Offering Buprenorphine to Inmates Has Hopeful Results

A study conducted in two rural Massachusetts jails found that people with opioid use disorder (OUD) who were incarcerated and received buprenorphine, a medication approved to treat OUD, were less likely to face rearrest and reconviction after release. 

After adjusting the data to account for baseline characteristics such as prior history with the criminal justice system, the study revealed a 32 percent reduction in rates of probation violations, reincarcerations or court charges when the facility offered buprenorphine to people in jail compared to when it did not. The findings were published in Drug and Alcohol Dependence.

The study, conducted by the Justice Community Opioid Innovation Network (JCOIN), a program to increase high-quality care for people with opioid misuse and OUD in justice settings, was funded by NIDA through the Helping to End Addiction Long-term (NIH HEAL) initiative.

“Studies like this provide much-needed evidence and momentum for jails and prisons to better enable the treatment, education and support systems that individuals with an opioid use disorder need to help them recover and prevent reincarceration,” said NIDA director Dr. Nora Volkow. “Not offering treatment...can have devastating consequences, including a return to use and heighted risk of overdose and death after release.”

Offering evidence-based medications to treat OUD—such as buprenorphine, methadone and naltrexone—is not currently standard-of-care in U.S. jails and prisons; most jails that do offer them are in large urban centers.

While previous studies have investigated the impact of buprenorphine on overdose rates, risk for infectious disease and other health effects among the incarcerated, this study is one of the first to evaluate the impact specifically on recidivism, defined as additional probation violations, reincarcerations or court charges. 

The researchers recognized an opportunity to assess this research gap when jails in two neighboring rural counties in Massachusetts both began to offer buprenorphine to adults in jail, but at different times. Franklin County began offering buprenorphine, in addition to naltrexone, in 2016. Hampshire County started in 2019.  

“There was sort of a ‘natural experiment’ where two rural county jails located within 23 miles of each other had very similar populations and different approaches to the same problem,” said study author Dr. Elizabeth Evans of the University of Massachusetts-Amherst. 

Researchers observed the outcomes of 469 adults who exited 1 of the 2 participating jails between Jan. 1, 2015 and Apr. 30, 2019, during which time Hampshire County was not yet offering buprenorphine. Most observed individuals were male, white and around 35 years old.

The researchers found that 48 percent of individuals from the Franklin County jail recidivated, compared to 63 percent of individuals in Hampshire County. The rate of reincarceration in the Franklin County group was 21 percent, compared to 39 percent in the Hampshire County group.

Additional research is underway in both urban and rural jails across more diverse populations, including women and people of color.

“Though this study was done with a small sample, the results show convincingly that providing these medications in jail can break the repressive cycle of arrest, reconviction and reincarceration that occurs in the absence of adequate help and resources,” said senior study author Dr. Peter Friedmann. “That’s huge.”