Yet, stigma, costs, and preferences for non-narcotic treatments in criminal-legal settings have stalled the implementation of life-saving treatment within the criminal-legal system.
Extended-release naltrexone (XR-NTX), methadone, and buprenorphine-naloxone are three widely studied and evidence-based medications for opioid use disorder. Given the preference for non-narcotic treatments in many carceral settings, XR-NTX is often selected rather than methadone or buprenorphine-naloxone despite its relatively high cost.
In a new study published in the Journal of Substance Abuse Treatment, researchers examined whether the combination of XR-NTX before release and linkage to community-based treatment has the potential to be a cost-effective treatment, compared to a referral to community-based treatment after release only. While there are documented barriers to meeting detoxification requirements before starting XR-NTX, randomized studies have shown XR-NTX to be just as effective as buprenorphine-naloxone among patients who successfully start treatment.
To reduce the health consequences of OUD among incarcerated populations and lower the economic burden of OUD on society, Ali Jalali, lead author, a CHERISH Research Affiliate, and assistant professor of population health science at Weill Cornell Medicine, led a comprehensive economic evaluation with colleagues at Weill Cornell Medicine, the Crime Prevention Research Center, Johns Hopkins University, and the University of Pennsylvania. They compared health economic outcomes of administrating XR-NTX before release plus linkage to community-based care, versus providing only a referral after an individual with OUD is released from incarceration. The incremental cost-effectiveness ratio was the primary measure of cost-effectiveness and was calculated at 12- and 24-week periods. Effectiveness measures included both quality-adjusted life-years (QALYs) and a clinical outcome, time free from opioids, as recommended by guidelines and the team’s own research.