Exploring methods to investigate sentencing decisions

Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study

Background

As opioid overdoses surge, medications for opioid use disorder (MOUD) remain underutilized. MOUD is rarely offered in correctional facilities although individuals involved in the criminal justice system have higher rates of OUD and mortality relative to the general population.

Methods

A retrospective cohort design examined the effect of MOUD while incarcerated on 12 months post-release treatment engagement and retention, overdose mortality, and recidivism. Individuals (N = 1600) who participated in the Rhode Island Department of Corrections (RIDOC) MOUD program (the United States' first statewide program) and were released from incarceration from December 1, 2016, to December 31, 2018, were included. The sample was 72.6% Male (27.4% female) and 80.8% White (5.8% Black, 11.4% Hispanic, 2.0% another race).

Findings

56% were prescribed methadone, 43% buprenorphine, and 1% naltrexone. During incarceration, 61% were continued on MOUD from the community, 30% were inducted onto MOUD upon incarceration, and 9% were inducted pre-release. At 30 days and 12 months post-release, 73% and 86% of participants engaged in MOUD treatment, respectively, and those newly inducted had lower post-release engagement than those who continued from the community. Reincarceration rates (52%) were similar to the general RIDOC population. Twelve overdose deaths occurred during the 12-month follow-up, with only one overdose death during the first two weeks post-release.

Interpretations

Implementing MOUD in correctional facilities, with seamless linkage to community care is a needed life-saving strategy.

Funding

Rhode Island General Fund, the NIH of Health HEAL Initiative, the NIGMS, and the NIDA.

Correctional "Free Lunch"? Cost Neglect Increases Punishment in Prosecutors

Prosecutors can influence judges’ sentencing decisions by the sentencing recommendations they make—but prosecutors are insulated from the costs of those sentences, which critics have described as a correctional “free lunch.” In a nationally distributed survey experiment, we show that when a sample of (n=178) professional prosecutors were insulated from sentencing cost information, their prison sentence recommendations were nearly one-third lengthier than sentences rendered following exposure to direct cost information. Exposure to a fiscally equivalent benefit of incarceration did not impact sentencing recommendations, as predicted. This pattern suggests that prosecutors implicitly value incorporating sentencing costs but selectively neglect them unless they are made explicit. These findings highlight a likely but previously unrecognized contributor to mass incarceration and identify a potential way to remediate it.