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Michener PS, Bianchet E, Fox S, Evans EA, Friedmann PD. "Expected to happen": perspectives on post-release overdose from recently incarcerated people with opioid use disorder. Harm Reduct J 2024; 21:138. [PMID: 39034384 PMCID: PMC11265078 DOI: 10.1186/s12954-024-01055-1] [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: 03/26/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Opioid-related overdose is the leading cause of death for people recently released from incarceration, however treatment with medications for opioid use disorder (MOUD) during incarceration can reduce the mortality risk. This study seeks to qualitatively analyze perceptions of post-release overdose risk from the perspectives of people who received MOUD while incarcerated in one of eight Massachusetts jails during 2021-2022 using the Risk Environment Framework to guide analyses. METHODS N = 38 participants with lived experience of MOUD treatment during incarceration who are now living in the community were interviewed on factors that may contribute to or protect against post-release overdose risk. Themes were identified inductively and deductively using the Risk Environment Framework and its domains, which organizes themes along physical, social, economic, and policy environments on both the micro- and macro- scales. RESULTS The physical risk environment included loss of opioid tolerance during incarceration, polysubstance use, and the toxicity of the regional drug supply as key producers of increased risk for post-release overdose. Social drivers of risk included peer group risk norms-including peer-driven harm reduction practices and interpersonal relationships between drug sellers and buyers-as well as macro-level social determinants of health such as housing insecurity and availability of mental health services. Economic drivers of post-release overdose risk included lack of income generation during incarceration and employment challenges. Participants discussed several aspects of policy that contribute to post-release overdose risk, including availability of harm reduction supplies, public health services, and broader policy around MOUD. CONCLUSIONS The perspectives of people with lived experience are vital to understanding the disproportionate risks of overdose for those recently released from incarceration. Our results highlight the intersectional factors that produce and reproduce the post-release overdose risk environment, providing support for interventions across each domain of the Risk Environment Framework. By capturing perspectives from people with lived experience of OUD and incarceration during this critical period of risk, we can better identify interventions that target and mitigate overdose-related harm in this population.
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Affiliation(s)
- Pryce S Michener
- Population Health Sciences, Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA.
| | - Elyse Bianchet
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
| | - Shannon Fox
- Tufts Medical School, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Elizabeth A Evans
- Dept. of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, 01003, Amherst, MA, USA
| | - Peter D Friedmann
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
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Lim S, Cherian T, Katyal M, Goldfeld KS, McDonald R, Wiewel E, Khan M, Krawczyk N, Braunstein S, Murphy SM, Jalali A, Jeng PJ, Rosner Z, MacDonald R, Lee JD. Jail-based medication for opioid use disorder and patterns of reincarceration and acute care use after release: A sequence analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209254. [PMID: 38072387 PMCID: PMC10947890 DOI: 10.1016/j.josat.2023.209254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Treatment with methadone and buprenorphine medications for opioid use disorder (MOUD) during incarceration may lead to better community re-entry, but evidence on these relationships have been mixed. We aimed to identify community re-entry patterns and examine the association between in-jail MOUD and a pattern of successful reentry defined by rare occurrence of reincarceration and preventable healthcare utilization. METHODS Data came from a retrospective, observational cohort study of 6066 adults with opioid use disorder who were incarcerated in New York City jails and released to the community during 2011-14. An outcome was community re-entry patterns identified by sequence analysis of 3-year post-release reincarceration, emergency department visits, and hospitalizations. An exposure was receipt of in-jail MOUD versus out-of-treatment (42 % vs. 58 %) for the last 3 days before discharge. The study accounted for differences in baseline demographic, clinical, behavioral, housing, and criminal legal characteristics between in-jail MOUD and out-of-treatment groups via propensity score matching. RESULTS This study identified five re-entry patterns: stability (64 %), hospitalization (23 %), delayed reincarceration (7 %), immediate reincarceration (4 %), and continuous incarceration (2 %). After addressing confounding, 64 % and 57 % followed the stability pattern among MOUD and out-of-treatment groups who were released from jail in 2011, respectively. In 2012-14, the prevalence of following the stability pattern increased year-by-year while a consistently higher prevalence was observed among those with in-jail MOUD. CONCLUSIONS Sequence analysis helped define post-release stability based on health and criminal legal system involvement. Receipt of in-jail MOUD was associated with a marker of successful community re-entry.
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Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America.
| | - Teena Cherian
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Monica Katyal
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Keith S Goldfeld
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ryan McDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Maria Khan
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Noa Krawczyk
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, New York, NY, United States of America
| | - Ali Jalali
- Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, New York, NY, United States of America
| | - Zachary Rosner
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Ross MacDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, United States of America
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Graves BD, Fendrich M. Community-based substance use treatment programs for reentering justice-involved adults: A scoping review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100221. [PMID: 38425420 PMCID: PMC10901914 DOI: 10.1016/j.dadr.2024.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
Introduction For adults involved with the criminal justice system who are reentering their communities post-incarceration, there is a large need for community-based substance use treatment. Little is known, however, about the types, availability, and benefits of programs targeting the reentry population in community settings that operate independently from the criminal justice system. Methods We conducted a scoping review of community-based treatment programs for substance use among reentering justice-involved adults to examine the contemporary state of literature and identify research gaps. We searched four databases for peer-reviewed articles conducted in the United States and published between 2017 and 2021. Results The final sample included 58 articles. Interventions varied, but the two most prominent were medications for opioid use disorder (35%) and peer support or social support interventions (22.4%). Studies were more likely to show positive impact on substance use outcomes than criminal justice outcomes. Themes were identified around participant characteristics, treatment delivery, and treatment benefits. Conclusions Findings from this scoping review suggest that the range of evidence-based strategies for substance use treatment targeting the reentry population is growing, but there is a need for additional research that examines implementation, cost effectiveness, and racial/ethnic disparities.
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del Pozo B, Reichert J, Martins K, Taylor B. Police Use of Discretion in Encounters with People with Opioid Use Disorder: a Study of Illinois Police Officers. JOURNAL OF POLICE AND CRIMINAL PSYCHOLOGY 2024; 39:141-156. [PMID: 38617402 PMCID: PMC11008765 DOI: 10.1007/s11896-023-09628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 04/16/2024]
Abstract
Police frequently encounter people with opioid use disorder (OUD), having a profound effect on their risk environment and health outcomes. Officers retain significant discretionary authority in their response to these encounters. To explore the factors that underlie these decisions, we surveyed a sample of Illinois police officers. We administered an online survey to Illinois police departments using a random sampling strategy, stratified by agency size and the rurality of their service areas. Our final sample was 248 police officers from 27 departments. We surveyed officers' beliefs about (1) influences and control over their decision making; (2) the approval of other actors in making referrals to treatment for addiction, and (3) the potential impacts of medication-assisted treatment (MAT). We analyzed the survey data using descriptive statistics and regression analyses. Most officers were highly influenced by the expectations of their supervisors when responding to subjects who appeared to have an OUD, and about half would take direction from addiction treatment providers. Police in urban departments perceived greater support for MAT and were more likely to believe MAT could reduce the need for future arrests. Our findings suggest ways police officers can be influenced to make discretionary decisions that improve the health outcomes of their encounters with people with OUD: (1) Supervisors should serve as champions to promote referrals to treatment for substance use disorders; (2) collaboration between law enforcement and community addiction treatment providers should be strengthened, and (3) MAT should be supported and expanded in rural areas.
