Alexandria Macmadu1, Joëlla W Adams2, S E Bessey2, Lauren Brinkley-Rubinstein3, Rosemarie A Martin4, Jennifer G Clarke5, Traci C Green6, Josiah D Rich1, Brandon D L Marshall7. 1. Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA. 2. Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA. 3. Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 South Columbia Street, Chapel Hill, NC 27514, USA. 4. Department of Behavioral and Social Science, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA. 5. Rhode Island Department of Corrections, 40 Howard Avenue, Cranston, RI 02920, USA. 6. Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA. 7. Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA. Electronic address: brandon_marshall@brown.edu.
Abstract
BACKGROUND: We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. METHODS: We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD). RESULTS: In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. CONCLUSIONS: Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.
BACKGROUND: We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. METHODS: We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD). RESULTS: In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. CONCLUSIONS: Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.
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