Medications for opioid use disorder in state prisons: Perspectives of formerly incarcerated persons

Abstract

Background: Opioid use disorder (OUD) is common among incarcerated persons and risk of overdose and other adverse drug-related consequences is high after release. Recognizing their potential to reduce these risks, some correctional systems are expanding access to medication for opioid use disorder (MOUD). This study explored the experiences and perspectives of formerly incarcerated individuals on MOUD use while incarcerated and after release. Methods: We interviewed 53 individuals with self-reported OUD who were released from New Jersey state prisons. Interviews explored motivations to use MOUD while incarcerated and after release, and experiences with prison-based MOUD and transition to community-based care. We performed cross-case analysis to examine common and divergent perspectives across participants. Results: A common reason for accepting prerelease MOUD was recognition of its effectiveness in preventing drug use, overdose, and other drug-related consequences. Participants who chose not to use MOUD often were focused on being completely medication-free or saw themselves as having relatively low-risk of substance use after a prolonged period without opioid use. A few participants reported challenges related to prison-based MOUD, including logistical barriers, stigma, and once-daily buprenorphine dosing. Most participants effectively transitioned to community-based care, but challenges included insurance lapses and difficulty locating providers. Conclusions: Many formerly incarcerated persons with OUD recognize the value of MOUD in supporting recovery, but some hold negative views of MOUD or underestimate the likelihood that they will return to drug use. Patient education on risks of post-release overdose, the role of MOUD in mitigating risk, and MOUD options available to them could increase engagement. Participants’ generally positive experiences with MOUD support the expansion of correctional MOUD programs.

Keywords:

• Opioid use disorder
• medication for opioid use disorder
• reentry
• correctional health care
• incarceration

Acknowledgements

For their assistance with recruiting participants for this study, we extend our gratitude to Micah Hillis, Rena Gitlitz, and peer health navigators at University Behavioral Health Care; and Amanda Leese, Kim Rowan, and staff at the Volunteers of America of Delaware Valley. We are grateful for interviewing and coding assistance provided by Leigh Belsky, Madeline Bono, Cadence Bowden, Daniel Passafiume, and Neal Sehgal.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

PT led study design, data collection and analysis, and manuscript preparation. ME conducted data analysis and prepared the manuscript. DR assisted with interpreting findings and manuscript editing. SC obtained funding and contributed to study design, interpretation, and manuscript editing.

Additional information

Funding

This research was funded by a contract from the New Jersey Department of Human Services to evaluate the Intensive Recovery Treatment Support (IRTS) program, and by a Subagreement from The Johns Hopkins University with funds provided by Bloomberg Philanthropies, with additional support from NIDA award 1R01 DA047347 and NCATS award UL1TR003017. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of funding organizations. The funding sources had no role in study design; in collection, analysis, and interpretation of data; in writing of the report; and in the decision to submit the article for publication.