Post-incarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System

As the epidemic of opioid use in the United States continues to shift from prescription opioids to illicit drugs, 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). This is especially unfortunate given the higher rates of opioid overdose immediately after release from incarceration. 

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.