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Affiliation(s)
- Brandon del Pozo
- The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA
| | - Jessica Reichert
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, Chicago, USA
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Krawczyk N, Joudrey PJ, Simon R, Russel DM, Frank D. Recent modifications to the US methadone treatment system are a Band-Aid-not a solution-to the nation's broken opioid use disorder treatment system. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad018. [PMID: 38756842 PMCID: PMC10986206 DOI: 10.1093/haschl/qxad018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/18/2024]
Abstract
For 5 decades, US federal regulations have segregated methadone treatment for opioid use disorder from the rest of the health care system, confining its availability to specialty treatment programs that are highly regulated. These regulations have led to severe shortages in the availability of methadone and grave underutilization of this lifesaving medication despite a worsening overdose crisis. In this commentary, we discuss current barriers to methadone in the US opioid treatment system and how recent changes to federal regulations fall short of the reforms needed to significantly expand access to this treatment. Instead, we propose the urgent need to expand methadone to mainstream health care settings by allowing for office-based prescribing and pharmacy dispensing of methadone, the norm in many other developed countries.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Paul J Joudrey
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Rachel Simon
- Departments of Medicine and Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Danielle M Russel
- School of Social Transformation, Arizona State University, Tempe, AZ 85287, United States
| | - David Frank
- NYU School of Global Public Health, New York, NY 10012, United States
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Mansoor M, Foreman-Mackey A, Ivsins A, Bardwell G. Community partner perspectives on the implementation of a novel safer supply program in Canada: a qualitative study of the MySafe Project. Harm Reduct J 2023; 20:61. [PMID: 37118799 PMCID: PMC10144900 DOI: 10.1186/s12954-023-00789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The adulteration of the illicit drug supply with fentanyl and its analogues is driving the ongoing overdose crisis in North America. While various harm reduction interventions address overdose-related risks, there is growing interest in safer supply programs, including the MySafe Project which utilizes a biometric dispensing machine that provides pharmaceutical opioid alternatives to the toxic drug supply. However, the experiences and perspectives of professional community partners on program implementation remain unexplored. This study aims to examine professional community partner perspectives on the feasibility, as well as barriers and facilitators to the implementation of the MySafe program. METHODS Semi-structured qualitative interviews were conducted with 17 professional community partners involved in program implementation across four pilot locations in Canada. Thematic analysis of interviews focused on perspectives on safer supply, barriers and facilitators faced during program implementation, and recommendations to inform future scale-up of low-barrier safer supply models across Canada. RESULTS Participants identified a variety of barriers, including the dependence on clinician buy-in, coupled with regulatory and logistical constraints. In addition, some participants perceived hydromorphone to be an inadequate substitute to the increasingly toxic street opioid supply. Lastly, technical difficulties were described as barriers to service uptake and delivery. Conversely, having political and community buy-in, availability of wrap-around services, and collaborative communication from the MySafe team served as facilitators to program implementation. Though community partners preferred establishing MySafe machines into existing community organizations, they also discussed benefits of housing-based MySafe programs. The potential role of this program in mid-sized to rural cities was also emphasized. CONCLUSIONS To address the overdose crisis, there is an urgent need to implement and evaluate novel solutions that address supply drivers of crisis. Community partner-informed research plays an integral role in ensuring program acceptability and proper implementation. Our findings identify current gaps and facilitators underlying the efficacy of one such model, together with future directions for improvement. Participant recommendations included a diversification of medications offered and types of locations for MySafe programs, a streamlined national approach to prescribing guidelines coupled with more robust training for healthcare professionals, and an emphasis on service delivery within an integrated services model. Our findings underscore a potential gap between the goals of healthcare providers in ensuring comprehensive care and the necessity for low-barrier models such as MySafe that can function both within and outside of integrated service models.
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Affiliation(s)
- Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Annie Foreman-Mackey
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada.
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Waite MR, Heslin K, Cook J, Kim A, Simpson M. Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208933. [PMID: 36805798 DOI: 10.1016/j.josat.2022.208933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. METHODS To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. RESULTS Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. CONCLUSIONS Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.
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Affiliation(s)
- Mindy R Waite
- Advocate Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Jonathan Cook
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Aengela Kim
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; Chicago Medical School, Rosalind Franklin University, 3333 Green Bay Rd, North Chicago, IL 60064, USA.
| | - Michelle Simpson
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; AAH Ed Howe Center for Health Care Transformation, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
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Cates L, Brown AR. Medications for opioid use disorder during incarceration and post-release outcomes. HEALTH & JUSTICE 2023; 11:4. [PMID: 36737503 PMCID: PMC9898706 DOI: 10.1186/s40352-023-00209-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/31/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Continuation or initiation of MOUDs during incarceration could improve post-release outcomes by preventing return to opioid use and reducing risk of overdose. People with OUD involved in the criminal legal system are a vulnerable population, yet little research has comprehensively examined post-release outcomes associated with receiving MOUDs in jail and prison settings. METHODS The authors conducted a review of published peer-reviewed literature on post-release outcomes associated with the use of MOUDs in correctional settings to determine implications for further research and policy. RESULTS Results showed compelling evidence supporting the use of MOUDs for currently incarcerated populations, with almost all studies showing that MOUDs provided during incarceration increased community-based treatment engagement post-release. There is also evidence that initiating or continuing MOUDs during incarceration is associated with decreased opioid use and overdoses post-release, without increasing criminal involvement. CONCLUSIONS Findings indicate that forcing tapering and withdrawal during incarceration can have dire consequences upon release into the community. Initiating or continuing MOUDs during incarceration reduces the risk for opioid use and overdose upon release by maintaining opioid tolerance and increasing community treatment engagement.
