Prior criminal charges and outcomes among individuals initiating office-based buprenorphine treatment

Elizabeth E Harris,Darius A Rastegar,Janet S Jacapraro

doi:10.1186/2194-7899-1-2

Abstract

BackgroundThere is little data on the impact of prior criminal activity on the treatment of opioid dependence with office-based buprenorphine. The goal of this study was to investigate the association between prior criminal charges and treatment outcomes in a cohort of patients initiating buprenorphine treatment in a primary care practice.MethodsThis was a retrospective study of 252 consecutive patients with opioid dependence who were given at least one prescription for buprenorphine in a primary care practice. A public database was used to collect data on criminal charges prior to enrollment. For every month after initiation of treatment, patients who remained in treatment were classified as “opioid-positive” or “opioid-negative” based on urine drug test results, patient report and clinician assessment. The primary outcomes of interest were treatment retention at one year and achieving ≥ 6 “opioid negative” months.ResultsMost (80%) of the subjects had at least one prior criminal charge. Those with prior criminal charges were more likely to have Medicare or Medicaid insurance, to be unemployed, to use cocaine and to have injected drugs. In the year after initiation of buprenorphine treatment, these subjects had significantly less opioid-negative months than those without criminal charges (5.1 months vs. 6.4 months; p = 0.030), and were less likely to have ≥ 6 opioid-negative months (43.2% vs. 58.4%; p = 0.048). While there was no difference in treatment retention at one-year for those who had any prior history (55.4% vs. 52.0%; p = 0.854), having recent charges (in the previous two years) was associated with poorer treatment retention and drug outcomes. On the other hand, having only distant charges (more than two years prior to treatment initiation) was not associated with poorer outcomes. Using multivariate analysis, recent criminal charges was the only factor significantly associated with treatment retention at one year and achieving ≥ 6 opioid-negative months.ConclusionsSubjects with recent criminal charges had poorer treatment retention and opioid-abstinence outcomes after initiating office-based buprenorphine treatment. These individuals may benefit from more intensive treatment than is typically offered in a primary care setting.

Highlights

There is little data on the impact of prior criminal activity on the treatment of opioid dependence with office-based buprenorphine
Given the prevalence of substance use in the criminal justice population and the current lack of access to pharmacologic treatment for opioid dependence, as well as the high rates of recidivism associated with substance use disorders (Hankansson and Berglund, 2012), there is a tremendous need for effective treatments
Studies suggest that buprenorphine is a feasible treatment post-release (Springer et al, 2010), treatment retention is associated with a reduction in opiate use and crime (Garcia et al, 2007). and treatment can improve other medical conditions (Springer et al, 2012)

Summary

Introduction

There is little data on the impact of prior criminal activity on the treatment of opioid dependence with office-based buprenorphine. Given the prevalence of substance use in the criminal justice population and the current lack of access to pharmacologic treatment for opioid dependence, as well as the high rates of recidivism associated with substance use disorders (Hankansson and Berglund, 2012), there is a tremendous need for effective treatments. For prisoners with opioid dependence, methadone maintenance treatment after release from prison has been associated with a reduction in mortality and re-incarceration (Dolan et al, 2005, Larney et al 2011). Studies suggest that buprenorphine is a feasible treatment post-release (Springer et al, 2010), treatment retention is associated with a reduction in opiate use and crime (Garcia et al, 2007). Buprenorphine maintenance therapy may be more acceptable than methadone to criminal offenders released from prison (Magura et al, 2009)

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