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Addictive Behaviors

Incarceration history is associated with MOUD initiation but not treatment completion for individuals in inpatient treatment for opioid use disorder

(PS1-34) Incarceration History Is Associated with MOUD Initiation but Not Treatment Completion for Individuals in Inpatient Treatment for Opioid Use Disorder

Friday, November 15, 2024

8:30 AM – 9:30 AM EST

Location: Franklin Hall, Level 4, Marriott Downtown

Author(s)

JT

Julia M. Thomas, B.S.

Clinical Research Coordinator
Maryland Treatment Centers, Inc
Baltimore, Maryland, United States

Co-Author(s)

LT

Lexi Taylor, B.S., B.A.

Clinical Research Assistant
Maryland Treatment Centers
Baltimore, Maryland, United States
KW

Kevin Wenzel, Ph.D.

Director of Research
Maryland Treatment Centers
Baltimore, Maryland, United States
JC

Jennifer Carrano, Ph.D.

Clinical Research Scientist
Maryland Treatment Centers
Baltimore, Maryland, United States
Marc Fishman, M.D.

Medical Director and Addiction Psychiatrist
Maryland Treatment Centers
Baltimore, Maryland, United States

Abstract Text: Medications for opioid use disorder (MOUD) are the standard of care for OUD; however, rates of initiation and retention are poor even in specialty care residential settings with the time and resources to overcome barriers to initiation. Individuals with OUD often interact with the justice system, and many have histories of incarceration. Formerly incarcerated individuals with OUD report high levels of treatment aversion. Those that do enroll in treatment show poorer treatment compliance compared to patients without a history of incarceration. However, little is known about how incarceration history affects MOUD induction rates or the odds of successfully completing residential treatment. This study examined if months of incarceration were associated with: 1. Successful completion of inpatient OUD treatment (yes/no), defined by the provider based on number of days spent inpatient and treatment goals met, and 2. New initiation of MOUD prior to discharge (yes/no). We extracted electronic health records (EHR) data from a regional SUD treatment provider in Maryland. Data from all OUD admissions to inpatient treatment programs from 12/01/2020– 11/30/2021 were examined. Patients self-reported number of lifetime months spent incarcerated. Successful treatment completion and MOUD initiation were collected from provider-completed discharge assessments. Data were tabulated and examined using logistic regression models. The study sample (N=853) was limited to OUD patients who reported a history of incarceration (M=55.8 lifetime months; SD=76.4) and who were not on MOUD at the time of admission. Mean age was 38.0 (SD=11.66, 18-69), with 72.3% male and 53.6% white. Slightly more than half (51.2%) of the sample completed treatment successfully and 38.0% of patients received MOUD before discharge. The first regression model showed that patients reporting more months of incarceration were less likely to initiate MOUD during treatment, after controlling for length of inpatient stay, age, and race. (or=0.996, se=0.002, p=0.005). The second regression model found that months of incarceration did not impact the odds of successful inpatient completion after controlling for length of stay, age, and race (p=0.178). In line with past studies, we found that p</span>atients with a history of incarceration may be at risk for worse OUD treatment outcomes, with more months spent incarcerated decreasing the likelihood of a patient receiving MOUD before discharge from inpatient OUD treatment. MOUD is rarely offered in carceral settings, many preferring “drug-free” interventions for individuals with OUD. One possible explanation for our finding is that patients with longer incarceration histories have internalized MOUD related stigma typical of jail/prison culture. Interestingly, months spent incarcerated did not impact successful completion of treatment. There may be other variables that overpower any impacts of incarceration history on treatment completion. Further, this data set is limited by heterogeneity among providers determining what constitutes a “successful” discharge. Identifying psychosocial factors that interfere with MOUD initiation and treatment retention illuminates areas to target for the continued improvement of OUD treatment.