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Affiliation(s)
- Lara Cates
- Department of Social Work, Western Carolina University, 3971 Little Savannah Road, Cullowhee, NC 28723 USA
| | - Aaron R. Brown
- College of Social Work, University of Kentucky, 619 Patterson Office Tower, Lexington, KY 40506 USA
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Russell C, Pang M, Nafeh F, Farrell Macdonald S, Derkzen D, Rehm J, Fischer B. Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada. Int J Qual Stud Health Well-being 2022; 17:2094111. [PMID: 35787743 PMCID: PMC9258049 DOI: 10.1080/17482631.2022.2094111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Michelle Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Frishta Nafeh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | | | - Dena Derkzen
- Policy Sector, Research Branch, Correctional Service of Canada, Ottawa, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Haney JL. Treatment interrupted: factors associated with incarceration during opioid use disorder treatment in the United States. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2120431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jolynn L. Haney
- Deerfield Data Management, LLC, Collegeville, Pennsylvania, USA
- Department of Social Work Education, Widener University, Chester, Pennsylvania, USA
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11
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King C, Cook R, Giang LM, Bart G, Hoffman K, Waddell EN, Korthuis PT. Incarceration and compulsory rehabilitation impede use of medication for opioid use disorder and HIV care engagement in Vietnam. J Subst Abuse Treat 2022; 134:108451. [PMID: 33962813 PMCID: PMC8558110 DOI: 10.1016/j.jsat.2021.108451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Non-prescribed opioid use is illegal in Vietnam. People who are apprehended for use of non-prescribed opioids may be arrested and incarcerated or sent to compulsory rehabilitation centers. For those on medication to treat opioid use disorder (MOUD), incarceration in either setting may disrupt treatment. This study estimates the effects of incarceration and compulsory rehabilitation on MOUD and HIV treatment outcomes in Vietnam. METHODS Data are from a clinical trial testing the effects of MOUD on HIV viral suppression in six Vietnamese HIV clinics. Participants were assessed quarterly for 12 months. We assessed the associations between incarceration or compulsory rehabilitation during months 0-9 and study outcomes of receipt of MOUD, HIV clinic engagement, and antiretroviral therapy prescription during months 9-12, among those who were released by month 9 of the study, using logistic regression and zero-inflated negative binomial models. RESULTS At nine months, 25 of 258 participants (9.7%) were incarcerated or sent to compulsory rehabilitation at least once and completed the month 9 assessment. Of those, 19 (76.0%) did not receive MOUD in months 9 through 12. Both incarceration and compulsory rehabilitation were negatively associated with subsequent receipt of MOUD (aOR = 0.05, 95% CI = (0.01, 0.24); 0.14 (0.04, 0.50), respectively) and HIV clinic engagement (aOR = 0.13, 95% CI = (0.03, 0.71); 0.09 (0.02, 0.39), respectively). In the final three months of the study, participants who were incarcerated had 42.5 fewer days of MOUD (95% CI = 23.1, 61.9), and participants in compulsory rehabilitation had 46.1 fewer days of MOUD (95% CI = 33.8, 58.4) than those not incarcerated or in compulsory rehabilitation. CONCLUSION Our findings suggest that both incarceration and compulsory rehabilitation disrupt MOUD and HIV treatment among people with HIV and Opioid Use Disorder in Vietnam. Prioritization of evidence-based strategies to support engagement in care for people who use drugs could potentially expand HIV and Opioid Use Disorder treatment access and curb substance use more effectively than reliance on incarceration or compulsory rehabilitation.
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Affiliation(s)
- Caroline King
- MD/PhD Program, Oregon Health & Science University, Portland, OR, USA; Dept. of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Ryan Cook
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Viet Nam
| | - Gavin Bart
- Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Kim Hoffman
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Needham Waddell
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Medications for opioid use disorder during pregnancy: Access and continuity in a state women's prison facility, 2016-2019. Drug Alcohol Depend 2022; 232:109308. [PMID: 35074696 PMCID: PMC8946772 DOI: 10.1016/j.drugalcdep.2022.109308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although medications to treat opioid use disorder (MOUD) are the standard of care during pregnancy, there are many potential gaps in the cascade of care for pregnant people experiencing incarceration. METHODS We conducted a retrospective cohort study of pregnant people with opioid use disorder incarcerated in a Southeastern women's prison from 2016 to 2019. The primary outcomes were access to MOUD during incarceration and continuity in the community. We used descriptive statistics to summarize aspects of our sample and logistic regression to identify predictors of MOUD receipt during incarceration. RESULTS Of the 279 pregnant people with OUD included in the analysis, only 40.1% (n = 112) received MOUD during incarceration, including 67 (59.8%) who received methadone and 45 (40.1%) who received buprenorphine. Less than one-third of the participants were referred to a community MOUD provider (n = 83, 30%) on return to the community. Significant predictors of MOUD receipt included medium/close custody level during incarceration, incarceration during the latter portion of the study period, pre-incarceration heroin use, and receipt of pre-incarceration MOUD. CONCLUSIONS Although prisons can serve as an important site of retention in MOUD for some pregnant people, there were substantial gaps in initiation of MOUD and retention in MOUD among pregnant people with OUD imprisoned in the Southeast during the study period.
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Treitler PC, Enich M, Reeves D, Crystal S. Medications for opioid use disorder in state prisons: Perspectives of formerly incarcerated persons. Subst Abuse 2022; 43:964-971. [PMID: 35420973 PMCID: PMC9869935 DOI: 10.1080/08897077.2022.2060448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Opioid use disorder (OUD) is common among incarcerated persons and risk of overdose and other adverse drug-related consequences is high after release. Recognizing their potential to reduce these risks, some correctional systems are expanding access to medication for opioid use disorder (MOUD). This study explored the experiences and perspectives of formerly incarcerated individuals on MOUD use while incarcerated and after release. Methods: We interviewed 53 individuals with self-reported OUD who were released from New Jersey state prisons. Interviews explored motivations to use MOUD while incarcerated and after release, and experiences with prison-based MOUD and transition to community-based care. We performed cross-case analysis to examine common and divergent perspectives across participants. Results: A common reason for accepting prerelease MOUD was recognition of its effectiveness in preventing drug use, overdose, and other drug-related consequences. Participants who chose not to use MOUD often were focused on being completely medication-free or saw themselves as having relatively low-risk of substance use after a prolonged period without opioid use. A few participants reported challenges related to prison-based MOUD, including logistical barriers, stigma, and once-daily buprenorphine dosing. Most participants effectively transitioned to community-based care, but challenges included insurance lapses and difficulty locating providers. Conclusions: Many formerly incarcerated persons with OUD recognize the value of MOUD in supporting recovery, but some hold negative views of MOUD or underestimate the likelihood that they will return to drug use. Patient education on risks of post-release overdose, the role of MOUD in mitigating risk, and MOUD options available to them could increase engagement. Participants' generally positive experiences with MOUD support the expansion of correctional MOUD programs.
