Bridging the gap: Post-release outcome evaluation of the first jail-based telemedicine buprenorphine program.

Abstract

Release from incarceration poses significant risk for opioid-associated overdose. Treatment engagement with medications for opioid use disorder prior to community release is an effective overdose mitigation strategy. But this evidence-based intervention is infrequently implemented in rural jails, a gap that can be addressed with the use of telemedicine. The aim of this study was to evaluate a novel telemedicine buprenorphine (tele-buprenorphine) treatment program for incarcerated people diagnosed with moderate-to-severe opioid use disorder (OUD). We conducted a retrospective chart review of data collected from discharged patients who were enrolled in a rural jail-based telemedicine buprenorphine treatment between 4/26/2021-12/17/2022. Outcome measures included community buprenorphine treatment engagement at two weeks following release from jail (primary) and fatal and/or non-fatal overdose events occurring within two weeks of release from jail (secondary). A total of 151 incarcerated patients were enrolled in the tele-buprenorphine program, 98.7 % (n = 149) of whom remained in buprenorphine treatment throughout custody. Of these 149 patients, six were provided with extended-release buprenorphine prior to release, and 23 were transferred to another jail. Of the 120 patients who were discharged into the community, 78 % (n = 93) were engaged in buprenorphine treatment within the two weeks following release. Significantly more people in this group (75 %) received bridge buprenorphine prescription prior to release. These first-of-its-kind data suggest that like in-person jail-based buprenorphine provision, tele-buprenorphine may increase community treatment engagement and possibly prevent opioid overdose and fatality. This report provides proof-of-concept justification for a unique clinical implementation model that warrants wider adoption and evaluation.