The use of buprenorphine in US jails and prisons has increased by 224-fold, new study shows.
Opioid use disorder (OUD) affects about 15% of the 1.8 million people in prison in the United States. Following their release from prison, these individuals are at a far increased risk of overdosing.
Although pharmacotherapy for OUD has been linked to lower post-incarceration mortality, only around 14% of correctional institutions offered buprenorphine or methadone as of 2018. More municipalities and states have passed rules to provide access to OUD therapy in the last five years, but it’s unclear if this has resulted in an increase in buprenorphine use.
According to Johns Hopkins Medicine’s policy on deidentified data, this cross-sectional study did not qualify as human participant research, hence it was exempt from evaluation by the institutional review board and the requirement to get informed consent.
The study authors followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines.
They estimated the number of jailed people with OUD using previously reported prevalence statistics. They quantified US buprenorphine consumption overall and within correctional settings from June 1, 2016, through May 31, 2021, using data from the National Sales Perspectives (IQVIA).
National Pharmaceutical Sales Perspectives is based on direct measurements of more than 90% of all retail and nonretail pharmaceutical sales from manufacturers and wholesalers to pharmacies, clinics, hospitals, long-term care facilities, federal and state prisons, county and city jails, and juvenile detention centers.
Without regional, prescriber, or patient-specific information, the National Sales Perspectives reports buprenorphine statistics in extended units, with each extended unit equivalent to 1 film, pill, or injection.
As doses of at least 16 mg daily decrease illicit opioid use, they converted sublingual extended units to milligrams of buprenorphine and treated 16 mg as one day of treatment. Regardless of dose, each injection of extended-release buprenorphine was treated within 30 days of treatment.
Buccal, patch and intravenous buprenorphine formulations were omitted since they are not approved for the treatment of OUD. Over a rolling three-month period, the researchers reported the daily mean number of treated persons.
Methadone was not investigated since it is frequently transported to prisons after being sold to community-based opioid treatment programs, and the National Sales Perspectives database does not track these deliveries.
The statistics show buprenorphine use in jails and prisons has surged 224-fold, from 44 people per day in June 2016 to 9841 people per day in May 2021.
The majority of this rise occurred between 2020 and 2021. Buprenorphine use climbed by 53.9 percent nationwide, from 466,781 people in January 2015 to 718,591 people in May 2021, across all retail and nonretail contexts.
Correctional settings accounted for about 1.5 percent of total buprenorphine use in the United States by May 2021.
Buprenorphine was given to an estimated 3.6 percent of the 270,000 jailed people in the United States who had OUD.
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