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Affiliation(s)
- Peter C. Treitler
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA,School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA
| | - Michael Enich
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA,School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA
| | - Donald Reeves
- Rutgers University Correctional Health Care, Bates Building, 2nd Floor, PO Box 863, Whittlesey Road & Stuyvesant Avenue, Trenton, NJ 08625, USA,Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, 671 Hoes Lane West, D325, Piscataway, NJ 08854, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA,School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA,School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA
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14
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Bandara S, Kennedy-Hendricks A, Merritt S, Barry CL, Saloner B. Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters. Addiction 2021; 116:3473-3481. [PMID: 33999458 DOI: 10.1111/add.15565] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/19/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
AIMS To identify implementation barriers and facilitators to the adoption and implementation of programs that provide opioid agonist treatments (OAT) with methadone and buprenorphine to treat opioid use disorder in jails and prisons in the United States. DESIGN Qualitative analysis: semi-structured interviews were conducted and thematic analyses of transcripts and notes were performed using a hybrid inductive/deductive coding approach. SETTING Jails and prisons in the United States. PARTICIPANTS From August 2019 to January 2020, we conducted 20 key informant interviews with 35 individuals representing 19 carceral systems that both initiate and maintain OAT. MEASUREMENTS Interviews covered four domains: (1) program adoption; (2) policy influence on implementation; (3) program structure; and (4) program outcomes. FINDINGS Stigma among staff, particularly medical staff, challenged program adoption, but reduced over time as staff were exposed to the program. Regulations on OAT dispensation, such as licensing requirements and prescribing limits, were key challenges to program implementation and shaped program structure. Dispensing medication required significant staff, time and space. Facilities were further challenged to overcome stigma and concerns about diversion, as OAT medication is often treated as contraband in carceral settings. Some systems deviated from evidence-based treatment by limiting OAT dosage to low levels, requiring counseling for participation and requiring detoxification before medication initiation. Despite these challenges, early adopters felt strongly that other jails and prisons in the United States should provide OAT and that legislation and litigation may soon force OAT expansion in these carceral settings. CONCLUSIONS Despite identifying regulatory and logistical challenges, early adopters of opioid agonist treatment (OAT) programs in US jails and prisons demonstrate that OAT programs can successfully be implemented in carceral settings with tailoring to the specific context.
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Affiliation(s)
- Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney Merritt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen L Barry
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Howell BA, Puglisi L, Clark K, Albizu-Garcia C, Ashkin E, Booth T, Brinkley-Rubinstein L, Fiellin DA, Fox AD, Maurer KF, Lin HJ, McCollister K, Murphy S, Morse DS, Shavit S, Wang K, Winkelman T, Wang EA. The Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A hybrid type-1 effectiveness trial of enhanced primary care to improve opioid use disorder treatment outcomes following release from jail. J Subst Abuse Treat 2021; 128:108315. [PMID: 33583610 PMCID: PMC8319218 DOI: 10.1016/j.jsat.2021.108315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/22/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2016, at least 20% of people with opioid use disorder (OUD) were involved in the criminal justice system, with the majority of individuals cycling through jails. Opioid overdose is the leading cause of death and a common cause of morbidity after release from incarceration. Medications for OUD (MOUD) are effective at reducing overdoses, but few interventions have successfully engaged and retained individuals after release from incarceration in treatment. OBJECTIVE To assess whether follow-up care in the Transitions Clinic Network (TCN), which provides OUD treatment and enhanced primary care for people released from incarceration, improves key measures in the opioid treatment cascade after release from jail. In TCN programs, primary care teams include a community health worker with a history of incarceration, and they attend to social needs, such as housing, food insecurity, and criminal legal system contact, along with patients' medical needs. METHODS AND ANALYSIS We will bring together six correctional systems and community health centers with TCN programs to conduct a hybrid type-1 effectiveness/implementation study among individuals who were released from jail on MOUD. We will randomize 800 individuals on MOUD released from seven local jails (Bridgeport, CT; Niantic, CT; Bronx, NY; Caguas, PR; Durham, NC; Minneapolis, MN; Ontario County, NY) to compare the effectiveness of a TCN intervention versus referral to standard primary care to improve measures within the opioid treatment cascade. We will also determine what social determinants of health are mediating any observed associations between assignment to the TCN program and opioid treatment cascade measures. Last, we will study the cost effectiveness of the approach, as well as individual, organizational, and policy-level barriers and facilitators to successfully transitioning individuals on MOUD from jail to the TCN. ETHICS AND DISSEMINATION Investigation Review Board the University of North Carolina (IRB Study # 19-1713), the Office of Human Research Protections, and the NIDA JCOIN Data Safety Monitoring Board approved the study. We will disseminate study findings through peer-reviewed publications and academic and community presentations. We will disseminate study data through a web-based platform designed to share data with TCN PATHS participants and other TCN stakeholders. Clinical trials.gov registration: NCT04309565.
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Affiliation(s)
- Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States of America; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Lisa Puglisi
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States of America; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Katie Clark
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Evan Ashkin
- University of North Carolina, Chapel Hill, NC, United States of America
| | - Tyler Booth
- InterCommunity Health Care, East Hartford, CT, United States of America
| | | | - David A Fiellin
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Aaron D Fox
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | | | - Hsiu-Ju Lin
- University of Connecticut, Storrs, CT, United States of America
| | | | - Sean Murphy
- Weill Cornell Medical College, New York, NY, United States of America
| | - Diane S Morse
- University of Rochester, School of Medicine, Rochester, NY, United States of America
| | | | - Karen Wang
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Tyler Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States of America
| | - Emily A Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States of America; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America.
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16
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Howell BA, Martin RA, Lebeau R, Truong AQ, Wang EA, Rich JD, Clarke JG. Changes In Health Services Use After Receipt Of Medications For Opioid Use Disorder In A Statewide Correctional System. Health Aff (Millwood) 2021; 40:1304-1311. [PMID: 34339247 DOI: 10.1377/hlthaff.2020.02156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To decrease opioid overdose mortality, prisons and jails in the US are increasingly offering medications for opioid use disorder (OUD) to incarcerated people. It is unknown how receipt of these medications in a correctional setting affects health services use after release. In this article we analyze changes in postrelease health care use after the implementation of a statewide medications for OUD program in the unified jail and prison system of the Rhode Island Department of Corrections. Using Medicaid claims data, we examined individual health care use in the community before and after receipt of medications for OUD while incarcerated. We found that inpatient admissions did not change, emergency department visits decreased, and both nonacute outpatient services and pharmacy claims increased after people received medications for OUD while incarcerated. There was no change in total health care costs paid by Medicaid. Our findings provide evidence that people's use of health care services paid for by Medicaid did not increase after they started medications for OUD in correctional settings. Given the frequent interaction of people with OUD with the criminal justice system, offering evidence-based treatment of OUD in correctional settings is an important opportunity to initiate addiction treatment.
