# Retention on Buprenorphine for Opioid Use Disorder in Justice-Involved Individuals: A Retrospective Cohort Study

## TL;DR

This study found that individuals involved with the criminal justice system had similar retention rates on buprenorphine treatment for opioid use disorder as others, when provided low-barrier services.

## Contribution

The study provides new evidence on MOUD retention among justice-involved individuals using a low-barrier outpatient program.

## Key findings

- CJS-involved individuals had similar 180-day retention rates (38%) as non-CJS individuals on buprenorphine/naloxone.
- Behavioral health sessions were strongly associated with longer retention (10.81 days/session).
- CJS participants reported earlier substance use initiation and higher heroin/injection drug use.

## Abstract

Criminal justice system (CJS) involvement is common among individuals with opioid use disorder (OUD), yet limited research examines retention in medications for OUD (MOUD) within community settings. This study assessed whether CJS involvement predicted retention on buprenorphine/naloxone and explored related demographic and clinical factors. A retrospective cohort included adults (n = 367) enrolled in a low-barrier outpatient MOUD program in Texas (January 2022–April 2024). CJS involvement was identified from program records. Retention was measured as the number of continuous days with buprenorphine/naloxone prescriptions. Analyses used univariate tests, logistic regression, and nonparametric kernel regression. Nearly one-quarter (24.8%) were CJS-involved. Retention at 180 days was similar between CJS and non-CJS groups (38%). CJS participants initiated substance use earlier and reported higher heroin and injection drug use. Behavioral health sessions were associated with both CJS involvement (OR = 1.10, p ≤ 0.001) and longer retention (β = 10.81 days/session, p = 0.001). With comprehensive, low-barrier services, individuals involved with CJS achieved MOUD retention comparable to their peers. Early behavioral health engagement was a strong predictor of retention, suggesting a key intervention point to enhance outcomes and advance equity for justice-involved populations.