Journal of General Internal Medicine

, Volume 25, Issue 7, pp 670–674 | Cite as

Effect of Incarceration History on Outcomes of Primary Care Office-based Buprenorphine/Naloxone

  • Emily A. Wang
  • Brent A. Moore
  • Lynn E. Sullivan
  • David A. Fiellin
Original Article



Behaviors associated with opioid dependence often involve criminal activity, which can lead to incarceration. The impact of a history of incarceration on outcomes in primary care office-based buprenorphine/naloxone is not known.


The purpose of this study is to determine whether having a history of incarceration affects response to primary care office-based buprenorphine/naloxone treatment.


In this post hoc secondary analysis of a randomized clinical trial, we compared demographic, clinical characteristics, and treatment outcomes among 166 participants receiving primary care office-based buprenorphine/naloxone treatment stratifying on history of incarceration.

Main Results

Participants with a history of incarceration have similar treatment outcomes with primary care office-based buprenorphine/naloxone than those without a history of incarceration (consecutive weeks of opioid-negative urine samples, 6.2 vs. 5.9, p = 0.43; treatment retention, 38% vs. 46%, p = 0.28).


Prior history of incarceration does not appear to impact primary care office-based treatment of opioid dependence with buprenorphine/naloxone. Community health care providers can be reassured that initiating buprenorphine/naloxone in opioid dependent individuals with a history of incarceration will have similar outcomes as those without this history.


buprenorphine/naloxone incarceration primary care jail prison 



This work was supported by a grant from the National Institute on Drug Abuse (NIDA) (R01 DA009803). Dr. Moore is supported by NIDA (K01 DA022398), Dr. Sullivan is a Robert Wood Johnson Physician Faculty Scholar, and Dr. Fiellin is supported by NIDA (R01 DA019511, R01 DA025991, and R01DA020576).

Conflicts of Interest

None of the authors reported any conflicts of interest.