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Affiliation(s)
- Benjamin A Howell
- Benjamin A. Howell is an instructor in the section of General Internal Medicine and the SEICHE Center at Yale School of Medicine, in New Haven, Connecticut
| | - Rosemarie A Martin
- Rosemarie A. Martin is an associate professor in the Department of Behavioral and Social Sciences, Brown University School of Public Health, in Providence, Rhode Island
| | - Rebecca Lebeau
- Rebecca Lebeau is the chief health program evaluator in the Rhode Island Executive Office of Health and Human Services, in Cranston, Rhode Island
| | - Ashley Q Truong
- Ashley Q. Truong is a PhD candidate in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Emily A Wang
- Emily A. Wang is an associate professor in the Section of General Internal Medicine, Yale School of Medicine
| | - Josiah D Rich
- Josiah D. Rich is a professor of medicine and epidemiology in the Division of Infectious Diseases at Brown University and director and cofounder of the Center for Prisoner Health and Human Rights, the Miriam Hospital, in Providence, Rhode Island
| | - Jennifer G Clarke
- Jennifer G. Clarke is the medical programs director at the Rhode Island Department of Corrections, in Cranston, Rhode Island
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17
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Winetsky D, Fox A, Nijhawan A, Rich JD. Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System. Infect Dis Clin North Am 2021; 34:585-603. [PMID: 32782103 DOI: 10.1016/j.idc.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an overview of the diagnosis and management of opioid use disorder and its infectious complications among populations with criminal justice involvement. Opioid use disorder and chronic infections such as human immunodeficiency virus and hepatitis C virus are highly prevalent among incarcerated individuals and some of the unique features of correctional facilities present challenges for their appropriate medical management. We outline evidence-based strategies for integrated, patient-centered treatment during incarceration and the potentially hazardous transition back to the community upon release.
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Affiliation(s)
- Daniel Winetsky
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 8 W-876, New York, NY 10032, USA; HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Fox
- Department of Internal Medicine, Montefiore Medical Center, 305 East 161th Street, Room 4, Bronx, NY, USA
| | - Ank Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Josiah D Rich
- Department of Medicine, Brown University, 164 Summit Avenue, Providence, RI 02906, USA; Department of Epidemiology, Brown University, 164 Summit Avenue, Providence, RI 02906, USA
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18
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Frost T, Deutsch S, Brown S, Lemien E, Cunningham CO, Fox AD. "We'll be able to take care of ourselves" - A qualitative study of client attitudes toward implementing buprenorphine treatment at syringe services programs. Subst Abus 2021; 42:983-989. [PMID: 33759722 PMCID: PMC10112278 DOI: 10.1080/08897077.2021.1901173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) complement substance use disorder treatment in providing services that improve the health of people who use drugs (PWUD). Buprenorphine treatment is an effective underutilized opioid use disorder treatment. Regulations allow buprenorphine prescribing from office-based settings, potentially including SSPs although few studies have examined this approach. Our objective was to assess the attitudes among PWUD toward the potential introduction of buprenorphine treatment in an SSP. Methods: In this qualitative study, we recruited 34 participants who were enrolled at a New York City-based SSP to participate in one of seven focus group sessions. The focus group facilitators prompted participants to share their thoughts in five domains: attitudes toward (1) medical clinics; (2) harm reduction in general; (3) SSP-based buprenorphine treatment; (4) potential challenges of SSP-based treatment; and (5) logistical considerations of an SSP-based buprenorphine treatment program. Four researchers analyzed focus group transcripts using thematic analysis. Results: Of the 34 participants, most were white (68%), over the age of 40 years old (56%), and had previously tried buprenorphine (89%). Common themes were: 1) The SSP is a supportive community for people who use drugs; 2) Participants felt less stigmatized at the SSP than in general medical settings; 3) Offering buprenorphine treatment could change the SSP's culture; and 4) SSP participants receiving buprenorphine may be tempted to divert their medication. Participants offered suggestions for a slow intentional introduction of buprenorphine treatment at the SSP including structured appointments, training medical providers in harm reduction, and program eligibility criteria. Conclusion: Overall, participants expressed enthusiasm for onsite buprenorphine treatment at SSPs. Research on SSP-based buprenorphine treatment should investigate standard buprenorphine treatment outcomes but also any effects on the program itself and medication diversion. Implementation should consider cultural and environmental aspects of the SSP and consult program staff and participants.
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Affiliation(s)
- Taeko Frost
- Washington Heights CORNER Project, New York, New York, USA
| | - Sarah Deutsch
- Washington Heights CORNER Project, New York, New York, USA
| | - Shoshana Brown
- Washington Heights CORNER Project, New York, New York, USA
| | - Ellen Lemien
- Washington Heights CORNER Project, New York, New York, USA
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Aaron D Fox
- Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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19
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Cioe K, Biondi BE, Easly R, Simard A, Zheng X, Springer SA. A systematic review of patients' and providers' perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat 2020; 119:108146. [PMID: 33138929 PMCID: PMC7609980 DOI: 10.1016/j.jsat.2020.108146] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/02/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The opioid epidemic is a public health crisis. Medications for opioid use disorder (MOUD) include: 1) buprenorphine, 2) methadone, and 3) extended-release naltrexone (XR-NTX). Research should investigate patients' and providers' perspectives of MOUD since they can influence prescription, retention, and recovery. METHODS This systematic review focused on patients' and providers' perceptions of MOUD. The review eligibility criteria included inclusion of the outcome of interest, in English, and involving persons ≥18 years. A PubMed database search yielded 1692 results; we included 152 articles in the final review. RESULTS There were 63 articles about buprenorphine, 115 articles about methadone, and 16 about naltrexone. Misinformation and stigma associated with MOUD were common patient themes. Providers reported lack of training and resources as barriers to MOUD. CONCLUSION This review suggests that patients have significant misinformation regarding MOUD. Due to the severity of the opioid epidemic, research must consider the effects of patients' and providers' perspectives on treatment for OUD, including the effects on the type of MOUD prescribed, patient retention and adherence, and ultimately the number of patients treated for OUD, which will aid in curbing the opioid epidemic.
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Affiliation(s)
- Katharine Cioe
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Breanne E Biondi
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America
| | - Rebecca Easly
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Amanda Simard
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Xiao Zheng
- Yale University, New Haven, CT 06520, United States of America
| | - Sandra A Springer
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, United States of America.
