Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails

•Medications for opioid use disorder in prisons/jails reduced overdose post-release.•Our model predicted that treatment alone would have saved 1840 lives.•We predicted that treatment and post-release retention would have saved 4400 lives. Medications for opioid use disorder (OUD) are the most effect...

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Bibliographic Details
Published in:Drug and alcohol dependence Vol. 208; p. 107858
Main Authors: Macmadu, Alexandria, Goedel, William C., Adams, Joëlla W., Brinkley-Rubinstein, Lauren, Green, Traci C., Clarke, Jennifer G., Martin, Rosemarie A., Rich, Josiah D., Marshall, Brandon D.L.
Format: Journal Article
Language:English
Published: Ireland Elsevier B.V 01.03.2020
Elsevier Science Ltd
Subjects:
Adult
Analgesics, Opioid - therapeutic use
Clinical assessment
Computer simulation
Correctional Facilities - statistics & numerical data
Deaths
Drug addiction
Drugs
Female
High risk
Humans
Imprisonment
Jail
Jails
Life Tables
Male
Mass Screening - mortality
Medical screening
Medications for opioid use disorder
Middle Aged
Monte Carlo Method
Monte Carlo simulation
Narcotics
Opioid-Related Disorders - diagnosis
Opioid-Related Disorders - drug therapy
Opioid-Related Disorders - mortality
Opioids
Overdose
Prison
Prisoners
Prisons
Procedures and Techniques Utilization - statistics & numerical data
Risk Factors
Simulation
Statistics
Substance abuse treatment
Substance use disorder
Tests
Treatment Outcome
United States - epidemiology
Uptake
Vital statistics
Young Adult
United States
United States > US
Prison
Jail
Overdose
Medications for opioid use disorder
Opioids
ISSN:0376-8716, 1879-0046, 1879-0046
Online Access:Get full text
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Description
Summary:•Medications for opioid use disorder in prisons/jails reduced overdose post-release.•Our model predicted that treatment alone would have saved 1840 lives.•We predicted that treatment and post-release retention would have saved 4400 lives. Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 – 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 – 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 – 1812) and 1609 (95% SI: 972 – 2037) lives saved per 10,000 persons incarcerated, respectively. Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.
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CONTRIBUTORS
AM, BDLM, JDR, and WCG conceptualized the study and design. AM developed initial drafts of the manuscript. AM and WCG conducted all analyses. JWA contributed significantly to writing the methods section. WCG, JWA, LBR, TCG, JGC, RAM, JDR, and BDLM provided iterative and substantive feedback on the overall approach and all drafts of the manuscript. All authors have approved the final manuscript.
ISSN:0376-8716
1879-0046
1879-0046
DOI:10.1016/j.drugalcdep.2020.107858