Improving Care for Opioid Use Disorder in the Criminal-Legal System

Recently, there has been increased alignment of OUD care across the criminal-legal system with the patient-centered American Society of Addiction Medicine guidelines. Whether by choice or through legislation, carceral facilities are increasingly offering FDA-approved medications for OUD (MOUD), which include methadone, buprenorphine, and naltrexone. However, MOUD delivery models and formulations offered vary by facility. The newest formulations on the market are extended-release buprenorphine (XR-BUP). These have been of particular interest to carceral facilities due to the potential benefits associated with prolonged relief from withdrawal symptoms, without the need for daily dosing, including fewer administrative resources, and security incidents, among others. However, XR-BUP is substantially more expensive than most alternative treatment options, and carceral budgets are notoriously limited and rigid.

In a commentary piece for The American Journal of Drug and Alcohol Abuse, Dr. Sean Murphy, professor of population health sciences, discusses the tradeoffs that decision-makers should consider when determining whether to utilize XR-BUP. The costs and downstream benefits associated with MOUD in carceral settings impact not only patients and staff, but also the public, who typically funds healthcare for this population and bears the costs of recidivism. Thus, Dr. Murphy also emphasizes the importance of expanding the limited economic evidence base for XR-BUP in criminal-legal settings. According to Dr. Murphy, “Maximizing the health and well-being of this, or any, population requires the simultaneous consideration of relevant costs and benefits via rigorous economic analyses designed to inform resource allocation decisions at multiple levels.”