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20
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Grella CE, Ostile E, Scott CK, Dennis M, Carnavale J. A Scoping Review of Barriers and Facilitators to Implementation of Medications for Treatment of Opioid Use Disorder within the Criminal Justice System. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 81:102768. [PMID: 32446130 DOI: 10.1016/j.drugpo.2020.102768] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Policies aimed at addressing the high rates of opioid overdose have prioritized increasing access to medications for treatment of opioid use disorder (MOUD). Numerous barriers exist to providing MOUD within the criminal justice system and/or to justice-involved populations. The aim of this study was to conduct a scoping review of the peer-reviewed literature on implementation of MOUD within criminal justice settings and with justice-involved populations. METHODS A systematic search process identified 53 papers that addressed issues pertaining to implementation barriers or facilitators of MOUD within correctional settings or with justice-involved populations; these were coded and qualitatively analyzed for common themes. RESULTS Over half of the papers were published outside of the U.S. (n = 28); the most common study designs were surveys or structured interviews (n = 20) and qualitative interviews/focus groups (n = 18) conducted with correctional or treatment staff and with incarcerated individuals. Four categories of barriers and facilitators were identified: institutional, programmatic, attitudinal, and systemic. Institutional barriers typically limited capacity to provide MOUD to justice-involved individuals, which led to programmatic practices in which MOUD was not implemented following clinical guidelines, often resulting in forcible withdrawal or inadequate treatment. These programmatic practices commonly led to aversive experiences among justice-involved individuals, who consequently espoused negative attitudes about MOUD and were reluctant to seek treatment with MOUD following their release to the community. Facilitators of MOUD implementation included increased knowledge and information from training interventions and favorable prior experiences with individuals being treated with MOUD among correctional and treatment staff. Few systemic facilitators to implementing MOUD with justice-involved individuals were evident in the literature. CONCLUSION Barriers to implementing MOUD in criminal justice settings and/or with justice-involved populations are pervasive, multi-leveled, and inter-dependent. More work is needed on facilitators of MOUD implementation.
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Affiliation(s)
- Christine E Grella
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA. (CORRESPONDING AUTHOR).
| | - Erika Ostile
- Carnevale Associates LLC, 4 Belinder Rd., Gaithersburg, MD 20878, USA..
| | - Christy K Scott
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA..
| | - Michael Dennis
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA..
| | - John Carnavale
- Carnevale Associates LLC, 4 Belinder Rd., Gaithersburg, MD 20878, USA..
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21
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Jones S, Jack B, Kirby J, Wilson TL, Murphy PN. Methadone-Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness. Am J Addict 2020; 30:11-20. [PMID: 32424883 DOI: 10.1111/ajad.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment guidelines emphasize patients' readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. METHODS Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone-assisted withdrawal in all settings. Time 2 (T2) was a 6-month follow-up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. RESULTS At T1, inpatients had higher self-efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self-efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. DISCUSSION AND CONCLUSIONS Self-efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. SCIENTIFIC SIGNIFICANCE These findings advance existing literature and knowledge by highlighting the importance of self-efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry). (Am J Addict 2021;30:11-20).
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Affiliation(s)
- Steve Jones
- Department of Psychology, Faculty of Health, Social Care, and Medicine, Edge Hill University, Ormskirk, UK
| | - Barbara Jack
- Evidence-Based Practice Research Centre, Faculty of Health, Social Care, and Medicine, Edge Hill University, Ormskirk, UK
| | - Julie Kirby
- Faculty of Health, Social Care, and Medicine, Edge Hill University, Ormskirk, UK
| | - Thomas L Wilson
- School of Applied Social Sciences, De Montford University, Leicester, UK
| | - Philip N Murphy
- Department of Psychology, Edge Hill University, Ormskirk, UK
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22
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Medications for Opioid Use Disorder Among Incarcerated Individuals: a Review of the Literature and Focus on Patient Preference. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00283-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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23
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Velasquez M, Flannery M, Badolato R, Vittitow A, McDonald RD, Tofighi B, Garment AR, Giftos J, Lee JD. Perceptions of extended-release naltrexone, methadone, and buprenorphine treatments following release from jail. Addict Sci Clin Pract 2019; 14:37. [PMID: 31570100 PMCID: PMC6771097 DOI: 10.1186/s13722-019-0166-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have documented patient attitudes and experiences with extended-release naltrexone (XR-NTX) opioid relapse prevention in criminal justice settings. This study assessed barriers and facilitators of jail-to-community reentry among adults with opioid use disorder (OUD) treated with XR-NTX, buprenorphine, methadone, and no medications. Methods This qualitative study conducted individual interviews with a purposeful and convenience sample of adults with OUD who were recently released from NYC jails. XR-NTX, no medication, and methadone participants were concurrently enrolled in a large randomized controlled trial evaluating XR-NTX vs. a no medication Enhanced Treatment As Usual (ETAU) condition, or enrolled in a non-randomized quasi-experimental methadone maintenance cohort. Buprenorphine participants were referred from NYC jails to a public hospital office-based buprenorphine program and not enrolled in the parent trial. Interviews were audio recorded, transcribed, independently coded by two researchers, and analyzed per a grounded theory approach adapted to the Social Cognitive Theory framework. The research team reviewed transcripts and coding to reach consensus on emergent themes. Results N = 33 adults with OUD (28 male, 5 female) completed a single individual interview. Purposeful sampling recruited persons leaving jail on XR-NTX (n = 11), no active medication treatment (n = 9), methadone (n = 9), and buprenorphine (n = 4). Emergent themes were: (1) general satisfaction with XR-NTX’s long-acting antagonist effects and control of cravings; (2) “testing” XR-NTX’s blockade with heroin upon reentry was common; (3) early discontinuation of XR-NTX treatment was most common among persons with high self-efficacy and/or heavy exposure to drug use environments and peers; (4) similar satisfaction regarding effects of methadone and buprenorphine maintenance among retained-in-treatment individuals, alongside general dissatisfaction with daily observed dosing requirements and misinformation and stigmas regarding methadone adverse effects; (5) unstable housing, economic insecurity, and exposure to actively using peers were attributed to early termination of treatment and relapse; (6) individual motivation and willpower as central to long-term opioid abstinence and reentry success. Conclusions In the context of more familiar agonist maintenance treatments, XR-NTX relapse prevention during jail-to-community reentry was viewed as a helpful and unique intervention though with important limitations. Commonly described barriers to treatment retention and heroin abstinence included homelessness, economic insecurity, and drug-using peers. Trial registration ClinicalTrials.gov, NCT01999946 (XOR), Registered 03 December 2013, https://clinicaltrials.gov/ct2/show/NCT01999946.
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Affiliation(s)
- Melissa Velasquez
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Mara Flannery
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ryan Badolato
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alexandria Vittitow
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ryan D McDonald
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Babak Tofighi
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ann R Garment
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Jonathan Giftos
- Correctional Health Services, New York City Health + Hospitals Corporation, 55 Water Street, New York, NY, 10041, USA
| | - Joshua D Lee
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA. .,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA. .,New York University School of Medicine, 180 Madison Avenue, 17th Floor, 1714, New York, NY, 10016, USA.
