths.
Over 100,000 individuals in the United States lose their lives annually due to overdose, and this number continues to rise each year. Unfortunately, individuals struggling with addiction are often more likely to end up in jail or prison rather than receiving appropriate treatment. Moreover, communities of color that are affected by drug use are disproportionately incarcerated compared to their White counterparts. In many correctional facilities across the country, medications for opioid use disorder (MOUD) are discontinued upon incarceration, even if the individual was stable on MOUD prior to entering the facility, and MOUD is not initiated prior to release. As a result, incarcerated individuals often endure withdrawal symptoms, and the post-release period becomes extremely high-risk for overdose fatalities.
Lead author Avik Chatterjee, MD, who is a primary care and addiction medicine physician at Boston Medical Center and Boston Healthcare for the Homeless, as well as an assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine, emphasized that providing medications for opioid addiction to incarcerated individuals has a life-saving impact. The study found that offering all three medications for opioid addiction - buprenorphine, methadone, and naltrexone - is the most effective approach in terms of saving lives and is also cost-effective. Dr. Chatterjee expressed hope that the study's findings will drive policy changes at both state and federal levels, leading to the requirement of providing medications for opioid use disorder to individuals who are incarcerated.
The study conducted a modeling analysis to assess the effects of providing medications for opioid use disorder (MOUD) during and after incarceration on overdose mortality and treatment costs in Massachusetts. Three different strategies were evaluated: 1) no MOUD provided during incarceration or upon release, 2) offering only extended-release naltrexone (XR-NTX) upon release from incarceration, and 3) offering all three MOUD (buprenorphine, methadone, and naltrexone) at intake.
Among a population of 30,000 incarcerated individuals with opioid use disorder (OUD), the study found that offering no MOUD (medications for opioid use disorder) was associated with 40,927 MOUD treatment starts over a 5-year period and resulted in 1,259 overdose deaths after 5 years. On the other hand, offering extended-release naltrexone (XR-NTX) at release led to 10,466 additional treatment starts and 40 fewer overdose deaths over 5 years. In comparison, offering all three MOUD (buprenorphine, methadone, and naltrexone) at intake led to 11,923 additional treatment starts and 83 fewer overdose deaths, compared to offering no MOUD.
When considering the entire population of individuals with OUD in Massachusetts, the "XR-NTX only" strategy resulted in averting 95 overdose deaths over 5 years, which corresponds to a 0.9% decrease in state-level overdose mortality. On the other hand, the strategy of offering all three MOUD at intake resulted in averting 192 overdose deaths, which corresponds to a 1.8% decrease in state-level overdose mortality.
In this simulation modeling study, researchers found that offering any MOUD to incarcerated individuals with OUD would prevent overdose deaths and offering all three MOUD would prevent more deaths and save money.
According to the researchers, a treatment-based approach is more suitable than an incarceration-based approach for addressing addiction. Proactively providing treatment during incarceration has the potential to save lives and is a cost-effective health intervention. Additionally, it aligns with the notion of upholding the dignity of individuals who are incarcerated, recognizing that addiction is a health issue that requires appropriate medical care and support.
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About Boston Medical Center
Boston Medical Center is a leading academic medical center with a deep commitment to health equity and a proud history of serving all who come to us for care. BMC provides high-quality healthcare and wrap around support that treats the whole person, extending beyond our physical campus into our vibrant and diverse communities. BMC is advancing medicine, while training the next generation of healthcare providers and researchers as the primary teaching affiliate of Boston University Chobanian & Avedisian School of Medicine. BMC is a founding member of Boston Medical Center Health System, which supports patients and health plan members through a value based, coordinated continuum of care.
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