TY - JOUR PY - 2020// TI - Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: a microsimulation modeling study JO - International journal on drug policy A1 - Macmadu, Alexandria A1 - Adams, Joƫlla W. A1 - Bessey, S. E. A1 - Brinkley-Rubinstein, Lauren A1 - Martin, Rosemarie A. A1 - Clarke, Jennifer G. A1 - Green, Traci C. A1 - Rich, Josiah D. A1 - Marshall, Brandon D. L. SP - ePub EP - ePub VL - ePub IS - ePub N2 - 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.

Language: en

LA - en SN - 0955-3959 UR - http://dx.doi.org/10.1016/j.drugpo.2020.102841 ID - ref1 ER -