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Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal. J Addict Med 2019; 12:156-162. [PMID: 29341974 DOI: 10.1097/adm.0000000000000381] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Methadone maintenance treatment (MMT) is underutilized in correctional settings, and those receiving MMT in the community often undergo withdrawal upon incarceration. Federal and state regulations present barriers to providing methadone in correctional facilities. For this investigation, a community provider administered methadone to inmates who had been receiving methadone prior to incarceration. We hypothesized that inmates continued on MMT would have improved behavior during incarceration and post-release. METHODS This open-label quasi-experimental trial (n = 382) compared MMT continuation throughout incarceration (n = 184) to an administrative control group (ie, forced withdrawal; n = 198) on disciplinary tickets and other program attendance during incarceration. Post-release, re-engagement in community-based MMT and 6-month recidivism outcomes were evaluated. RESULTS Inmates in the MMT continuation group versus controls were less likely to receive disciplinary tickets (odds ratio [OR] = 0.32) but no more likely to attend other programs while incarcerated. MMT continuation increased engagement with a community MMT provider within 1 day of release (OR = 32.04), and 40.6% of MMT participants re-engaged within the first 30 days (vs 10.1% of controls). Overall, re-engagement in MMT was not associated with recidivism. However, among a subset of inmates who received MMT post-incarceration from the jail MMT provider (n = 69), re-engagement with that provider was associated with reduced risk of arrest, new charges, and re-incarceration compared with those who did not re-engage. CONCLUSIONS Results support interventions that facilitate continuity of MMT during and after incarceration. Engagement of a community provider is feasible and can improve access to methadone in correctional facilities.
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Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysis. LANCET PUBLIC HEALTH 2019; 4:e326-e333. [DOI: 10.1016/s2468-2667(19)30104-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/20/2023]
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Joudrey PJ, Khan MR, Wang EA, Scheidell JD, Edelman EJ, McInnes DK, Fox AD. A conceptual model for understanding post-release opioid-related overdose risk. Addict Sci Clin Pract 2019; 14:17. [PMID: 30982468 PMCID: PMC6463640 DOI: 10.1186/s13722-019-0145-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/26/2019] [Indexed: 12/28/2022] Open
Abstract
Post-release opioid-related overdose mortality is the leading cause of death among people released from jails or prisons (PRJP). Informed by the proximate determinants framework, this paper presents the Post-Release Opioid-Related Overdose Risk Model. It explores the underlying, intermediate, proximate and biological determinants which contribute to risk of post-release opioid-related overdose mortality. PRJP share the underlying exposure of incarceration and the increased prevalence of several moderators (chronic pain, HIV infection, trauma, race, and suicidality) of the risk of opioid-related overdose. Intermediate determinants following release from the criminal justice system include disruption of social networks, interruptions in medical care, poverty, and stigma which exacerbate underlying, and highly prevalent, substance use and mental health disorders. Subsequent proximate determinants include interruptions in substance use treatment, including access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone access, and a return to solitary opioid use. This leads to the final biological determinant of reduced respiratory tolerance and finally opioid-related overdose mortality. Mitigating the risk of opioid-related overdose mortality among PRJP will require improved coordination across criminal justice, health, and community organizations to reduce barriers to social services, ensure access to health insurance, and reduce interruptions in care continuity and reduce stigma. Healthcare services and harm reduction strategies, such as safe injection sites, should be tailored to the needs of PRJP. Expanding access to opioid agonist therapy and naloxone around the post-release period could reduce overdose deaths. Programs are also needed to divert individuals with substance use disorder away from the criminal justice system and into treatment and social services, preventing incarceration exposure.
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Affiliation(s)
- Paul J Joudrey
- VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Ave, West Haven, CT, 06516, USA.
- National Clinician Scholars Program, Yale School of Medicine, 333 Cedar Street, Sterling Hall of Medicine IE-68, PO Box 208088, New Haven, CT, 06520, USA.
| | - Maria R Khan
- Department of Population Health, New York University, 227 East 30th Street, New York, NY, 10016, USA
| | - Emily A Wang
- Department of Internal Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA
| | - Joy D Scheidell
- Department of Population Health, New York University, 227 East 30th Street, New York, NY, 10016, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA
| | - D Keith McInnes
- Department of Veterans Affairs, Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
- Montefiore Medical Center, Bronx, NY, 10467, USA
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Moore KE, Roberts W, Reid HH, Smith KMZ, Oberleitner LMS, McKee SA. Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. J Subst Abuse Treat 2019; 99:32-43. [PMID: 30797392 PMCID: PMC6391743 DOI: 10.1016/j.jsat.2018.12.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/16/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022]
Abstract
This study examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Randomized controlled trials (RCTs) and quasi-experimental studies published through December 2017 that examined induction to or maintenance on methadone (n = 18 studies), buprenorphine (n = 3 studies), or naltrexone (n = 3 studies) in correctional settings were identified from PsycINFO and PubMed databases. There were a sufficient number of methadone RCTs to meta-analyze; there were too few buprenorphine or naltrexone studies. All quasi-experimental studies were systematically reviewed. Data from RCTs involving 807 inmates (treatment n = 407, control n = 400) showed that methadone provided during incarceration increased community treatment engagement (n = 3 studies; OR = 8.69, 95% CI = 2.46; 30.75), reduced illicit opioid use (n = 4 studies; OR = 0.22, 95% CI = 0.15; 0.32) and injection drug use (n = 3 studies; OR = 0.26, 95% CI = 0.12; 0.56), but did not reduce recidivism (n = 4 studies; OR = 0.93, 95% CI = 0.51; 1.68). Data from observational studies of methadone showed consistent findings. Individual review of buprenorphine and naltrexone studies showed these medications were either superior to methadone or to placebo, or were as effective as methadone in reducing illicit opioid use post-release. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use; additional work is needed to understand the reduction of recidivism and other health risk behaviors.
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, United States of America
| | - Walter Roberts
- Department of Psychiatry, Yale University School of Medicine, United States of America
| | - Holly H Reid
- Beaumont Health System, MI, United States of America
| | - Kathryn M Z Smith
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, United States of America
| | | | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, United States of America.
