The relationship between incarceration and opioid addiction treatment

1. The relationship between incarceration and opioid addiction treatment Daniel P. Riggins Mentor: Aaron D. Fox M.D.

2. Background – Cycle of Addiction and Incarceration: Incarceration Treatment? Detox? Relapse X Release

3. Background – Opioid replacement therapy with buprenorphine (bupe): • Opioid derivative with mixed effects at opioid receptors • Can be used to treat withdrawal, for titrated cessation, or for long-term maintenance. • Advantages over methadone: • Can be self-administered at home • Low potential for abuse • Less stigmatized

4. Study Objectives: To determine if criminal justice status is associated with buprenorphine treatment outcomes To determine if buprenorphine treatment is associated with lower rates of incarceration

5. Methods: • Design: Secondary analysis longitudinal cohort study • Setting: Buprenorphine, HIV Evaluation and Support Collaborative (BHIVES) • 10 community and hospital-based care centers • Population: HIV+ primary care patients • Initiating buprenorphine treatment for opioid use disorder • Data collection: Surveys (baseline, quarterly x 1 yr) • Chart review (at study completion)

6. Methods - Variables:

7. Methods - Variables:

8. Results – Population Characteristics:

9. Methods - Variables:

10. Do people reporting recent incarceration at baseline have lower retention rates in bupe treatment?

11. Methods - Variables:

12. Do people retained on bupe treatment have lower rates of incarceration? * Is p < 0.05; ** is p < 0.01

13. Conclusions: • Recent incarceration was associated with: homelessness, unemployment, mental illness • Over time, those with recent incarceration seemed to have lower treatment retention • Over time, those retained in treatment had lower rates of incarceration

14. Implications: • Individuals with recent incarceration before starting therapy may need additional support to maintain retention in treatment • Buprenorphine maintenance therapy may help decrease incarceration rates for individuals with opioid use disorder

15. Acknowledgments: • Linda Weiss and Bert Chantarat from the New York Academy of Medicine for providing data • YumingNing for preparing the dataset • Aaron Fox for providing mentorship and allowing me to shadow at the Transitions Clinic • Ellie Schoenbaum for coordinating student research at Einstein

16. If we have time…

17. What is the profile of people with each criminal justice status? • Those who have ever been incarcerated are more likely to: • Be male • Not have a high school diploma • Have a lower composite score of addiction severity • Have ever injected drugs • Have ever used methadone and marijuana • Have been using opioids longer • Have overdosed more frequently • Have been treated for drug abuse more frequently

18. What is the profile of people with each criminal justice status? • Those who have recently been incarcerated are more likely to: • Live alone • Be homeless • Be unemployed • Have a diagnosed mental illness • Have a lower composite score for addiction severity • Have ever injected drugs • Have ever used heroin • Been treated for drug abuse more frequently

19. What is the profile of people with each criminal justice status? • Those on parole or probation are more likely to: • Not speak English as their primary language • Be male • Have a lower composite score for addiction severity • Have ever injected drugs • Have ever used heroin and methadone • Have been using opioids longer • Have overdosed more frequently • Have been treated for drug abuse more frequently