Use of non–prescribed buprenorphine in the criminal justice system: Perspectives of individuals recently released from incarceration

Abstract

Buprenorphine, an effective treatment for opioid use disorder (OUD), remains underutilized in many U.S. jails and prisons. However, use of non–prescribed (i.e., diverted) buprenorphine has been reported in these settings. The current study examined non–prescribed buprenorphine use experiences in correctional and community contexts. The study conducted face-to-face interviews with 300 adults with OUD/opioid misuse and recent incarceration, recruited in Baltimore, MD, and New York, NY (n = 150 each). Illicit/non–prescribed opioid use during incarceration was reported by 63% of participants; 39% reported non–prescribed buprenorphine. Non–prescribed buprenorphine was considered the most widely available opioid in jails/prisons in both states (81% reported “very” or “somewhat” easy to get). The average price of non–prescribed buprenorphine in jail/prison was ~10× higher than in the community (p < 0.001). Participants were more likely to endorse getting high/mood alteration as reasons for using non–prescribed buprenorphine during incarceration, but tended to ascribe therapeutic motives to use in the community (e.g., self-treatment; p < 0.001). Multivariable logistic regression analyses showed that different individual-level characteristics were associated with history of non–prescribed buprenorphine use during incarceration and in the community. Use of non–prescribed buprenorphine during incarceration was associated with younger age (p = 0.006) and longer incarceration history (p < 0.001), while use of non–prescribed buprenorphine in the community was associated with MD recruitment site (p = 0.001), not being married (p < 0.001), prior buprenorphine treatment experience (p < 0.001), and housing situation (p = 0.01). These findings suggest that different dynamics and demand characteristics underlie the use of non–prescribed buprenorphine in community and incarceration contexts, with implications for efforts to expand OUD treatment in correctional settings.