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Stopka TJ, Rottapel R, Friedmann PD, Pivovarova E, Evans EA. Perceptions of extended-release buprenorphine among people who received medication for opioid use disorder in jail: a qualitative study. Addict Sci Clin Pract 2024; 19:68. [PMID: 39267138 PMCID: PMC11395844 DOI: 10.1186/s13722-024-00486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 07/08/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Incarceration provides an opportunity for health interventions, including opioid use disorder (OUD) treatment and prevention of opioid-related overdoses post-release. All FDA-approved forms of medication for OUD (MOUD) treatment were mandated in several Massachusetts jails in 2019, with some jails offering extended-release buprenorphine (XR-Bup). Little is known about patient perspectives on and experiences with XR-Bup in carceral settings. METHODS We conducted semi-structured interviews in 2022 with community-dwelling people who received MOUD during a recent incarceration in a Massachusetts jail. We asked participants about their experiences with and perspectives on XR-Bup while in jail. Qualitative data were double-coded deductively and reviewed inductively to identify emergent themes, which were structured using the Theoretical Framework of Acceptability (TFA). RESULTS Participants (n = 38) had a mean age of 41.5 years, were 86% male, 84% White, 24% Hispanic, and 95% continued to receive MOUD at the time of their interview, including 11% receiving XR-Bup. Participants who viewed XR-Bup favorably appreciated avoiding the taste of sublingual buprenorphine; avoiding procedural difficulties and indignities associated with daily dosing in carceral settings (e.g., mouth checks, stigmatizing treatment from correctional staff); avoiding daily reminders of their addiction; experiencing less withdrawal; having extra time for other activities, such as work; and reduction of diversion of MOUD within the jail setting. Participants who viewed XR-Bup less favorably preferred to maintain their daily dosing routine; liked daily time out of their housing unit; wanted to know what was "going into my body everyday"; and feared needles and adverse events. Participants also reported that jail clinicians used XR-Bup for patients who were previously caught diverting sublingual buprenorphine, suggesting limited patient participation in decision-making around XR-Bup initiation in some jails. CONCLUSION People who received MOUD in Massachusetts jails had both favorable and unfavorable views and experiences with XR-Bup. Understanding these preferences can inform protocols in jails that are considering implementation of XR-Bup treatment.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Rebecca Rottapel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Peter D Friedmann
- Office of Research, University of MA Chan Medical School - Baystate and Baystate Health, Springfield, MA, USA
| | - Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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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.
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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
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Volkow ND. Drugs and Addiction Science: NIDA Celebrates 50 Years of Research and Looks to the Future. Am J Psychiatry 2024; 181:349-352. [PMID: 38706329 DOI: 10.1176/appi.ajp.20230880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
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Marotta P, Hass A, Viera A, Doernberg M, Barbour R, Grau LE, Heimer R. Technical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014-2018. Subst Abuse Treat Prev Policy 2023; 18:43. [PMID: 37420271 PMCID: PMC10329353 DOI: 10.1186/s13011-023-00541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND We investigated the interaction between arrests for technical violations vs. receiving new charges with receiving community-based methadone treatment on time-to reincarceration (TTR) in a cohort of men with opioid use disorder (OUD) released from custody from two Connecticut jails from 2014 to 2018. METHODS Hazard ratios (HR) were estimated for time to reincarceration for technical violations/infractions, misdemeanors only, felonies only, and both misdemeanors and felonies after adjusting for age, race/ethnicity, and receiving methadone treatment during incarceration or in the community following release. Moderation analyses tested the hypotheses that the benefits of receiving methadone in jail or the community on TTR were significantly different for people with only technical violations and infractions compared to misdemeanor and felony charges. RESULTS In the sample of 788 men who were reincarcerated, 29.4% received technical violations with no new charges (n = 232) with the remainder of the sample receiving new charges consisting of 26.9% new misdemeanor charges, 6.5% felony charges, and 37.2% both felony and misdemeanor charges. Compared to men who received new misdemeanor charges, TTR was significantly shorter among those who received technical violations and infractions with no new charges amounting to a 50% increase in TTR (334.5 days, SD = 321.3 vs. 228.1 days, SD = 308.0, p < 0.001; aHR = 1.5, 95% CI = 1.3, 1.8, p < 0.001). TTR of men who resumed methadone and were charged with a new crime was 50% longer than those who resumed methadone and received technical violations/infractions with no new charges. (230.2 days, SD = 340.2 vs. 402.3 days, SD = 231.3; aHR = 1.5, 95%CI = 1.0, 2.2, p = 0.038). CONCLUSIONS Reducing technical violations may enhance the benefits of providing community-based methadone following release from incarceration on extending the time between incarcerations during the vulnerable time post-incarceration and reduce the burden on correctional systems.
