Faculty Bibliography

BACKGROUND:Correctional facilities increasingly offer medications for opioid use disorder (OUD), including buprenorphine. Nevertheless, retention in treatment post-incarceration is suboptimal and overdose mortality remains high. Our objectives were to understand how incarcerated patients viewed buprenorphine treatment and identify modifiable factors that influenced treatment continuation post-release. METHODS:We conducted semi-structured interviews with 22 men receiving buprenorphine treatment in an urban jail. Interviews were audio recorded, professionally transcribed, and analyzed using a grounded-theory approach. Team members constructed preliminary case memos from transcripts, and then interactively discussed themes within respective memos. We established participant 'typologies' by consensus. RESULTS:Distinct typologies emerged based on participants' post-release treatment goals: (1) those who viewed buprenorphine treatment as a cure for OUD; (2) those who thought buprenorphine would help manage opioid-related problems; and (3) those who did not desire OUD treatment. Participants also described common social structural barriers to treatment continuation and community re-integration. Participants reported that post-release housing instability, unemployment, and negative interactions with parole contributed to opioid use relapse and re-incarceration. CONCLUSION:Participants had different goals for post-release buprenorphine treatment continuation, but their prior experiences suggested that social structural issues would complicate these plans. Incarceration can intensify marginalization, which when combined with heightened legal supervision, reinforced cycles of release, relapse, and re-incarceration. Participants valued buprenorphine treatment, but other structural and policy changes will be necessary to reduce incarceration-related inequities in opioid overdose mortality.

Formerly incarcerated persons (FIPs) face a disproportionate risk of death and serious illness in the immediate post-release period. Therefore, it is a critical time to initiate community-based care for chronic illnesses and behavioural disorders. Little is known about the unique transitional health and social support needs of FIPs in Louisiana, which has the highest incarceration rate in the world. As the average age of prisoners in the United States rises, the release of older prisoners with chronic conditions will become increasingly common. The aim of this study was to explore the healthcare experiences of FIPs in Louisiana in order to inform delivery of services tailored to this population. This research was done in partnership with a community organisation that advocates for restoration of voting rights to FIPs and helps newly released individuals transition back into society. This organisation identified FIPs in the Greater New Orleans area, and from January to May 2015, we conducted 24 semi-structured, in-person, audio-recorded interviews at the community organisation's transitional living facility. The interviews assessed FIPs' experiences with and barriers to receiving healthcare during and after incarceration. These discussions also explored FIPs' desires for services and attitudes towards health and healthcare. Interviews were transcribed and independently coded by two researchers. Interviewees reported negative experiences with healthcare during incarceration, and limited health guidance during the pre-release process. Post-release concerns included lack of insurance, difficulty accessing care and medication, and interest in learning about healthy lifestyles. Results suggest a need for a formalised system of transitional healthcare for FIPs. Findings are being used to inform a pilot transitional care clinic in New Orleans, Louisiana.