Rhode Island Study Shows Benefit To Medication-Assisted Addiction Treatment In Jails

A new study out of Rhode Island shows a dramatic reduction in overdose deaths among inmates who were offered medication to help combat their addictions.

The study comes as Massachusetts considers offering more so-called medication-assisted treatment in jails and prisons.

The study, published in the Journal of the American Medical Association Wednesday, showed a more than 60 percent reduction in opioid overdose deaths among those who were recently incarcerated, after medication-assisted treatments were offered to them behind bars.

"This study shows that not only is medication for addiction treatment an evidence-based approach, it's doable, feasible within current structures, and an important contribution toward reducing overdose deaths," said lead researcher Traci Green, an associate professor at Brown University and physician at Boston Medical Center.

All three approved addiction medications — buprenorphine, methadone and naltrexone — were offered at the Rhode Island Department of Corrections in early 2017. The inmates were also referred to treatment after their release.

The researchers compared the opioid overdose death rate from the first six months of 2016, before the program began, to the first six months of 2017. They found 26 deaths in early 2016 compared with nine deaths in 2017.

"We thought these preliminary data were so important that we wanted to get this study out," Green said. "We want to get states — and others — thinking about legislative and other investments that are important for reversing the opioid epidemic, particularly in this population."

Most correctional facilities, including those in Massachusetts, do not offer all three approved addiction medications. That's despite data from the Massachusetts Department of Public Health indicating that the opioid related overdose death rate is 120 times higher for people released from prisons and jails, compared to the rest of the adult population in the state.

A criminal justice reform bill before Massachusetts lawmakers contains a provision that would require prisons and jails to offer all approved addiction medications, but several law enforcement officials have concerns — especially about the possible abuse or diversion of the medicines.

In Rhode Island, Green says, state officials approved spending $2 million to offer the treatment behind bars, and clinicians revised the treatment as needed. That included, in one case, offering the medication in a non-pill form to reduce abuse.

"This program is the first in the country to offer all three medications behind the walls in a patient-centered fashion," Green said. "The Rhode Island Correctional System was able to align and learn and create a protocol that reduced concerns about diversion, improved patient safety, and gave a clear sense of public safety within the facilities. These data show it's possible to do this in a large state setting."

Green says the study's data are particularly compelling because in Rhode Island, like most states, the majority of overdose deaths are blamed on the powerful opioid fentanyl, which is said to be at least 10 times more powerful than heroin and is often mixed with street drugs.

She admits that a major drawback to the study is its size and the fact that the researchers did not closely follow the inmates after their release, so they don't know if any of those receiving treatment died of an overdose. The researchers next plan to review individual data on the inmates and their treatment.