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Affiliation(s)
- Phillip Marotta
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO USA
| | - Alissa Hass
- Indiana University School of Medicine, Bloomington, USA
| | - Adam Viera
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Molly Doernberg
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Russell Barbour
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Lauretta E. Grau
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Robert Heimer
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
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Martin NK, Beletsky L, Linas BP, Bayoumi A, Pollack H, Larney S. Modeling as Visioning: Exploring the Impact of Criminal Justice Reform on Health of Populations with Substance Use Disorders. MDM Policy Pract 2023; 8:23814683231202984. [PMID: 37841498 PMCID: PMC10568988 DOI: 10.1177/23814683231202984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/20/2023] [Indexed: 10/17/2023] Open
Abstract
In the context of historic reckoning with the role of the criminal-legal system as a structural driver of health harms, there is mounting evidence that punitive drug policies have failed to prevent problematic drug use while fueling societal harms. In this explainer article, we discuss how simulation modeling provides a methodological framework to explore the potential outcomes (beneficial and harmful) of various drug policy alternatives, from incremental to radical. We discuss potential simulation modeling opportunities while calling for a more active role of simulation modeling in visioning and operationalizing transformative change. Highlights This article discusses opportunities for simulation modeling in projecting health and economic impacts (beneficial and harmful) of drug-related criminal justice reforms.We call on modelers to explore radical interventions to reduce drug-related harm and model grand alternative futures in addition to more probable scenarios, with a goal of opening up policy discourse to these options.
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Affiliation(s)
- Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
- School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, USA
| | | | - Ahmed Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Harold Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
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Cartus AR, Goedel WC, Jent VA, Macmadu A, Pratty C, Hallowell BD, Allen B, Li Y, Cerdá M, Marshall BDL. Neighborhood-level association between release from incarceration and fatal overdose, Rhode Island, 2016-2020. Drug Alcohol Depend 2023; 247:109867. [PMID: 37084507 PMCID: PMC10198932 DOI: 10.1016/j.drugalcdep.2023.109867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/23/2023]
Abstract
The association between recent release from incarceration and dramatically increased risk of fatal overdose is well-established at the individual level. Fatal overdose and. arrest/release are spatially clustered, suggesting that this association may persist at the neighborhood level. We analyzed multicomponent data from Rhode Island, 2016-2020, and observed a modest association at the census tract level between rates of release per 1000 population and fatal overdose per 100,000 person-years, adjusting for spatial autocorrelation in both the exposure and outcome. Our results suggest that for each additional person released to a given census tract per 1000 population, there is a corresponding increase in the rate of fatal overdose by 2 per 100,000 person years. This association is more pronounced in suburban tracts, where each additional release awaiting trial is associated with an increase in the rate of fatal overdose of 4 per 100,000 person-years and 6 per 100,000 person-years for each additional release following sentence expiration. This association is not modified by the presence or absence of a licensed medication for opioid use disorder (MOUD) treatment provider in the same or surrounding tracts. Our results suggest that neighborhood-level release rates are moderately informative as to tract-level rates of fatal overdose and underscore the importance of expanding pre-release MOUD access in correctional settings. Future research should explore risk and resource environments particularly in suburban and rural areas and their impacts on overdose risk among individuals returning to the community.
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Affiliation(s)
- Abigail R Cartus
- Department of Epidemiology, Brown University School of Public Health, United States
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Victoria A Jent
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Claire Pratty
- Department of Epidemiology, Brown University School of Public Health, United States
| | | | - Bennett Allen
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, United States
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, United States; Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, United States.
