Offering Addiction Medication to Incarcerated People Reduces Overdose Deaths

The Bottom Line

Offering medication for opioid use disorder (MOUD) to treat people with opioid addiction in prisons and jails leads to a decrease in overdose deaths.

Context

The most recent overdose death data from 2021 shows that more than 100,000 people died that year — with the majority, roughly 70,000, of those deaths attributed to an opioid overdose. In general, people with substance use disorder are more likely to be incarcerated than treated, which is particularly and historically true for people of color. Most prisons and jails in the U.S. discontinue MOUD treatment upon incarceration, even if the person has taken the medication stably prior to incarceration. As a result, patients often suffer withdrawal symptoms while incarcerated and are at very high risk for overdose death post-incarceration.

The most common and effective FDA-approved medications to treat opioid addiction are buprenorphine, methadone, and naltrexone.

Study Objective

To understand if providing MOUD to incarcerated people with addiction will affect overall overdose death rates.

The Details

Researchers from Boston Medical Center in collaboration with Brown University School of Public Health, Weill Cornell Medical College, Yale School of Public Health, and Franklin County House of Corrections used a simulated model to assess the impact of MOUD access during and upon release from incarceration. They compared that with general population overdose mortality and OUD-related treatment costs in Massachusetts using three different strategies:

1. No MOUD provided during incarceration or upon release
2. Offer only extended-release naltrexone (XR-NTX) upon release from incarceration
3. Offer all three MOUD — buprenorphine, methadone, and naltrexone — at intake.

Findings

Researchers looked at 30,000 incarcerated people with opioid addiction and came up with three findings according to the three MOUD offering strategies:

1. Offering no MOUD was associated with 40,927 MOUD treatment starts in the community after release over a five-year period and 1,259 overdose deaths after five years.
2. Offering XR-NTX at a person’s release led to 10,466 additional treatment starts and 40 fewer overdose deaths over five years.
3. Offering all three MOUD options at intake led to 11,923 additional treatment starts, compared to offering no MOUD, and 83 fewer overdose deaths.

Among everyone with OUD in Massachusetts, the XR-NTX-only group averted 95 overdose deaths across five years—a 0.9% decrease in state-level overdose mortality, while the all-MOUD strategy averted 192 overdose deaths—a 1.8% decrease.

Pull Quote

“Offering medications for opioid addiction for incarcerated individuals saves lives. Specifically, offering all three medications—buprenorphine, methadone, and naltrexone—is the most effective at saving lives and is more cost-effective,” said lead author Avik Chatterjee, MD, primary care and addiction medicine physician at Boston Medical Center, in a recent press release. “We hope our study supports policy change at the state and federal level, requiring treating opioid use disorder with medications among people who are incarcerated.”