  1. 1.
    Sabol WJ, Couture H. Prison and jail inmates at midyear 2007. Washington DC: US Department of Justice; 2008.Google Scholar
  2. 2.
    The PEW Center on the States. One in 31: the long reach of American corrections. In. Washington, DC; 2009.Google Scholar
  3. 3.
    Office of National Drug Control Policy. Drug Facts-Heroin. Executive Office of the President, ONDCP, 2007. (Accessed at
  4. 4.
    Rich JD, Boutwell AE, Shield DC, et al. Attitudes and practices regarding the use of methadone in US state and federal prisons. J Urban Health. 2005;82:411–419.PubMedGoogle Scholar
  5. 5.
    Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and buprenorphine prescribing and referral practices in US prison systems: Results from a Nationwide Survey. Drug Alcohol Depend 2009Google Scholar
  6. 6.
    Mumola C, Karberg JC. Drug use and dependence, state and federal prisoners. 2006; Washgington DC.Google Scholar
  7. 7.
    Hanlon TE, Nurco DN, Kinlock TW, Duszynski KR. Trends in criminal activity and drug use over an addiction career. Am J Drug Alcohol Abuse. 1990;16:223–238.CrossRefPubMedGoogle Scholar
  8. 8.
    Morrow KM. HIV, STD, and hepatitis risk behaviors of young men before and after incarceration. AIDS care. 2009;21:235–243.CrossRefPubMedGoogle Scholar
  9. 9.
    Binswanger IA, Stern MF, Deyo RA, et al. Release from prison–a high risk of death for former inmates. N Engl J Med. 2007;356:157–165.CrossRefPubMedGoogle Scholar
  10. 10.
    Gore SM, Bird AG, Burns SM, Goldberg DJ, Ross AJ, Macgregor J. Drug injection and HIV prevalence in inmates of Glenochil prison. BMJ. 1995;310:293–296.PubMedGoogle Scholar
  11. 11.
    Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009;301:183–190.CrossRefPubMedGoogle Scholar
  12. 12.
    Diversion and Abuse of Buprenoprhine: A Brief Assessment of Emerging Indicators. Center for Substance Abuse Treatment., 2006 (Accessed February 9, 2010, at
  13. 13.
    Barry DT, Moore BA, Pantalon MV, et al. Patient satisfaction with primary care office-based buprenorphine/naloxone treatment. J Gen Intern Med. 2007;22:242–245.CrossRefPubMedGoogle Scholar
  14. 14.
    Schwartz RP, Kelly SM, O’Grady KE, et al. Attitudes toward buprenorphine and methadone among opioid-dependent individuals. Am J Addict. 2008;17:396–401.CrossRefPubMedGoogle Scholar
  15. 15.
    Travis J. But they all come back: facing the challenges of prisoner reentry. Washington, D.C.: Urban Institute; 2005.Google Scholar
  16. 16.
    van Olphen J, Eliason MJ, Freudenberg N, Barnes M. Nowhere to go: how stigma limits the options of female drug users after release from jail. Subst Abuse Treat Prev Policy. 2009;4:10.CrossRefPubMedGoogle Scholar
  17. 17.
    Schnittker J, John A. Enduring stigma: the long-term effects of incarceration on health. J Health Soc Behav. 2007;48:115–130.CrossRefPubMedGoogle Scholar
  18. 18.
    Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997;38:177–190.CrossRefPubMedGoogle Scholar
  19. 19.
    Cunningham CO, Kunins HV, Roose RJ, Elam RT, Sohler NL. Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians. J Gen Intern Med. 2007;22:1325–1329.CrossRefPubMedGoogle Scholar
  20. 20.
    Fiellin DA, Pantalon MV, Chawarski MC, et al. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med. 2006;355:365–374.CrossRefPubMedGoogle Scholar
  21. 21.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  22. 22.
    McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the addiction severity index. J Subst Abuse Treat. 1992;9:199–213.CrossRefPubMedGoogle Scholar
  23. 23.
    National Commission on Correctional Health Care ed. The health status of soon-to-be-released inmates: a report to congress I & II. 2002.Google Scholar
  24. 24.
    McLellan TA, Zanis D, Incmikoski R, et al. Treatment Service Review (TSR). In: The Center for Studies in Addiction, Department of Psychiatry: Philadelphia VA Medical Center & The University of Pennsylvania; 1989Google Scholar
  25. 25.
    French MT, Roebuck MC, McLellan AT, Sindelar JL. Can the treatment services review be used to estimate the costs of addiction and ancillary services? J Subst Abuse. 2000;12:341–361.CrossRefPubMedGoogle Scholar
  26. 26.
    Hindelang MJ, Hiraschi T, Weis JG. Measuring delinquency. Thousand Oaks, CA: Sage Publications; 1981.Google Scholar
  27. 27.
    Kosten TR, Rounsaville BJ, Kleber HD. Concurrent validity of the addiction severity index. J Nerv Ment Dis. 1983;171:606–610.CrossRefPubMedGoogle Scholar
  28. 28.
    Cacciola JS, Alterman AI, Lynch KG, Martin JM, Beauchamp ML, McLellan AT. Initial reliability and validity studies of the revised treatment services review (TSR-6). Drug Alcohol Depend. 2008;92:37–47.CrossRefPubMedGoogle Scholar
  29. 29.
    Makela K. Studies of the reliability and validity of the addiction severity index. Addiction. 2004;99:398–410. discussion 1–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Bovasso GB, Alterman AI, Cacciola JS, Cook TG. Predictive validity of the addiction severity index’s composite scores in the assessment of 2-year outcomes in a methadone maintenance population. Psychol Addict Behav. 2001;15:171–176.CrossRefPubMedGoogle Scholar
  31. 31.
    Alterman AI, Cacciola JS, Habing B, Lynch KG. Addiction severity index recent and lifetime summary indexes based on nonparametric item response theory methods. Psychol Assess. 2007;19:119–132.CrossRefPubMedGoogle Scholar
  32. 32.
    McDermott PAA, Arthur I, Brown L, Zaballero A, Snider EC, McKay JR. Construct refinement and confirmation for the addiction severity index. Psychol Assess. 1996;8:182–9.CrossRefGoogle Scholar
  33. 33.
    Radloff L. The CES-D Scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  34. 34.
    Knight K, Halcom M, Simpson D. TCU psychosocial functioning motivation scale: manual on psychometric properties. In: Institute for Behavioral Research; Texas Christian University; 1994.Google Scholar
  35. 35.
    Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 1985;39:33–38.CrossRefGoogle Scholar
  36. 36.
    Gordon MS, Kinlock TW, Schwartz RP, O’Grady KE. A randomized clinical trial of methadone maintenance for prisoners: findings at 6 months post-release. Addiction. 2008;103:1333–1342.CrossRefPubMedGoogle Scholar
  37. 37.
    Kinlock TW, Gordon MS, Schwartz RP, Fitzgerald TT, O’Grady KE. A randomized clinical trial of methadone maintenance for prisoners: results at 12 months postrelease. J Subst Abuse Treat. 2009;37:277–285.CrossRefPubMedGoogle Scholar
  38. 38.
    Albizu-Garcia C, Caraballo-Correa G, Hernadez-Viver AD, et al. Buprenorphine-naloxone treatment of pre-release opioid-dependent inmates in Puerto Rico. J Addict Med. 2007;1:126–132.CrossRefGoogle Scholar
  39. 39.
    Magura S, Lee JD, Hershberger J, et al. Buprenorphine and methadone maintenance in jail and post-release: a randomized clinical trial. Drug Alcohol Depend. 2009;99:222–230.CrossRefPubMedGoogle Scholar
  40. 40.
    Becker WC, Fiellin DA, Merrill JO, et al. Opioid use disorder in the United States: insurance status and treatment access. Drug Alcohol Depend. 2008;94:207–213.CrossRefPubMedGoogle Scholar
  41. 41.
    Jones ES, Moore BA, Sindelar JL, O’Connor PG, Schottenfeld RS, Fiellin DA. Cost analysis of clinic and office-based treatment of opioid dependence: results with methadone and buprenorphine in clinically stable patients. Drug Alcohol Depend. 2009;99:132–140.CrossRefPubMedGoogle Scholar
  42. 42.
    Alterman AI, Bovasso GB, Cacciola JS, McDermott PA. A comparison of the predictive validity of four sets of baseline ASI summary indices. Psychol Addict Behav. 2001;15:159–162.CrossRefPubMedGoogle Scholar
  43. 43.
    Thornberry TP, Krohn M. The self report method for measuring delinquency and crime. In: Measurement and Analysis of Crime and Justice. Washington DC: United States Department of Justice; 2000.Google Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Emily A. Wang
    • 1
    • 4
  • Brent A. Moore
    • 2
  • Lynn E. Sullivan
    • 1
    • 4
  • David A. Fiellin
    • 1
    • 3
    • 4
  1. 1.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  2. 2.Department of PsychiatryYale University School of MedicineNew HavenUSA
  3. 3.Investigative Medicine ProgramYale University School of MedicineNew HavenUSA
  4. 4.General Internal MedicineYale University School of MedicineNew HavenUSA

Personalised recommendations