Thomas Lincoln1, Benjamin D Johnson2, Patrick McCarthy3, Ellen Alexander4. 1. Baystate Medical Center, Baystate Brightwood Health Center, 380 Plainfield St., Springfield, MA 01107, United States; Hampden County Sheriff's Department, 627 Randall Rd., Ludlow, MA 01056-1079, United States. Electronic address: thomas.lincoln@baystatehealth.org. 2. Baystate Medical Center, Baystate Brightwood Health Center, 380 Plainfield St., Springfield, MA 01107, United States. Electronic address: bdjohns11@icloud.com. 3. Hampden County Sheriff's Department, 627 Randall Rd., Ludlow, MA 01056-1079, United States. Electronic address: patmcc10@gmail.com. 4. Clean Slate Addiction Treatment Centers, Administrative Office, P.O. Box 32, Northampton, MA 01061, United States. Electronic address: ealexander@cleanslatecenters.com.
Abstract
A western Massachusetts county jail began initiating extended-release naltrexone (XR-NTX) prior to release from incarceration and linking participants to community treatment providers upon release. Program barriers prevented the start of XR-NTX prior to release for a subset. METHODS: This report consists of the initial 67 jail releasees with opioid dependence, 47 who received XR-NTX before release, and 20 after release. Utility of the program was assessed by determining medication addiction treatment (MAT) retention rates at 4, 8, and 24 weeks. RESULTS: Forty-seven commenced XR-NTX approximately 7 days prior to release, and 20 were referred to commence XR-NTX at outpatient treatment centers. Rate of retention at week 4 was higher in group with treatment initiation prior to release as compared to those started in community: week 4: 55% (24 XR-NTX+2 agonist MAT out of 47) versus 25% (4 XR-NTX+1 agonist MAT out of 20) (p=0.03); week 8: 36% (13 XR-NTX+4 agonist) versus 25% (3 XR-NTX+2 agonist) (p=0.41); week 24: 21% (6 XR-NTX+4 agonist) versus 15% (1 XR-NTX+2 agonist) (p=0.74). Three patients died, all in the pre-release group, all from overdose at 3-5months after release and 2.5 or more months after stopping XR-NTX, compared to none of 20 in community group (p=0.55). Limitations include that cohorts were non-random and observational; substance use could not be consistently determined; and overdose deaths in MA occurred partly in clusters, limiting historical comparisons. CONCLUSIONS: Receiving XR-NTX prior to jail release for opioid use disorder appears to increase the treatment retention rate as compared to commencing after release. The treatment attrition and striking rate of overdose deaths are concerning, and support expanded availability of opioid agonist treatments prior to release and other evidence-based supports and retention strategies in the community.
A western Massachusetts county jail began initiating extended-release naltrexone (XR-NTX) prior to release from incarceration and linking participants to community treatment providers upon release. Program barriers prevented the start of XR-NTX prior to release for a subset. METHODS: This report consists of the initial 67 jail releasees with opioid dependence, 47 who received XR-NTX before release, and 20 after release. Utility of the program was assessed by determining medication addiction treatment (MAT) retention rates at 4, 8, and 24 weeks. RESULTS: Forty-seven commenced XR-NTX approximately 7 days prior to release, and 20 were referred to commence XR-NTX at outpatient treatment centers. Rate of retention at week 4 was higher in group with treatment initiation prior to release as compared to those started in community: week 4: 55% (24 XR-NTX+2 agonist MAT out of 47) versus 25% (4 XR-NTX+1 agonist MAT out of 20) (p=0.03); week 8: 36% (13 XR-NTX+4 agonist) versus 25% (3 XR-NTX+2 agonist) (p=0.41); week 24: 21% (6 XR-NTX+4 agonist) versus 15% (1 XR-NTX+2 agonist) (p=0.74). Three patientsdied, all in the pre-release group, all from overdose at 3-5months after release and 2.5 or more months after stopping XR-NTX, compared to none of 20 in community group (p=0.55). Limitations include that cohorts were non-random and observational; substance use could not be consistently determined; and overdose deaths in MA occurred partly in clusters, limiting historical comparisons. CONCLUSIONS: Receiving XR-NTX prior to jail release for opioid use disorder appears to increase the treatment retention rate as compared to commencing after release. The treatment attrition and striking rate of overdose deaths are concerning, and support expanded availability of opioid agonist treatments prior to release and other evidence-based supports and retention strategies in the community.
Authors: Marc R Larochelle; Dana Bernson; Thomas Land; Thomas J Stopka; Na Wang; Ziming Xuan; Sarah M Bagley; Jane M Liebschutz; Alexander Y Walley Journal: Ann Intern Med Date: 2018-06-19 Impact factor: 25.391
Authors: Ali Jalali; Philip J Jeng; Daniel Polsky; Sabrina Poole; Yi-Chien Ku; George E Woody; Sean M Murphy Journal: J Subst Abuse Treat Date: 2022-07-02
Authors: Brantley P Jarvis; August F Holtyn; Shrinidhi Subramaniam; D Andrew Tompkins; Emmanuel A Oga; George E Bigelow; Kenneth Silverman Journal: Addiction Date: 2018-03-24 Impact factor: 6.526
Authors: Kathleen M Carroll; Charla Nich; Tami L Frankforter; Sarah W Yip; Brian D Kiluk; Elise E DeVito; Mehmet Sofuoglu Journal: Drug Alcohol Depend Date: 2018-10-04 Impact factor: 4.492
Authors: Melissa Velasquez; Mara Flannery; Ryan Badolato; Alexandria Vittitow; Ryan D McDonald; Babak Tofighi; Ann R Garment; Jonathan Giftos; Joshua D Lee Journal: Addict Sci Clin Pract Date: 2019-10-01