(107) Treatment Experience of Previously Incarcerated People In Outpatient Methadone Treatment

Introduction: Drug-related overdose, particularly from opioids, is a leading cause of death among formerly incarcerated individuals [1]. Opioid use disorder (OUD) is more common among individuals experiencing incarceration than the general population and medications for opioid use disorder (MOUD) are effective at reducing opioid-related and all-cause mortality [2]. People with incarceration histories face structural barriers to accessing medical treatment [3]. Prior qualitative work suggests that among individuals with OUD who have experienced incarceration, negative treatment experiences or withdrawal may dissuade enrollment in MOUD [4, 5]. We utilized a strengths-based research approach to examine the perceptions and experiences with the criminal justice system and OUD treatment among people with incarceration histories who were successfully enrolled in outpatient methadone treatment.

Methods: Study participants were 42 (23 male, 19 female) patients recruited from a low-barrier methadone treatment program from January-December 2017. The research team conducted one-on-one, semi-structured, audio-recorded interviews using an interview guide developed by members with qualitative research expertise. Interview recordings were transcribed and de-identified by trained research assistants. Two members of the research team (M.G.G., a senior medical student, and L.O., a clinical psychologist) coded the transcriptions using a Grounded Theory approach utilizing NVivo software.

Results: Participants’ average age was 42.9 (SD=10.1) with a range of 26-70. Twenty-seven participants self-identified as white, 10 as Black, and 8 as Hispanic. Participants’ self-reported number of times incarcerated ranged from 1 to 60 (median 4.0, 25th IQR=2.0, 75th IQR=8.3). The range of self-reported number of family members (parents, siblings, children, cousins, uncles or aunts) who ever had been incarcerated was 0 to 26 (median 4.0, 25th IQR=1.0, 75th IQR=5.0). Participants reported varied charges, and not all participants used opioids prior to incarceration. OUD treatment-specific themes from the interviews included: 1) Negative experiences with treatment during incarceration; 2) Lack of pharmacological treatment for opioid withdrawal syndrome and/or OUD during incarceration; 3) Lack of MOUD community-based treatment prior to incarceration (among those participants with OUD prior to incarceration). Main themes surrounding personal correctional system experience included: 1) Negative perceptions and experiences during incarceration; 2) Feeling unsafe while incarcerated; 3) Personal growth and change during incarceration. Participants also shared common themes around changes they would make to the criminal justice system to improve outcomes for individuals with substance use disorder: 1) Increased opportunities for rehabilitation (e.g., vocational or educational opportunities or treatment rather than imprisonment for people with substance use disorder and mental health conditions) and 2) Altered charge severity (e.g., more lenient sentences for drug-related charges).

Conclusions: This study is one of the first to examine perceptions and experiences of OUD treatment and the criminal justice system among formerly incarcerated individuals enrolled in MOUD. Although participants reported negative incarceration experiences, many shared common themes about personal resilience and growth. Common themes about proposed improvements to the criminal justice system suggest a need to increase the rehabilitation options for substance use disorders and mental health, as well as reducing criminal sentencing for drug-specific charges to improve outcomes of individuals with substance use disorders involved in the criminal justice system.

References:

1. Binswanger, I.A., et al., Release from prison--a high risk of death for former inmates. N Engl J Med, 2007. 356(2): p. 157-65.

2. Sordo, L., et al., Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. Bmj, 2017. 357: p. j1550.

3. Binswanger, I.A., et al., "From the prison door right to the sidewalk, everything went downhill," a qualitative study of the health experiences of recently released inmates. Int J Law Psychiatry, 2011. 34(4): p. 249-55.

4. Fox, A.D., et al., Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder. Addiction science & clinical practice, 2015. 10(1): p. 2-2.

5. Mitchell, S.G., et al., Incarceration and opioid withdrawal: the experiences of methadone patients and out-of-treatment heroin users. Journal of psychoactive drugs, 2009. 41(2): p. 145-152.