title: Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder.
abstract: BACKGROUND
  The United States has the highest rate of incarceration in the world (937 per 100,000 adults). Approximately one-third of heroin users pass through correctional facilities annually. Few receive medication assisted treatment (MAT; either methadone or buprenorphine) for opioid use disorder during incarceration, and nearly three-quarters relapse to heroin use within 3 months of release. This qualitative study investigated barriers to and facilitators of buprenorphine maintenance treatment (BMT) following release from incarceration ("re-entry").
  
  
  METHODS
  We conducted 21 semistructured interviews of former inmates with opioid use disorder recruited from addiction treatment settings. Interviews were audio-recorded, transcribed, and analyzed using a grounded theory approach. Themes that emerged upon iterative readings of transcripts were discussed by the research team.
  
  
  RESULTS
  Participants reported adverse re-entry conditions, including persistent exposure to drug use and stressful life events, which were perceived to contribute to opioid relapse and affected addiction treatment decisions during re-entry. Themes that emerged relating to BMT included: 1) reliance on willpower; 2) fear of dependency on medications; 3) variable exposure to buprenorphine; and 4) acceptability of BMT following relapse. Willpower was perceived to be more important for recovery than medications. Many participants experienced painful withdrawal from methadone during incarceration and were fearful that using MAT would lead to opioid tolerance and painful withdrawal again in the future. Participants reported both positive and negative experiences taking illicit buprenorphine, which affected interest in BMT. Overall, BMT was perceived to be a good treatment option for opioid use disorder that could reduce the risk of re-incarceration.
  
  
  CONCLUSIONS
  BMT was perceived to be acceptable, but former inmates with opioid use disorder may be reluctant to utilize BMT upon re-entry. Factors limiting utilization of BMT could be mitigated though policy change or interventions. Policies of the criminal justice system (e.g., forced detoxification) may be dissuading former inmates from utilizing effective treatments for opioid use disorder. Interventions that improve education and access to BMT for former inmates with opioid use disorder could facilitate entrance into treatment. Both policy changes and interventions are urgently needed to reduce the negative consequences of opioid relapse following re-entry.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, 10461, USA. adfox@montefiore.org.|Montefiore Medical Center, Bronx, NY, 10467, USA. adfox@montefiore.org.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Fox
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, 10461, USA. jmaradia@montefiore.org.
authors.forename: Jeronimo
authors.initials: J
authors.lastname: Maradiaga
authors.affiliation: New York Academy of Medicine, New York, NY, 10029, USA. Lweiss@nyam.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Weiss
authors.affiliation: Montefiore Medical Center, Bronx, NY, 10467, USA. jennsanc@montefiore.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sanchez
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, 10461, USA. jostarre@montefiore.org.|Montefiore Medical Center, Bronx, NY, 10467, USA. jostarre@montefiore.org.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Starrels
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, 10461, USA. ccunning@montefiore.org.|Montefiore Medical Center, Bronx, NY, 10467, USA. ccunning@montefiore.org.
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006040:Goals; D006556:Heroin Dependence / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology*; D011329:Prisoners / Q000523:psychology*; D036301:Qualitative Research; D044469:Racial Groups; D012008:Recurrence; D020377:Self Efficacy; D014481:United States
chemical_list: D002047:Buprenorphine