Use of non-prescribed buprenorphine in the criminal justice system: Perspectives of individuals recently released from incarceration.

Abstract

Buprenorphine, an effective treatment for opioid use disorder (OUD), remains underutilized in many U.S. jails and prisons. However, use of non-prescribed (i.e., diverted) buprenorphine has been reported in these settings. The current study examined non-prescribed buprenorphine use experiences in correctional and community contexts. The study conducted face-to-face interviews with 300 adults with OUD/opioid misuse and recent incarceration, recruited in Baltimore, MD, and New York, NY (n\xa0=\xa0150 each). Illicit/non-prescribed opioid use during incarceration was reported by 63% of participants; 39% reported non-prescribed buprenorphine. Non-prescribed buprenorphine was considered the most widely available opioid in jails/prisons in both states (81% reported very or somewhat easy to get). The average price of non-prescribed buprenorphine in jail/prison was ~10× higher than in the community (p\xa0<\xa00.001). Participants were more likely to endorse getting high/mood alteration as reasons for using non-prescribed buprenorphine during incarceration, but tended to ascribe therapeutic motives to use in the community (e.g., self-treatment; p\xa0<\xa00.001). Multivariable logistic regression analyses showed that different individual-level characteristics were associated with history of non-prescribed buprenorphine use during incarceration and in the community. Use of non-prescribed buprenorphine during incarceration was associated with younger age (p\xa0=\xa00.006) and longer incarceration history (p\xa0<\xa00.001), while use of non-prescribed buprenorphine in the community was associated with MD recruitment site (p\xa0=\xa00.001), not being married (p\xa0<\xa00.001), prior buprenorphine treatment experience (p\xa0<\xa00.001), and housing situation (p\xa0=\xa00.01). These findings suggest that different dynamics and demand characteristics underlie the use of non-prescribed buprenorphine in community and incarceration contexts, with implications for efforts to expand OUD treatment in correctional settings.