1
|
Fredericksen RJ, Mixson LS, Estadt AT, Leichtling G, Bresett J, Zule W, Walters SM, Friedmann PD, Romo E, Whitney BM, Delaney JAC, Crane HM, Tsui JI, Young A, Seal D, Stopka TJ. Barriers to retention in inpatient and residential drug treatment among persons who use opioids and/or injection drugs living in the rural U.S. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209453. [PMID: 39033853 PMCID: PMC11347080 DOI: 10.1016/j.josat.2024.209453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/30/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
AIM Barriers to retention in inpatient and residential care for persons who use drugs are understudied in the rural context. We sought to better understand barriers to retention in inpatient and residential drug treatment in a large, multi-site, geographically diverse sample of persons who use opioids and/or injection drugs in the rural U.S. METHODS We conducted semi-structured individual interviews with persons currently using opioids and/or injection drugs in 9 U.S. states, including Illinois, Kentucky, Massachusetts, North Carolina, New Hampshire, Ohio, Oregon, Vermont, and Wisconsin. Content areas included substance use history and experiences with all modalities of drug treatment. We performed initial structural coding followed by an iterative "open-coding" process of itemizing and categorizing content within each code, and a multi-coder memoing process to summarize themes. We identified themes using three levels of the Social-Ecological Model (SEM): individual, interpersonal, and facility-level (organizational) barriers. RESULTS Among 304 interviewed, over half (n = 166, 54 %) reported having experienced inpatient and residential treatment. Lack of treatment retention was driven by interrelated factors at all levels of the SEM. Person-level factors inhibiting retention included lack of readiness to stop using, which was particularly true for court-ordered treatment, and dislike of "freedom limitations". The sole interpersonal-level factor was the influence of other patients on re-initiation of drug use. Facility-level barriers included unaddressed withdrawal symptoms and lack of access to MOUD, staff relatability, inadequate staff training, and, particularly in residential treatment, lack of structure and supervision. Lack of preparation for coping with real-world triggers was seen as a barrier to engagement in ongoing treatment. CONCLUSION Barriers to retention in inpatient and residential substance use treatment were present at three levels of the SEM. Interviews suggest much room for improvement in inpatient and residential drug treatment programs with respect to improving access to MOUD, tailoring content to better address social challenges in the rural context, and improving quality control measures with respect to staff and resident supervision.
Collapse
Affiliation(s)
- R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA.
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - A T Estadt
- Ohio State University, College of Public Health, Columbus, OH, USA
| | | | - J Bresett
- Southern Illinois University, School of Human Sciences, Carbondale, IL, USA
| | - W Zule
- RTI International, Durham, NC, USA
| | - S M Walters
- New York University, School of Global Public Health, New York, NY, USA
| | - P D Friedmann
- University of Massachusetts, Department of Medicine, Springfield, MA, USA
| | - E Romo
- University of Massachusetts, Clinical and Population Health Research, Springfield, MA, USA
| | - B M Whitney
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J A C Delaney
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - H M Crane
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J I Tsui
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - A Young
- University of Kentucky, Department of Epidemiology, Lexington, KY, USA
| | - D Seal
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - T J Stopka
- Tufts University, Department of Public Health and Community Medicine, Boston, MA, USA
| |
Collapse
|
2
|
Satcher MF, Belenko S, Coetzer-Liversage A, Wilson KJ, McCart MR, Drazdowski TK, Fallin-Bennett A, Zaller N, Schultheis AM, Hogue A, Vest N, Sheidow AJ, Del Pozo B, Watson DP, Hibbard PF, Stevens R, Stein LAR. Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners. HEALTH & JUSTICE 2024; 12:36. [PMID: 39207608 PMCID: PMC11363440 DOI: 10.1186/s40352-024-00291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.
Collapse
Affiliation(s)
- Milan F Satcher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Department of Community & Family Medicine, Dartmouth Health, Lebanon, NH, USA.
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19122, USA
| | | | | | | | | | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, Lexington, KY, USA
- Voices of Hope, Lexington, KY, USA
| | - Nickolas Zaller
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alysse M Schultheis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Aaron Hogue
- Partnership to End Addiction, New York, NY, USA
| | - Noel Vest
- Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Ashli J Sheidow
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, USA
| | - Brandon Del Pozo
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, USA
| | | | - Randy Stevens
- Hope for New Hampshire Recovery, Manchester, NH, USA
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- Department of Behavioral & Social Sciences, Brown University, Providence, RI, USA
- Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, Cranston, RI, USA
| |
Collapse
|
3
|
O'Connor AB, Gelsinger C, Donovan SM, Marshall J, Ahrens KA. Community buprenorphine continuation post-release following extended release vs. sublingual buprenorphine during incarceration: a pilot project in Maine. HEALTH & JUSTICE 2024; 12:28. [PMID: 38940853 PMCID: PMC11212228 DOI: 10.1186/s40352-024-00281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The aim of our study was to evaluate the post-release outcomes of incarcerated individuals with opioid use disorder (OUD) treated with extended-release buprenorphine (XRB) in a rural county jail. Administrative data were collected from a pilot program within a jail in Maine that introduced XRB treatment in 2022 and a comparable jail utilizing sublingual buprenorphine (SLB) during the same period to compare post-release outcomes. Log-binomial regression models were used to estimate the risk ratio (RR) and 95% confidence interval (CI) for jail use of XRB vs. SLB on post-release community buprenorphine continuation. RESULTS From September 2022 to September 2023, 70 individuals who received XRB were released from the pilot jail and 130 individuals who received SLB were released from the comparison jail. After adjusting for age, sex, and buprenorphine use at entry to jail, individuals released from the pilot jail were almost 3 times (adjusted RR = 2.67, 95% CI 1.84, 3.88) as likely to continue community buprenorphine treatment post-release relative to the comparison jail. In addition, utilization of XRB allowed for expanded access to OUD treatment, was well tolerated, and reduced medication diversion. CONCLUSIONS In this pilot program in Maine, XRB treatment during incarceration was associated with higher post-release community buprenorphine continuation when compared to individuals treated with SLB. These findings provide strong evidence for the superiority of XRB vs. SLB for the treatment of OUD in jail settings.
Collapse
Affiliation(s)
- Alane B O'Connor
- Somerset County Jail, 131 E. Madison Rd, Madison, ME, 04950, USA.
| | - Catherine Gelsinger
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Sadie M Donovan
- Somerset County Jail, 131 E. Madison Rd, Madison, ME, 04950, USA
| | - Jessica Marshall
- Somerset County Jail, 131 E. Madison Rd, Madison, ME, 04950, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| |
Collapse
|