AMHERST, Mass. (WWLP) – Researchers from UMass Amherst and other institutions collaborated to discover that enhancing the release process and maintaining treatment continuity may help to prevent opioid overdoses among those that are incarcerated.

Tufts University School of Medicine, the University of Massachusetts Amherst, and UMass Chan Medical School-Baystate discovered there is a need for changes in at least three crucial areas as prisoners go from prison to the community.

“Continued treatment reduces the risk of death and leads to improved health and social outcomes,” says Liz Evansprofessor of public health at UMass Amherst and co-principal investigator of the study, along with Dr. Peter Friedmann, professor of medicine at UMass-Baystate. “Many people with opioid use disorder engage with the justice system, making it a critical place to offer evidence-based treatment. As people are released from jail, their ability to continue life-saving treatment largely depends on innovative collaborations that have been established between community treatment providers and jails.”

In Massachusetts, those who are released from jail or prison have a 120 times higher risk of overdosing on opioids than the general population.

The Massachusetts Legislature established a new opioid use disorder treatment program that was implemented in seven county jails in 2019 to lower that danger.

The initiative consists of a broader five-year study called the Massachusetts Justice Community Opioid Innovation Network (JCOIN), which gives inmates access to methadone, buprenorphine, and naltrexone for treating opioid use disorder (MOUD).

International MOUD treatment programs have shown considerable potential in lowering the danger of deadly overdoses once someone is released from jail; they are uncommon but growing in U.S. correctional facilities.

“But here in Massachusetts, we learned that many individuals were released after-hours or late on Friday, after community treatment centers are closed, and they may be left not knowing where their next treatment will come from,” says Thomas Stopka, an epidemiologist and associate professor at Tufts School of Medicine and first author of the study, which was published Aug. 11 in theInternational Journal of Drug Policy.

“Most correctional settings detoxify clients with MOUD, lowering their tolerance and raising the risk of overdose right after release,” Dr. Friedmann says. “Prior research has shown that the period immediately after release from jail or prison is a critical time to ensure that persons with opioid use disorder receive MOUD to mitigate that risk. This study highlights the challenges of that period immediately after release from jail, as well as best practices to ensure continuity of MOUD care.”

“It’s a long way until Monday if the treatment center they believe they are going to is closed,” Stopka says. Even with a prescription in hand, they may not have a driver’s license or other federal ID they need to pick up the medication. “Many also don’t have a cell phone upon release to call a community treatment center or for someone at a community treatment center to reach them to schedule a first appointment,” adds Stopka.

The majority of inmates in American prisons and jails are there for drug-related charges. “We believe this research has uncovered clear ways the Massachusetts program can be improved. The effort can save hundreds if not thousands of lives,” Stopka emphasizes.

According to the team’s investigation, three things require improvement:

  1. Bridge doses: Individuals being released from jail need medication to cover them until they can connect with a treatment program in the community.
     
  2. Better communication: Solid, consistent communication is required between staff working with an incarcerated person, while inside the jail, and the community-based staff outside to facilitate a smooth transition.
     
  3. Phone access: Individuals who are released must be given access to a cellphone so they can connect with an outside treatment program.

There are 36 medical, administrative, and supervisory staff members from 18 MOUD treatment programs that accept patients who have been referred from jail that were interviewed for the qualitative study.

However, 14 of the people who were interviewed worked as independent contractors for a community-based organization that offered addiction services inside nearby jails. Patient navigators in prisons assist inmates in overcoming obstacles to receiving adequate medical care and obtaining the financial, legal, clinical, and social support they require.

The interviews also revealed that some jail officials still have reservations about utilizing drugs to treat opioid addiction that were once thought to be illegal. And for those who have completed therapy in jail, a variety of other issues may prevent them from routinely attending programs for treatment outside of jail. “Lack of housing, money, food, a job – all of these forces conspire to make it hard for a person in recovery to continue treatment,” Stopka says.

In order to determine how the three important areas may be improved, the researchers are collaborating with state agencies.

“People are dying from an opioid overdose more than ever before,” Evans says. “To tackle this problem, Massachusetts jails are leading a huge shift in our nation’s drug policy, showing how the justice system can work together with community-based healthcare to make communities safer and healthier. Learning lessons from this innovative program can help to refine it, with immense potential for better public health.”