Headline
Corrections-based medications for opioid use disorder (MOUD) program is shown to be feasible and improve health outcomes for people incarcerated in these settings with opioid use disorder (OUD).
Context
There is an opioid overdose crisis nationwide and the risk of overdose is significant for people reentering communities after incarceration. In 2016, Rhode Island sought to address these challenges by establishing an MOUD program in its statewide jail and prison system. Preliminary outcomes include a 12% reduction in statewide overdose deaths and 61% reduction in post-incarceration overdose deaths. This study examined the implementation and growth of this program from October 2016 to October 2017.
Findings
There were approximately 3,000 people in Rhode Island Department of Corrections (RIDOC) custody at the time of the study, with approximately 13,000 intakes and releases during the study period. The RIDOC MOUD program involves screening people for substance use disorders as they enter prison and jail facilities, offering MOUD treatment initiation to people who screen positive for OUD (or continuation for people who had received MOUD in a community clinic), and coordination of referrals to community-based treatment and health insurance enrollment support upon release. A nonprofit health care provider was contracted with to deliver the care and served as the community provider when people were released from corrections facilities.
Screening increased by 75% and individuals receiving medication assisted treatment (MAT) increased by 350%. Some key challenges to implementation included security concerns regarding diversion of the medications, negative perceptions of MOUD on the part of staff, and coordination of the continuation of MAT when people are transferred to facilitates not offering MAT, such as out-of-state or federal facilities. The program was found to be feasible, with sustained investments for the program coming from the state budget.
Takeaways
State policymakers, health care providers, and correctional professionals can partner to consider implementing MOUD programs in jails and prisons as a way of reducing overall statewide overdose rates and addressing the high risk of overdose that people with OUD experience as they reenter communities after incarceration. MOUD programs in correctional facilities are feasible and can now be supported with Medicaid funds if the state is approved for a 1115 demonstration waiver for pre-release services, which includes reimbursement for MAT in correctional settings.