REVIEW OF: Martin RA et al, J Subst Abuse Treat 2022;142:108851

STUDY TYPE: Retrospective cohort study 

Incarcerated individuals with opioid use disorder (OUD) face significant challenges in accessing medication treatment and are at high risk for overdose after release. Extended-release (XR) formulations offer unique benefits by reducing logistical barriers and minimizing diversion concerns. Until a few years ago, the only available XR medication for OUD (MOUD) was naltrexone (Vivitrol). But another option became available in recent years: an XR injection of buprenorphine that goes by the trade name Sublocade, administered subcutaneously in the abdomen and lasting for a month (for more information, see CATR Jan/Feb/Mar 2023).

In a recent randomized controlled trial (RCT), incarcerated individuals taking XR buprenorphine (XR-BUP) required fewer jail clinic visits and had improved OUD treatment retention post-release compared to those taking immediate-release sublingual buprenorphine (SL-BUP) (Lee JD et al, JAMA Netw Open 2021;4(9):e2123032; see CATR Sept/Oct 2022). But what does XR-BUP treatment look like outside of an RCT in a real-world correctional setting?

In the current study, researchers reviewed medical and correctional records to characterize the naturalistic use of XR-BUP at the Rhode Island Department of Corrections (RIDOC) from January 2019 through February 2022. All individuals with OUD incarcerated through RIDOC are offered treatment with XR-BUP, and researchers assessed reasons for use and discontinuation of XR-BUP, reported side effects, and whether users followed up with treatment after release from prison. 

Of 2,178 individuals taking MOUD, only 54 (96% male, 80% White) received XR-BUP. How well did these patients tolerate this medication? Sixty-one percent reported at least one side effect (average = 2.8 side effects), the most common being gastrointestinal, fatigue, and injection site pain/bruising. Nonetheless, 58% of individuals who chose to switch to XR-BUP (n = 29/50) preferred it to their previous medication (methadone or SL-BUP). The rate of treatment engagement after release was high. A total of 70% of those on XR-BUP (n = 23/33) received a form of MOUD in the community: either XR-BUP (n = 10) or another MOUD (n = 13).

The researchers identified several study limitations, including small sample size, a single study site limiting generalizability, nonrandom treatment arms, and limited data on post-release clinical outcomes. It’s also important to note that this study enrolled inmates from both jails and prisons, which can be comprised of substantially different populations. Unlike RIDOC, most facilities tend to be a jail or a prison, but not both, raising some questions about generalizability.

CARLAT TAKE

Though the overall number of participants was small, this study adds to the emerging evidence base that XR-BUP is feasible and effective in correctional settings. By addressing patient preference and diversion concerns, XR-BUP is a long-acting and potentially lifesaving MOUD option for this vulnerable population.