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

2. 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

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

7. 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

8. 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

9. 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

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

11. 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

12. Do people retained on bupe treatment have lower rates of incarceration?
Chi-squared analysis
* 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
Chi-squared analysis

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

15. 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

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