Abstract
BackgroundIt has been estimated that approximately 15% of people who are incarcerated in the US have histories of opioid use disorder. Relapse to opioid use after release from prison poses a serious risk of HIV infection. Prison-initiated buprenorphine may help to reduce HIV infection given the association between opioid use and HIV-risk behaviors.MethodsThe present study is a secondary analysis of longitudinal data gathered from a randomized controlled trial of buprenorphine-naloxone for people who were incarcerated (N = 211) between 2008 and 2012. It compares the impact of assignment to initiate buprenorphine in prison (N = 106 randomized, N = 104 analyzed) versus in the community (N = 107 randomized, N = 107 analyzed) and whether or not participants entered community treatment on the frequency of HIV-risk behaviors in the 12 months following release from prison. Data were analyzed hierarchically and for each outcome variable, a multilevel, over-dispersed Poisson model was fit to the data. Outcome variables were the number of times the following behaviors occurred in the last 30 days: (1) having sex without a condom (2) injecting drugs (3) using unsterilized needles, and (4) sharing injection paraphernalia.ResultsParticipants assigned to begin buprenorphine in the community experienced a greater decrease in injection drug use over time compared to participants assigned to begin buprenorphine in prison. There were no significant associations between treatment assignment or community treatment entry and instances of having sex without a condom, sharing injection paraphernalia, or using unsterilized needles.ConclusionsOverall, the present study did not find support for the initiation of buprenorphine in prison (as opposed to the community) as a means to reduce incidences of HIV-risk behaviors. Avenues for future research in the nexus of HIV-risk reduction, criminal justice, and pharmacotherapy are discussed.Trial registration This study was supported by the National Institute on Drug Abuse (NIDA), Buprenorphine for Prisoners (PI: Kinlock; R01DA021579). ClinicalTrials.gov identifier: NCT 00574067
Highlights
It has been estimated that approximately 15% of people who are incarcerated in the United States (US) have histories of opioid use disorder
Given that the vast majority of incarcerated persons will be released from prison at some point and that 626,024 individuals were released from state and federal prisons in 2016 [6], there is a considerable need to deliver effective treatment to this population in order to reduce relapse to drug use upon release
Individuals recently released from jail or prison are at increased risk for overdose death within their first month in the community [8,9,10,11,12,13,14,15,16,17] and a return to opioid use is associated with criminal activity [7, 18, 19] and re-incarceration [18, 20, 21]
Summary
It has been estimated that approximately 15% of people who are incarcerated in the US have histories of opioid use disorder. Compared to the general population, incarcerated persons have a disproportionally higher rate of opioid use disorders (OUDs) [2,3,4]; 13.1% and 9.2% of people incarcerated in state and federal prisoners respectively reported using heroin or other opiates regularly in the community before their incarceration [5]. Given that the vast majority of incarcerated persons will be released from prison at some point and that 626,024 individuals were released from state and federal prisons in 2016 [6], there is a considerable need to deliver effective treatment to this population in order to reduce relapse to drug use upon release. Relapse to drug use is a significant public health concern as it heightens the risk for HIV and hepatitis B and C infections [2, 4, 7]
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