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Hoffman KA, Thompson E, Gaeta Gazzola M, Oberleitner LMS, Eller A, Madden LM, Marcus R, Oberleitner DE, Beitel M, Barry DT. "Just fighting for my life to stay alive": a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories. Addict Sci Clin Pract 2023; 18:16. [PMID: 36944998 PMCID: PMC10031976 DOI: 10.1186/s13722-023-00377-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND During the period of community re-entry immediately following release from jail or prison, individuals with opioid use disorder (OUD) face structural barriers to successful re-entry and high risk of overdose. Few published studies investigate experiences in the immediate period (i.e., first 24 h) of re-entry among people with OUD. AIM To understand the barriers and facilitators to treatment and reintegration of people with OUD during the initial transition from carceral settings back into the community. METHODS From January-December 2017, we conducted 42 semi-structured qualitative interviews with patients with a history of incarceration who were receiving methadone at a not-for-profit, low-barrier opioid treatment program. Interviews probed participants' community re-entry experiences immediately following incarceration. Interviews were transcribed and analyzed using a Thematic Analysis approach. RESULTS The main themes described the experiences during the 24 h following release, reacclimating and navigating re-entry barriers, and re-entry preparedness and planning. Participants noted the initial 24 h to be a period of risk for returning to substance use or an opportunity to engage with OUD treatment as well as a tenuous period where many lacked basic resources such as shelter or money. When discussing the subsequent re-entry period, participants noted social challenges and persistent barriers to stable housing and employment. Participants overall described feeling unprepared for release and suggested improvements including formal transition programs, improved education, and support to combat the risk of overdose and return to substance use after incarceration. CONCLUSIONS In this study that qualitatively examines the experiences of people with incarceration histories and OUD enrolled in methadone treatment, we found that participants faced many barriers to community re-entry, particularly surrounding basic resources and treatment engagement. Participants reported feeling unprepared for release but made concrete suggestions for interventions that might improve the barriers they encountered. Future work should examine the incorporation of these perspectives of people with lived experience into the development of transition programs or re-entry classes.
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Affiliation(s)
- Kim A Hoffman
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
- APT Foundation, New Haven, CT, USA.
| | - Emma Thompson
- APT Foundation, New Haven, CT, USA
- Rutgers New Jersey Medical School, Rutgers, Newark, NJ, USA
| | - Marina Gaeta Gazzola
- APT Foundation, New Haven, CT, USA
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Lindsay M S Oberleitner
- APT Foundation, New Haven, CT, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Anthony Eller
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ruthanne Marcus
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David E Oberleitner
- APT Foundation, New Haven, CT, USA
- Department of Psychology, University of Bridgeport, Bridgeport, CT, USA
| | - Mark Beitel
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Stopka TJ, Rottapel RE, Ferguson WJ, Pivovarova E, Toro-Mejias LD, Friedmann PD, Evans EA. Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103803. [PMID: 35965159 PMCID: PMC10117037 DOI: 10.1016/j.drugpo.2022.103803] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People released from jail are at elevated opioid overdose risk. Medications for opioid use disorder (MOUD) are effective in reducing overdoses. MOUD treatment was recently mandated in seven Massachusetts jails, but little is known about barriers and facilitators to treatment continuity post-release. We aimed to assess MOUD provider perspectives on treatment continuity among people released from jail. METHODS We conducted qualitative interviews with 36 medical, supervisory, and administrative staff at MOUD programs that serve jail-referred patients. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide development of instruments, codes, and analyses. We employed deductive and inductive coding, and a grounded theory analytical approach to identify salient themes. RESULTS Inner context findings highlighted necessary adjustments among jail staff to approve MOUD treatment, especially with agonist medications that were previously considered contraband. Participants perceived that some staff within jails favored abstinence-based recovery, viewing agonists as a crutch. Bridging results highlighted the importance of inter-agency communication and coordination to ensure information transfer for seamless treatment continuity in the community post-release. Pre-release planning, release on pre-scheduled dates, medication provision to cover gaps between jail release and intake at community MOUD sites, and exchange of treatment information across agencies were viewed as paramount to success. Unexpected early releases and releases from court were viewed as barriers to treatment coordination. Outer context domains were largely tied to social determinants of health. Substantial barriers to treatment continuity included shelter, food security, employment, transportation, and insurance reactivation. CONCLUSION Through qualitative interviews with community-based MOUD staff, we identified salient barriers and facilitators to treatment continuity post-release from jails. Findings point to needed investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to continuity, and decreasing opioid overdose deaths during this high-risk transition.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States.
| | - Rebecca E Rottapel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Lizbeth Del Toro-Mejias
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, United States
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Dauria EF, Kulkarni P, Clemenzi-Allen A, Brinkley-Rubinstein L, Beckwith CG. Interventions Designed to Improve HIV Continuum of Care Outcomes for Persons with HIV in Contact with the Carceral System in the USA. Curr HIV/AIDS Rep 2022; 19:281-291. [PMID: 35674879 PMCID: PMC9175158 DOI: 10.1007/s11904-022-00609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe existing evidence and identify future directions for intervention research related to improving HIV care outcomes for persons with HIV involved in the carceral system in the USA, a population with high unmet HIV care needs. RECENT FINDINGS Few recent intervention studies focus on improving HIV care outcomes for this population. Successful strategies to improve care outcomes include patient navigation, substance use treatment, and incentivizing HIV care outcomes. Technology-supported interventions are underutilized in this population. Notable gaps in the existing literature include intervention research addressing HIV care needs for cisgender and transgender women and those under carceral supervision in the community. Future research should address existing gaps in the literature and respond to emergent needs including understanding how the changing HIV care delivery environment resulting from the COVID-19 pandemic and the approval of new injectable ART formulation shape HIV care outcomes in this population.
