Changing patterns and predictors of opioid use disorder and treatment of adults released from state detention in Pennsylvania

Introduction

There is increased effort among states to enhance access to pharmacological treatment, a best practice for those diagnosed with opioid use disorder (OUD), within carceral settings to lower risk of overdose fatalities after release. This study examines trends in OUD and medications for opioid use disorder (MOUD) received by individuals released from state correctional institutions (SCIs) in Pennsylvania.

Methods

Using prison data, this retrospective cohort study analyzes annual rates of substance use disorder by sub-type, focusing specifically on OUD and subsequent treatments, among adults (≥18 years) released between 2014 and 2022 (n = 134,781). Changes in rates were evaluated using Cochran-Armitage tests, while logistic regression models identified predictive factors for OUD and treatment received before release.

Results

From 2014 to 2022, the prevalence of OUD in Pennsylvania SCIs increased from 16.6 % to 25.2 % (p < .0001) and pharmacological engagement rose from 0.0% to 22.6% (p < .0001), especially for buprenorphine (0.0% to 15.7%; p < .0001). This occurred alongside reduced rates of behavioral health services, which dropped from 69.6 % to 41.9 % (p < .0001), and a decline in OUD prevalence in later years. Predictive factors for OUD and MOUD included being female, white, released in later years, and being younger, specifically in late 20s or early 30s.

Conclusion

The use of pharmacological treatment, particularly buprenorphine, has increased, while behavioral health services have declined for those released from PA SCIs with an OUD, with varying levels of OUD presence and demographic variations in its provision. This highlights the progress of MOUD expansions and reveals too that further improvements are necessary to meet treatment need to assist in recovery and reintegration into society.