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

X Background – Cycle of Addiction and Incarceration: Incarceration Treatment? Detox? Relapse X - In 2010, more than 900,000 Americans met criteria for an opioid use disorder (0.3%) - Up to 1/3 of heroin users are incarcerated annually - Fewer than 1% of incarcerated heroin users receive one of these medications in the United States - Opioids accounting for a 129x increased risk in the first two weeks of release - Up to ¾ of prisoners with opioid use disorders relapse to illicit opioid use within 6 months of prison release Release

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

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

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)

Methods - Variables: Recent incarceration (collected from surveys) Treatment retention (determined from chart review) Independent Variable Dependent Variable Serve as both independent and dependent variables

Methods - Variables: Recent incarceration Treatment retention Independent Variable Subject reported any incarceration in 30 days before baseline interview Dependent Variable Serve as both independent and dependent variables

Results – Population Characteristics: Not recently incarcerated (N = 266) Recently incarcerated (N = 40) P-value Age, mean years +/- SD 44.6 +/- 8.4 44.4 +/- 9.3 P = 0.93 Race/Ethnicity, % (N): White 22.9% (61) 20.0% (8) P = 0.68 Black 50% (133) 57.5% (23) P = 0.38 Hispanic 22.2% (59) P = 0.76 Other 3.4% (9) 2.5% (1) P = 1.00 Male, % (N) 67.3% (179) 67.5% (27) P = 0.98 Homeless, % (N) 22.6% (60) 40.0% (16) P = 0.02 Employed, % (N) 27.8% (74) 10% (4) Ever diagnosed with mental illness, % (N) 53.2% (140) 73.7% (28) Serve as both independent and dependent variables

Methods - Variables: Recent incarceration Treatment retention Independent Variable Subject reported any incarceration in 30 days before baseline interview Dependent Variable Number of consecutive quarters subject received buprenorphine treatment Serve as both independent and dependent variables

Do people reporting recent incarceration at baseline have lower retention rates in bupe treatment? Chi squared analysis

Subject received buprenorphine treatment for ≥ 1 quarter (yes/no) Methods - Variables: Recent incarceration Treatment retention Independent Variable Subject received buprenorphine treatment for ≥ 1 quarter (yes/no) Dependent Variable Subject reported any incarceration in 30 days before each quarterly interview Serve as both independent and dependent variables

Do people retained on bupe treatment have lower rates of incarceration? Chi-squared analysis * Is p < 0.05; ** is p < 0.01

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 Chi-squared analysis

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 - Peer mentorship might be one effective source of support - We intend to do multi-variable, time-adjusted analysis

Acknowledgments: Linda Weiss and Bert Chantarat from the New York Academy of Medicine for providing data Yuming Ning 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 Chi-squared analysis

If we have time…

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

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

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