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Affiliation(s)
- Emily F Dauria
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Priyanka Kulkarni
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine and Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Curt G Beckwith
- Alpert Medical School, Division of Infectious Diseases/Department of Medicine, Brown University, Providence, RI, USA
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Will J, Abare M, Olson M, Chyorny A, Wilhelm-Leen E. Emergency department utilization by individuals with opioid use disorder who were recently incarcerated. J Subst Abuse Treat 2022; 141:108838. [PMID: 35868162 DOI: 10.1016/j.jsat.2022.108838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/24/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Individuals with opioid use disorder (OUD) are highly represented among the incarcerated population and are frequent utilizers of the emergency department (ED). Medications for opioid use disorder (MOUD) are a recognized treatment option for individuals with OUD. Although the field recognizes the benefits of MOUD, we know little about what mitigating effects MOUD offered in jail might have on post-release ED utilization. METHODS In this retrospective cohort analysis, we searched electronic medical records (EMR) for incarcerations in the Santa Clara County jail between 8/1/2019 and 8/31/2021 for individuals with OUD (N = 4352) and collected demographic and medication administration data for these individuals. Individuals are considered as having received MOUD if they have at least one administration of methadone, naltrexone, or extended release (XR) buprenorphine during their incarceration. We also collected ED visit data from the same EMR for the 28 days following release from the identified incarcerations. Using logistic regression, we compared ED use within 24 h and 28 days for individuals who are incarcerated and treated with MOUD with those not receiving treatment. RESULTS Individuals who received methadone or XR buprenorphine during their incarceration were less likely to present at the 28 days following release than those not receiving treatment, after controlling for age, race, sex assigned at birth, preferred language, and housing status. Most individuals accessing the ED within 28 days of release do so within the first seven days, and the greatest volume occurred in the first 24 h. Individuals released before noon had a lower likelihood of ED presentation within 24 h than those released in the afternoon. CONCLUSIONS Offering methadone and XR buprenorphine to individuals with OUD who are incarcerated is beneficial in mitigating ED utilization within 28 days of release, although further research is needed to understand what other contributing variables, especially those related to follow-up care, could be influencing these results. If possible, release times for individuals could be shifted to the morning to maximize reduction in ED use within 24 h of release. Alternatively, further research should investigate why release times appear to influence ED utilization.
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Affiliation(s)
- John Will
- Santa Clara Valley Health and Hospital Systems, 751 S Bascom Ave., San Jose, CA 95128, USA.
| | - Marce Abare
- Santa Clara Valley Health and Hospital Systems, 751 S Bascom Ave., San Jose, CA 95128, USA.
| | - Mollie Olson
- Santa Clara Valley Health and Hospital Systems, 751 S Bascom Ave., San Jose, CA 95128, USA.
| | - Alexander Chyorny
- Santa Clara Valley Health and Hospital Systems, 751 S Bascom Ave., San Jose, CA 95128, USA.
