Receiving Buprenorphine for Opioid Use Disorder During Incarceration Decreases Recidivism

Adults with opioid use disorder (OUD) who were released from 2 jails in Massachusetts between 2015 and 2019 were included in this study to examine the effectiveness of medication for OUD in incarcerated individuals.

Individuals with opioid use disorder (OUD) who were offered buprenorphine during incarceration were at decreased risk for recidivism after release from jail. These findings were published in Drug and Alcohol Dependence.

All adults (N=469) with OUD who were released from 2 jails in Massachusetts (Franklin County Sheriff’s Office [FCSO] and Hampshire County House of Corrections [HCHC]) between 2015 and 2019 were included in this study. One-year postrelease recidivism and mortality were associated with whether or not the individual received medications for OUD during incarceration.

The FCSO (n=197) and HCHC (n=272) cohorts were 91.0% and 100% (P <.0001) men, 96.0% and 96.0% were White, 41.0% and 51.0% were first arraigned as a juvenile (P =.03), and 19.0% and 42.0% were sentenced (P <.0001), respectively.

Medications for OUD were only offered at FCSO, in which 86.2% received buprenorphine, 7.1% received naltrexone, and 6.1% received undocumented medications.

Recidivism rates were lower for FCSO (48.2% vs 62.5%; P =.001). Overall, fewer adults released from FCSO were incarcerated (21.3% vs 39.0%; P <.0001), were arraigned (36.0% vs 47.1%; P =.046), or were charged with property-related crimes (9.6% vs 23.2%; P =.001). In addition, those released from FCSO had a longer time to probation violation (mean, 229.4 vs 163.4 days; P =.003).

These trends indicated that release from FCSO associated with decreased risk for any recidivism (adjusted odds ratio [aOR], 0.51; 95% CI, 0.35-0.76; P =.001), arraignment (aOR, 0.67; 95% CI, 0.45-0.99; P =.046), and incarceration (aOR, 0.37; 95% CI, 0.24-0.58; P <.0001).

Similar findings were observed in subgroup analyses.

There were 6 deaths among the FCSO and 8 among the HCHC cohorts occurring at a median time from release of 287.5 and 141.5 days, respectively. The FCSO deaths were caused by overdose (n=2), injury or disease (n=2), and unknown (n=2) causes. The HCHC death were due to overdose (n=5), unknown cause (n=2), and other causes (n=1).

This study could have included some selection bias, as no randomization was performed and receipt of medications for OUD was based on the jail the individuals were sent to.

The study authors concluded, “this natural experiment found substantial reductions in postrelease outcomes among a large sample of individuals with OUD who received buprenorphine in jail compared to those who did not receive medications for OUD. […] In addition to the demonstrated reduction in overdose mortality, the current study provides legislators and correctional officials with compelling evidence that agonist medications for OUD in jail will reduce recidivism.”


Evans EA, Wilson D, Friedmann PD. Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug Alcohol Depend. 2022;231:109254. doi:10.1016/j.drugalcdep.2021.109254