Extended Release Buprenorphine in Correctional Settings Shows Increased Treatment Retention and Reduced Opioid Use
Findings from JCOIN’s New York University Research Hub
Both the rate of opioid use and the rate of overdose following release from jail or prison are disproportionately high in justice-involved populations [1]. Although medications for opioid use disorder (MOUD) are proven to reduce the likelihood for post-release overdose, they are largely underutilized in correctional facilities [2].
New formulations of extended-release MOUDs are some of the most recent advancements in opioid treatment and have the potential to increase medication availability in a variety of settings, including corrections. While sublingual buprenorphine (dissolved under the tongue) must be taken daily, extended-release buprenorphine is an injection given once per month.
A recent study published in the Journal of the American Medical Association (JAMA) found improved treatment outcomes for individuals prescribed extended-release buprenorphine in jail settings.
Key Results:
- Extended-release buprenorphine had greater treatment retention and lower rates of opioid use after release from jail.
- 69% of the extended-release group were still utilizing medication at 8 weeks post-release, vs 35% among the daily sublingual buprenorphine group.
- Rates of opioid-negative urine tests were also higher among the extended-release buprenorphine at 55%, compared to 38% of the daily medication cohort.
The study compared treatment retention of incarcerated adults following release from jail receiving daily sublingual buprenorphine compared to those receiving extended-release buprenorphine [3]. Study participants receiving extended-release medication began treatment prior to release and continued monthly through 8 weeks after release from Rikers Island jail in New York. Participants taking sublingual buprenorphine continued to receive daily directly observed in-jail administration, and were provided a 7-day supply at jail release, with instructions to follow up at a designated clinic.
Dr. Josh Lee, Professor at New York University’s Grossman School of Medicine shared: “We have several hundred people receiving buprenorphine and leaving jail each year in New York City. The primary outcome we were looking for here was were people able to stay on medication of any type, so staying on buprenorphine of any formulation. Extended-release buprenorphine had a clear advantage in terms of more people staying on buprenorphine for the next eight weeks.”
What this means for future research:
Extended-release buprenorphine demonstrated several advantages compared to sublingual buprenorphine, including fewer clinic visits during incarceration and improved treatment retention in the weeks following release from jail. These findings support wider use and further study of extended-release buprenorphine as a correctional and reentry opioid use disorder treatment.
This summary is based on the findings from the following publication:
Lee, J. D., Malone, M., McDonald, R., Cheng, A., Vasudevan, K., Tofighi, B., Garment, A., Porter, B., Goldfeld, K. S., Matteo, M., Mangat, J., Katyal, M., Giftos, J., & MacDonald, R. (2021). Comparison of treatment retention of adults with opioid addiction managed with extended-release buprenorphine vs daily sublingual buprenorphine-naloxone at time of release from jail. JAMA Network Open, 4(9), e2123032. https://doi.org/10.1001/jamanetworkopen.2021.23032