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Randomized Controlled Trial
. 2014 Sep 1:142:33-40.
doi: 10.1016/j.drugalcdep.2014.05.011. Epub 2014 Jun 2.

A randomized controlled trial of prison-initiated buprenorphine: prison outcomes and community treatment entry

Michael S Gordon  1 , Timothy W Kinlock  2 , Robert P Schwartz  3 , Terrence T Fitzgerald  4 , Kevin E O'Grady  5 , Frank J Vocci  6
Affiliations
Randomized Controlled Trial

A randomized controlled trial of prison-initiated buprenorphine: prison outcomes and community treatment entry

Michael S Gordon et al. Drug Alcohol Depend. .

Abstract

Background: Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population.

Methods: This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release.

Results: There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%).

Conclusions: Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.

Keywords: Buprenorphine; Correctional settings; Heroin; Opioid dependence; Opioid use disorder; Prison.

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Conflict of interest statement

Conflict of Interest

Authors Gordon, Kinlock, Schwartz, and Fitzgerald report no conflicts of interest. Drs. Vocci and O’Grady have, in the past, received reimbursement for their time from Reckitt-Benckiser, one of the manufacturers of buprenorphine. This study was supported by an unrestricted, unsolicited investigator initiated request from Reckitt Benckiser Pharmaceuticals, Inc. who had no role in study design; collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. The authors alone are responsible for the content and writing of this manuscript.

Figures

Figure 1
Figure 1
Consort Diagram. B+OTP: Buprenorphine in prison and continued at an Opioid Treatment Program (OTP) B+CHC: Buprenorphine in prison and continued an a Community Health Center (CHC) C+OTP: Counseling only in prison and initiation of buprenorphine at an OTP C+CHC: Counseling only in prison and initiation of buprenorphine at a CHC 1 participant was randomized prior to the prison closure 2 participant mispresented opiate use
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