Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: A microsimulation modeling study.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Macmadu, A; Adams, JW; Bessey, SE; Brinkley-Rubinstein, L; Martin, RA; Clarke, JG; Green, TC; Rich, JD; Marshall, BDL

Published Date

  • May 1, 2021

Published In

Volume / Issue

  • 91 /

Start / End Page

  • 102841 -

PubMed ID

  • 32712165

Pubmed Central ID

  • PMC7790977

Electronic International Standard Serial Number (EISSN)

  • 1873-4758

Digital Object Identifier (DOI)

  • 10.1016/j.drugpo.2020.102841


  • eng

Conference Location

  • Netherlands