Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study

Abstract

Purpose

Opioid use disorder (OUD) is a medical condition that is effectively treated with medications. A major challenge in breaking the cycle of OUD and related illegal activity is seamlessly introducing medications for opioid use disorder (MOUD) as individuals leave jail or prison. We examined the feasibility of a pilot intervention to link participants to ongoing MOUD and psychosocial supports following release from custody.

Methods

The study enrolled adults with a history of OUD released from Washington State prisons to Department of Corrections (DOC) community supervision. Participants were randomized to the study intervention or comparison group. The intervention consisted of education on OUD and available treatments, support with individualized treatment decision making, and continued care navigation for 6 months to facilitate linkage to chosen treatments. Participants randomized to the control condition received referral to services in the community from their community corrections officers. A care navigation activity log documented intervention participants’ intervention engagement, service utilization, and needs. Follow-up interviews were conducted at 1 and 6 months to assess satisfaction with the intervention.

Results

Fifteen participants were enrolled. All were male, most were white (86.6%) and the average age was 36.9 years. The majority (14 of 15 participants) were near-daily heroin users with severe OUD prior to incarceration. Of the seven intervention participants, two wished to start medications immediately. Three participants reported starting buprenorphine or methadone in the subsequent follow-up period, with or without social support and/or outpatient counseling, and three reported enrolling in social support and/or outpatient counseling without medications. Participants who received the intervention reported high satisfaction. We discuss barriers and facilitators to study implementation.

Conclusion

An intervention to link participants to ongoing MOUD and psychosocial supports following release from prison had broad acceptability among participants and was feasible to implement among those recruited; however, enrollment was much lower than anticipated and the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release in this small sample of participants. Given recent research showing benefits of pre-release medication initiation, the potential added benefits of this two-part intervention should be studied in systems that initiate MOUD prior to release.

Keywords:

• opioid use disorder
• opioids
• intervention development
• criminal justice
• treatment
• feasibility study

Acknowledgments

This study was supported by funds from Arnold Ventures in 2017–2019. The views expressed in this report are the authors’ and do not necessarily reflect the views of the funder. Study data were collected and managed using REDCap electronic data capture tools hosted at the Institute of Translational Health Sciences. REDCap at ITHS is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1 TR002319. Thank you to Barbara Burke, Kimberli Dewing, Vasiliki Georgoulas-Sherry, Steven Hammond, Paige Harrison, Dawn Williams, Ingrid Binswanger, Shane Mueller, and administrative support staff at the University of Washington, Alcohol and Drug Abuse Institute.

Disclosure

Caleb J Banta-Green reports grants from Laura and John Arnold Foundation, during the conduct of the study. Kristin Vick is currently affiliated with the Study and Advancement of Justice Effectiveness Center at the University of Washington in Seattle, WA. Jen Arthur is currently affiliated with Country Doctor Community Health Centers in Seattle, WA. The authors report no other conflicts of interest in this work.