Many people who are arrested and brought to jail on Rikers Island in New York City use opioids, and are forced to detox while in jail. Researchers at New York University (NYU) are studying whether providing the opioid-addiction medicine extended-release naltrexone (Vivitrol) to these individuals when they leave jail reduces their risk of relapse and overdose.
“When we launched the study, many people used methadone to detox in jail, but didn’t continue it for maintenance,” said Joshua D. Lee MD, MSc, Associate Professor of Population Health and Medicine/General Internal Medicine and Clinical Innovation at the NYU School of Medicine. “That means they are leaving jail with no maintenance medication, which puts them at great risk of relapse and overdose, as well as HIV and hepatitis C from injection drug use.”
Vivitrol is a monthly injection that blocks the effects of opioids, including pain relief or the feelings of well-being that can lead to opioid misuse. It has no potential for abuse.
“Many people leaving jail think they can stay opiate-free on their own, but the chance of successful recovery without medication-assisted treatment is low,” Dr. Lee said. “If they receive naltrexone, they can either continue using it once they are out of jail, or at least it gives them a month to make arrangements for methadone or buprenorphine.”
The study, funded by the National Institute on Drug Abuse (NIDA), is looking at how people receiving Vivitrol before leaving jail fare in the year or two afterwards in terms of relapse and overdose.
The researchers are comparing 85 people with an opioid use disorder who receive six months of Vivitrol with 85 who don’t receive medication-assisted treatment, but are given counseling and resources to find treatment after they leave jail. The study is also comparing these groups with 85 people who continue on methadone while in jail and after release.
The researchers have been following participants for a year after they are released from jail, but are seeking funding to extend follow-up for an additional year. The study is still recruiting patients. Dr. Lee noted that in New York State, Medicaid covers the cost of medication-assisted treatment, including Vivitrol. He said most people leaving Rikers Island are Medicaid-eligible.
A study published in the New England Journal of Medicine in 2016 studied adult criminal justice offenders who were not currently incarcerated, who received Vivitrol for six months. They were compared with peers who received usual treatment, consisting of brief counseling and referrals for community treatment programs. The study found the 153 participants receiving Vivitrol had a lower rate of relapse than those receiving usual treatment (43 percent vs. 64 percent). There were no overdoses in the Vivitrol group, compared with seven in the usual-treatment group.
Unlike that study, the new study is recruiting participants in a correctional facility. “In the New England Journal study, everyone was in the criminal justice system, but most were on parole. Patients already had to be off opiates, which means they probably were a much healthier population than ours,” Dr. Lee said.
Two other NIDA-funded studies underway also are looking at medication-assisted treatment for people leaving jail. One, being conducted with UCLA and the University of New Mexico, is combining Vivitrol with patient navigation at the Albuquerque, N.M. city jail. Patient navigators help get people to medical appointments, make sure they take their medications, and perform other tasks that help patients be successful in their treatment. The second study, conducted in the Baltimore city jail by the Friends Research Institute, is looking at methadone maintenance for new methadone patients.
“Jails are different from prisons,” Dr. Lee said. “They can involve a short stay, but they have high rates of acute detox, and not much treatment. Through these studies, we hope to show how important local jails can be in dealing with the opiate epidemic.”