| | - Emilee Wilhelm-Leen
- Santa Clara Valley Health and Hospital Systems, 751 S Bascom Ave., San Jose, CA 95128, USA
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Chaillon A, Bharat C, Stone J, Jones N, Degenhardt L, Larney S, Farrell M, Vickerman P, Hickman M, Martin NK, Bórquez A. Modeling the population-level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia. Addiction 2022; 117:1338-1352. [PMID: 34729841 PMCID: PMC9299987 DOI: 10.1111/add.15736] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The individual-level effectiveness of opioid agonist treatment (OAT) in reducing mortality is well established, but there is less evidence on population-level benefits. We use modeling informed with linked data from the OAT program in New South Wales (NSW), Australia, to estimate the impact of OAT provision in the community and prisons on mortality and the impact of eliminating excess mortality during OAT initiation/discontinuation. DESIGN Dynamic modeling. SETTING AND PARTICIPANTS A cohort of 49 359 individuals who ever received OAT in NSW from 2001 to 2018. MEASUREMENTS Receipt of OAT was represented through five stages: (i) first month on OAT, (ii) short (1-9 months) and (iii) longer (9+ months) duration on OAT, (iv) first month following OAT discontinuation and (v) rest of time following OAT discontinuation. Incarceration was represented as four strata: (i) never or not incarcerated in the past year, (ii) currently incarcerated, (iii) released from prison within the past month and (iv) released from prison 1-12 months ago. The model incorporated elevated mortality post-release from prison and OAT impact on reducing mortality and incarceration. FINDINGS Among the cohort, mortality was 0.9 per 100 person-years, OAT coverage and retention remained high (> 50%, 1.74 years/episode). During 2001-20, we estimate that OAT provision reduced overdose and other cause mortality among the cohort by 52.8% [95% credible interval (CrI) = 49.4-56.9%] and 26.6% (95% CrI =22.1-30.5%), respectively. We estimate 1.2 deaths averted and 9.7 life-years gained per 100 person-years on OAT. Prison OAT with post-release OAT-linkage accounted for 12.4% (95% CrI = 11.5-13.5%) of all deaths averted by the OAT program, primarily through preventing deaths in the first month post-release. Preventing elevated mortality during OAT initiation and discontinuation could have averted up to 1.4% (95% CrI = 0.8-2.0%) and 3.0% (95% CrI = 2.1-5.3%) of deaths, respectively. CONCLUSION The community and prison opioid agonist treatment program in New South Wales, Australia appears to have substantially reduced population-level overdose and all-cause mortality in the past 20 years, partially due to high retention.
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Affiliation(s)
- Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicola Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) and Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.,National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
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Morse E, Binswanger IA, Taylor E, Gray C, Stimmel M, Timko C, Harris AHS, Smelson D, Finlay AK. Strategies to improve implementation of medications for opioid use disorder reported by veterans involved in the legal system: A qualitative study. J Subst Abuse Treat 2021; 129:108353. [PMID: 34080564 DOI: 10.1016/j.jsat.2021.108353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/07/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Veterans involved in the legal system have a high risk of overdose mortality but limited utilization of medications for opioid use disorder (MOUD). To increase the use of MOUD in Veterans Health Administration (VHA) facilities and reduce overdose mortality, the VHA should incorporate strategies identified by legal-involved veterans to improve quality of care and ensure that their patients' experiences are integrated into care delivery. This study aims to determine strategies to increase use of MOUD from the perspective of legal-involved veterans with a history of opioid use or opioid use disorder (OUD). METHODS Between February 2018 and March 2019, we conducted semistructured interviews with 18 veterans with a history of opioid use or OUD and legal involvement (15 men and 3 women; mean age 41, standard deviation 13, range 28-61). Veterans were from 9 geographically dispersed United States VHA facilities. The study analyzed verbatim transcripts using the framework method. The primary focus was themes that represented legal-involved veteran-identified strategies to improve the use of MOUD. RESULTS The 18 veterans interviewed had legal involvement directly related to their opioid use and most (n = 15; 83%) had previously used MOUD. Veteran-identified strategies to improve access to and use of MOUD included: (1) VHA should provide transportation or telehealth services; (2) legal agencies should increase access to MOUD during incarceration; (3) the VHA should reduce physician turnover; (4) the VHA should improve physician education to deliver compassionate, patient-centered treatment; (5) the VHA should improve veteran education about MOUD; and (6) the VHA should provide social support opportunities to veterans. CONCLUSIONS Legal-involved veterans provided strategies that can inform and expand MOUD to better meet their needs and the treatment needs of all patients with OUD. The VHA should consider incorporating these strategies into care, and should evaluate their impact on patients' experience, initiation of and retention on medications, and overdose rates.
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Affiliation(s)
- Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA.
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA; Colorado Permanente Medical Group, 1835 Franklin St, Denver, CO 80218, USA; Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA.
| | - Emmeline Taylor
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Clinical Psychology, University of Colorado, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, USA.
| | - Caroline Gray
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Matthew Stimmel
- Veterans Justice Programs, U.S. Department of Veterans Affairs (MS), 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1199 Welch Road, Stanford, CA 94304, USA.
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Always Building, Suite M121, 300 Pasteur Drive, Stanford, CA 94305-2200, USA.
| | - David Smelson
- Center for Organization and Implementation Science, Edith Nourse Rogers VA Medical Center, 200 Springs Road, Bedford, MA 01730, USA.
| | - Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; National Center on Homelessness Among Veterans, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
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