Treatment lowers rates of rearrest and reincarceration
AMHERST, Mass. – A new study conducted by Baystate Medical Center and the University of Massachusetts Amherst and published today in Drug and Alcohol Dependence strengthens the case for providing agonist medications in jail.
The study, part of a national effort to address the opioid crisis in criminal justice settings, found a 32% reduction in recidivism – including probation violation, reincarceration or court charges – when a jail offered buprenorphine to people who were incarcerated, compared to when it did not.
The study was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, through the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative, and its Justice Community Opioid Innovation Network (JCOIN). A JCOIN Accelerator grant was awarded to Dr. Peter Friedmann, chief research officer at Baystate Health and associate dean for research at UMass Chan Medical School-Baystate. The paper’s lead author is epidemiology researcher Elizabeth Evans, associate professor in the UMass Amherst School of Public Health and Health Sciences.
“When jails offer buprenorphine and other evidence-based medications to treat opioid use disorder, it can improve public safety,” Evans says. “This is a critical outcome to be aware of as jails nationwide consider whether to offer this type of healthcare.”
“These results show convincingly that on top of their positive health effects, providing these medications to treat opioid use disorder in jail can break the repressive cycle of arrest, reconviction and reincarceration,” adds Dr. Friedmann.
In addition to reducing recidivism, opioid agonist medications, including buprenorphine and methadone, show great promise to stem overdose and drug use in correctional populations. The challenge is that their use is not standard-of-care in U.S. jails. The few correctional facilities that do offer medications to treat opioid use disorder are large urban jails in New York City, San Francisco and Albuquerque, or are part of state systems in Rhode Island and Vermont, for example, or they only offer the opioid antagonist naltrexone.
The study is one of the first to evaluate the impact on recidivism of providing buprenorphine to people in jail. Co-lead investigators Evans and Friedmann recognized an opportunity to assess this research gap when jails in two neighboring rural counties – the Franklin County Sheriff’s Office and the Hampshire County House of Corrections – both began to offer buprenorphine to adults in jail, but at different times. Franklin County was one of the first rural jails in the nation to offer buprenorphine – in addition to naltrexone – beginning in February 2016. Hampshire County began providing buprenorphine in May 2019.
Prior research on post-release outcomes found beneficial effects of methadone and buprenorphine on drug use, injection risk behaviors associated with HIV and overdoses.
“Less established is the impact of buprenorphine in jails on post-release recidivism, a crucial outcome to convince lawmakers and public safety officials of its value in correctional settings,” says Dr. Friedmann, the study’s senior author.
“Most people convicted of crimes carry out short-term sentences in jail, not prisons, so it was important for us to study our research question in jails,” Evans notes.
The researchers followed 469 adults who were incarcerated and had opioid use disorder – 197 individuals in Franklin County and 272 in Hampshire County – and who exited one of the jails between Jan. 1, 2015, and April 30, 2019. During this time, Franklin County jail began offering buprenorphine while the Hampshire County facility did not. Most of the observed individuals were male, white and in their mid-30s.
Using statistical models to analyze data from each jail’s electronic booking system, the researchers found that 48% of individuals from the Franklin County jail recidivated, compared to 63% of individuals in Hampshire County. As well, 36% of the people who were incarcerated in Franklin County faced new criminal charges in court, compared to 47% of people in Hampshire County. The rate of re-incarceration in the Franklin County group was 21%, compared to 39% in the Hampshire County group.
Further analyses found that recidivism related to property crime was reduced, in keeping with the idea that medication treatment effectively managed the opioid use disorder, and thus reduced property crime to support drug use. Analyses also found no differences in violations of parole or probation, suggesting that differing rates of rearrest for technical violations and variation in community correctional practices did not explain the findings.
After decades in which access to effective medications to treat opioid use disorder was limited in correctional settings, lawsuits and legislation have created momentum for jails and prisons to provide these lifesaving therapies. In Massachusetts, a 2018 legislative mandate caused seven jails, including the two examined in the current study, to expand agonist treatment options and related services. These jails provide all FDA-approved types of medications to treat opioid use disorder during incarceration, as well as programs to connect individuals to continued medication treatment in the community after they exit jail.
“In addition to the demonstrated reduction in overdose mortality, the current study provides legislators and correctional officials with compelling evidence that agonist medications in jail will reduce recidivism. Since recidivism and reincarceration are costly, and the implementation costs associated with agonist treatment in jails are substantial, future work should examine the state and societal costs associated with medications to treat opioid use disorder in jail,” the study states.
That work has already begun.
The collaboration between Dr. Friedmann at Baystate and Evans at UMass Amherst also resulted in a $10 million grant from the NIH HEAL Initiative in 2019 to support the Massachusetts JCOIN Research Hub, which is extending this work on medications for opioid use disorder to urban and rural jails across the Commonwealth that are participating in the pilot program mandated by legislation to provide all FDA-approved forms of medication for opioid use disorder. Working closely with Massachusetts Bureau of Substance Addiction Services, the Department of Public Health and jail officials, this ongoing research will examine the comparative effectiveness of all FDA-approved medications for opioid use disorder in jail populations, the challenges jails face in implementing them and the related costs to the correctional system and society.
The Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative, is an aggressive, trans-NIH effort to speed scientific solutions to stem the national opioid public health crisis. Launched in April 2018, the initiative is focused on improving prevention and treatment strategies for opioid misuse and addiction, and enhancing pain management.
For more information on Massachusetts’ effort, visit the Massachusetts JCOIN Research Hub.