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. 2022 Mar 1:232:109291.
doi: 10.1016/j.drugalcdep.2022.109291. Epub 2022 Jan 11.

Changes in the availability of medications for opioid use disorder in prisons and jails in the United States during the COVID-19 pandemic

David Dadiomov  1 , Rebecca Trotzky-Sirr  2 , Andrew Shooshtari  3 , Dima M Qato  4
Affiliations

Changes in the availability of medications for opioid use disorder in prisons and jails in the United States during the COVID-19 pandemic

David Dadiomov et al. Drug Alcohol Depend. .

Abstract

Background: During the COVID-19 pandemic, federal agencies relaxed buprenorphine prescribing restrictions including for incarcerated individuals. The impact of COVID-19 on the supply of MOUD in U.S. prisons and jails is not known.

Methods: We used cross-sectional national monthly data from the IQVIA National Sales Perspective (NSP) for the total volume of medicines supplied to city, county and state prisons and jails and other types of institutional facilities in the U.S. We measured the total monthly supply (or volume) as extended units (EUs) for MOUDs overall and by type. We used interrupted time series analysis to evaluate changes in monthly volume of MOUDs in prisons and jails and other types of facilities (hospitals, clinics and long-term care) before (January 2018-February 2020) and during the COVID-19 (March 2020-October 2020) pandemic.

Results: The availability of MOUD in jails and prisons increased by 471.3% between January 2018 (52,784 EU) and October 2020 (333,226 EU). This increase was largely driven by increased volume of buprenorphine/naloxone and was not observed in other institutional facilities, including hospitals, clinics and long-term care, and. Specifically, the mean monthly volume of buprenorphine/naloxone at prisons/jails increased every month before the pandemic by 1860 EU (95% CI, 1110-2360). In March 2020, the mean volume of buprenorphine/naloxone increased by 81,930 EU (95% CI, 59,040-104,820) per month, followed by a significant increase of 24,010 EU (95% CI 19,530-28,490) per month during the pandemic vs before the pandemic.

Conclusion: These findings may indicate increased availability of buprenorphine/naloxone, a safe and effective MOUD, in prisons and jails since the start of the COVID-19 pandemic in the U.S. despite previous barriers in its use.

Keywords: Addiction treatment; Buprenorphine; Justice-involved population; Opioid use disorder; Opioids; Pharmacy distribution.

PubMed Disclaimer

Conflict of interest statement

Dr. Qato serves as a paid consultant to Public Citizen’s Health Research Group.

Figures

Fig. 1
Fig. 1
Trends in the Supply of Medications for Opioid Use Disorder Before and During the COVID-19 Pandemic in Prisons and Jails and Other Facilities. No. = number; NSP = National Sales Perspectives™; YoY = Year-over-Year. Monthly supply trends of medications for opioid use disorder by facility type from January 2018 through October 2020 are displayed in Panel A. Supply volume is reported in extended units, measured by the number of tablets or capsules for oral products and volume in milliliters for liquid products. The secondary y-axis amplifies low-use facility types which includes prisons and jails, home health care, and all other miscellaneous facility types (Universities and non-VA federal facilities). Panel B displays the YoY percent change in supply from January 2019 through October 2020 by month, determined by the difference in product supply in a given month and the supply in the same month the year prior. All other category includes other facilities such as federal facilities and miscellaneous universities.
Fig. 2
Fig. 2
Trends in the Distribution of Medications for Opioid Use Disorder (MOUD) by Specific Medication in U.S. Prisons - January 2018 to October 2020. NSP = National Sales Perspectives; MOUD = medications for opioid use disorder. Data spans from January 2018 to October 2020. Monthly supply trends of MOUDs at U.S. prisons and jails from January 2018 to October 2020. Supply volume is reported in extended units, measured by the number of tablets or capsules for oral products and volume in milliliters for liquid products. The primary (left) y axis represents the number of extended units, in thousands, for specific MOUDs, while the total number of extended units for all MOUDs are charted on the secondary y-axis (right-axis). Using simple linear regression, buprenorphine, naltrexone, and overall MOUDs increased significantly annually from 2018 to 2020.
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