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Research Letter
April 2018

Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System

Author Affiliations
  • 1Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 2Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
  • 3Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 4Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
  • 5Rhode Island Department of Corrections, Cranston
  • 6Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 7Department of Social Medicine, University of North Carolina, Chapel Hill
  • 8Rhode Island Department of Health, Providence
  • 9Rhode Island Department of Behavioral Health, Disabilities, and Hospitals, Cranston
  • 10Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island
JAMA Psychiatry. 2018;75(4):405-407. doi:10.1001/jamapsychiatry.2017.4614

As the epidemic of opioid use in the United States continues to shift from prescription opioids to illicit drugs,1 more people living with opioid use disorder are encountering the criminal justice system. Most US correctional facilities do not continue or initiate medications for addiction treatment (MAT).2 This is especially unfortunate given the higher rates of opioid overdose immediately after release from incarceration.3

In July 2016, a new model of screening and protocoled treatment with MAT (including methadone, buprenorphine, or naltrexone) launched at the Rhode Island Department of Corrections (RIDOC), a unified prison/jail. A community vendor with statewide capacity to provide MAT after release was engaged to help run the program in November 2016, and all sites were operational by January 2017. Individuals arriving into RIDOC while receiving MAT were to be maintained on their respective medications regimen without tapering or discontinuing their medications. Contemporaneously, a system of 12 community-located Centers of Excellence in MAT was established to promote transitions and referrals of inmates released from RIDOC. This analysis examines preliminary association of the program with overall overdose fatalities and deaths from overdose among those individuals who were recently incarcerated.