University of Massachusetts Amherst: Opioid Overdoses Among Incarcerated People May Be Reduced by Improving Release Process and Treatment Continuity

People released from jail or prison are 120 times more likely to overdose on opioids than the general population in Massachusetts. A new, jail-based opioid use disorder treatment program approved by the Massachusetts Legislature and instituted in 2019 at seven county jails is intended to decrease that risk.

A new study by researchers at Tufts University School of Medicine, the University of Massachusetts Amherst and UMass Chan Medical School-Baystate suggests improvements are needed in at least three critical areas as incarcerated individuals transition from jail to the community.

“Continued treatment reduces the risk of death and leads to improved health and social outcomes,” says Liz Evans, professor of public health at UMass Amherst and co-principal investigator of the study, along with Dr. Peter Friedmann, professor of medicine at UMass-Baystate. “Many people with opioid use disorder engage with the justice system, making it a critical place to offer evidence-based treatment. As people are released from jail, their ability to continue life-saving treatment largely depends on innovative collaborations that have been established between community treatment providers and jails.”

The effort, part of a larger five-year project called the Massachusetts Justice Community Opioid Innovation Network (JCOIN), provides incarcerated individuals with medications for opioid use disorder (MOUD), including methadone, buprenorphine and naltrexone. Rare but increasing in U.S. corrections facilities, MOUD treatment programs internationally have shown great promise in reducing the risk of fatal overdoses once someone is released from jail.

“But here in Massachusetts, we learned that many individuals were released after-hours or late on Friday, after community treatment centers are closed, and they may be left not knowing where their next treatment will come from,” says Thomas Stopka, an epidemiologist and associate professor at Tufts School of Medicine and first author of the study, which was published Aug. 11 in the International Journal of Drug Policy.

Many people with opioid use disorder engage with the justice system, making it a critical place to offer evidence-based treatment.

Liz Evans, professor of public health and co-principal investigator of the study
“Most correctional settings detoxify clients with MOUD, lowering their tolerance and raising the risk of overdose right after release,” Dr. Friedmann says. “Prior research has shown that the period immediately after release from jail or prison is a critical time to ensure that persons with opioid use disorder receive MOUD to mitigate that risk. This study highlights the challenges of that period immediately after release from jail, as well as best practices to ensure continuity of MOUD care.”

“It’s a long way until Monday if the treatment center they believe they are going to is closed,” Stopka says. Even with a prescription in hand, they may not have a driver’s license or other federal ID they need to pick up the medication. “Many also don’t have a cell phone upon release to call a community treatment center or for someone at a community treatment center to reach them to schedule a first appointment,” adds Stopka.

Close to half of the people in U.S. corrections facilities are incarcerated for drug offenses. “We believe this research has uncovered clear ways the Massachusetts program can be improved. The effort can literally save hundreds if not thousands of lives,” Stopka emphasizes.

The team’s research identifies three areas in need of improvement:

Bridge doses: Individuals being released from jail need medication to cover them until they can connect with a treatment program in the community.
Better communication: Solid, consistent communication is required between staff working with an incarcerated person, while inside the jail, and the community-based staff outside to facilitate a smooth transition.
Phone access: Individuals who are released must be given access to a cellphone so they can connect with an outside treatment program.
In the qualitative study, the team interviewed 36 medical, supervisory and administrative staff from 18 MOUD treatment programs that serve jail-referred patients. Among those interviewed, 14 worked within local jails as outside contractors on behalf of a community-based agency providing addiction services. Patient navigators in the jails help patients overcome barriers to quality care and get the financial, legal, clinical and social support they need.

To tackle [the opioid overdose] problem, Massachusetts jails are leading a huge shift in our nation’s drug policy…. Learning lessons from this innovative program can help to refine it, with immense potential for better public health.

Liz Evans, professor of public health and co-principal investigator of the study
The interviews also uncovered that some jail staff still question using medications to treat opioid addiction that were at one time considered contraband. And for individuals released after treatment in jail, a host of other concerns may keep them from consistently attending treatment programs outside. “Lack of housing, money, food, a job – all of these forces conspire to make it hard for a person in recovery to continue treatment,” Stopka says.

The researchers are working with state agencies to see how improvements in the three key areas can be made.

“People are dying from an opioid overdose more than ever before,” Evans says. “To tackle this problem, Massachusetts jails are leading a huge shift in our nation’s drug policy, showing how the justice system can work together with community-based healthcare to make communities safer and healthier. Learning lessons from this innovative program can help to refine it, with immense potential for better public health.”

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