• Alexandria Macmadu, Joëlla W Adams, S E Bessey, Lauren Brinkley-Rubinstein, Rosemarie A Martin, Jennifer G Clarke, Traci C Green, Josiah D Rich, and MarshallBrandon D LBDLDepartment of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA. Electronic address: brandon_marshall@brown.edu..
• Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA.
• Int. J. Drug Policy. 2021 May 1; 91: 102841.

BackgroundWe examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality.MethodsWe developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD).ResultsIn the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively.ConclusionsExpanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.Copyright © 2020. Published by Elsevier B.V.

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