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Russolillo A, Moniruzzaman A, Somers JM. Association of Methadone Treatment With Substance-Related Hospital Admissions Among a Population in Canada With a History of Criminal Convictions. JAMA Netw Open 2019; 2:e190595. [PMID: 30874778 PMCID: PMC6484638 DOI: 10.1001/jamanetworkopen.2019.0595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE People with criminal histories experience high rates of opioid dependence and are frequent users of acute health care services. It is unclear whether methadone adherence prevents hospitalizations. OBJECTIVE To compare hospital admissions during medicated and nonmedicated methadone periods. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study involving linked population-level administrative data among individuals in British Columbia, Canada, with provincial justice contacts (n= 250 884) and who filled a methadone prescription between April 1, 2001, and March 31, 2015. Participants were followed from the date of first dispensed methadone prescription until censoring (date of death, or March 31, 2015). Data analysis was conducted from May 1 to August 31, 2018. EXPOSURES Methadone treatment was divided into medicated (methadone was dispensed) and nonmedicated (methadone was not dispensed) periods and analyzed as a time-varying exposure. MAIN OUTCOME AND MEASURES Adjusted hazard ratios (aHRs) of acute hospitalizations for any cause and cause-specific (substance use disorder [SUD], non-substance-related mental disorders [NSMDs], and medical diagnoses [MEDs]) were estimated using multivariable Cox proportional hazards regression. RESULTS A total of 11 401 people (mean [SD] age, 34.9 [9.4] years; 8230 [72.2%] men) met inclusion criteria and were followed up for a total of 69 279.3 person-years. During a median follow-up time of 5.5 years (interquartile range, 2.8-9.1 years), there were 19 160 acute hospital admissions. Dispensed methadone was associated with a 50% lower rate of hospitalization for any cause (aHR, 0.50; 95% CI, 0.46-0.53) during the first 2 years (≤2.0 years) following methadone initiation, demonstrating significantly lower rates of admission for SUD (aHR, 0.32; 95% CI, 0.27-0.38), NSMD (aHR, 0.41; 95% CI, 0.34-0.50), and MED (aHR, 0.57; 95% CI, 0.52-0.62). As duration of time increased (2.1 to ≤5.0 years; 5.1 to ≤10.0 years), methadone was associated with a significant but smaller magnitude of effect: SUD (aHR, 0.43; 95% CI, 0.36-0.52; aHR, 0.47; 95% CI, 0.37-0.61), NSMD (aHR, 0.51; 95% CI, 0.41-0.64; aHR, 0.60; 95% CI, 0.47-0.78), and MED (aHR, 0.71; 95% CI, 0.65-0.77; aHR, 0.85; 95% CI, 0.76-0.95). CONCLUSIONS AND RELEVANCE In this study, methadone was associated with a lower rate of hospitalization among a large cohort of Canadian individuals with histories of convictions and prevalent concurrent health and social needs. Practices to improve methadone adherence are warranted.
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Affiliation(s)
- Angela Russolillo
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julian M. Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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28-year-old Woman With Opioid Use Disorder Delivers Healthy Baby While in Custody: Addressing Forced Detox. J Addict Med 2018; 13:237-240. [PMID: 30379779 DOI: 10.1097/adm.0000000000000468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid agonist treatment (OAT) in pregnancy reduces overdose risk, drug use, increases prenatal care engagement, and improves birth outcomes. Yet many pregnant women lack access to adequate treatment. OAT, while incarcerated, reduces subsequent overdose risk, improves continuation to treatment on release, and reduces recidivism. Yet most correction facilities do not follow evidence-based guidelines for treatment, resulting in destabilization and overdose. This case is unique in illustrating 1 example of a patient who is justice-involved during pregnancy and the postpartum period, and highlighting an area of advocacy that is under-reported in the medical literature. CASE PRESENTATION A 28-year-old G2P0010 woman with a history of severe opioid use disorder (OUD) learned she was 13 weeks pregnant after a polysubstance overdose while on methadone treatment. She did not engage in prenatal care, despite many encounters with the healthcare system. Her pregnancy course was marked by polysubstance use, hospitalizations, and incarcerations. While incarcerated, she delivered a healthy baby at 37 weeks, and her parental custody rights were suspended.The obstetrics team successfully advocated with the jail for continuing methadone postpartum due to the increased risk of relapse and overdose on release. After release, she continued methadone treatment with no further illicit opioid use, began to engage in counseling, 12-step meetings, and worked towards custody of her son. CONCLUSIONS The postpartum and postincarceration periods are 2 high-risk periods for women with OUD. OAT in and out of incarceration provided some stability and benefit, in the midst of a prenatal course that was fragmented by polysubstance use, hospitalization, and incarceration. Maintaining and prioritizing access to OAT for patients who are incarcerated is necessary, though not sufficient, to address the high risk of overdose. Empowering healthcare providers to advocate for incarcerated patients with OUD on an individual level is 1 key strategy to optimize addiction treatment for incarcerated people.
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Murphy PN, Mohammed F, Wareing M, Cotton A, McNeill J, Irving P, Jones S, Sharples L, Monk R, Elton P. High drug related mortality rates following prison release: Assessing the acceptance likelihood of a naltrexone injection and related concerns. J Subst Abuse Treat 2018; 92:91-98. [DOI: 10.1016/j.jsat.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 12/20/2022]
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Winkelman TN, Chang VW, Binswanger IA. Health, Polysubstance Use, and Criminal Justice Involvement Among Adults With Varying Levels of Opioid Use. JAMA Netw Open 2018; 1:e180558. [PMID: 30646016 PMCID: PMC6324297 DOI: 10.1001/jamanetworkopen.2018.0558] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Health profiles and patterns of involvement in the criminal justice system among people with various levels of opioid use are poorly defined. Data are needed to inform a public health approach to the opioid epidemic. OBJECTIVE To examine the association between various levels of opioid use in the past year and physical and mental health, co-occurring substance use, and involvement in the criminal justice system. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional analysis used the 2015-2016 National Survey on Drug Use and Health to assess the independent association of intensity of opioid use with health, co-occurring substance use, and involvement in the criminal justice system among US adults aged 18 to 64 years using multivariable logistic regression. EXPOSURES No opioid use vs prescription opioid use, misuse, or use disorder or heroin use. MAIN OUTCOMES AND MEASURES Self-reported physical and mental health, disability, co-occurring substance use, and past year and lifetime involvement in the criminal justice system. RESULTS The sample consisted of 78 976 respondents (42 495 women and 36 481 men), representative of 196 280 447 US adults. In the weighted sample, 124 026 842 adults reported no opioid use in the past year (63.2%; 95% CI, 62.6%-63.7%), 61 462 897 reported prescription opioid use in the past year (31.3%; 95% CI, 30.8%-31.8%), 8 439 889 reported prescription opioid misuse in the past year (4.3%; 95% CI, 4.1%-4.5%), 1 475 433 reported prescription opioid use disorder in the past year (0.8%; 95% CI, 0.7%-0.8%), and 875 386 reported heroin use in the past year (0.4%; 95% CI, 0.4%-0.5%). Individuals who reported any level of opioid use were significantly more likely than individuals who reported no opioid use to be white, have a low income, and report a chronic condition, disability, severe mental illness, or co-occurring drug use. History of involvement in the criminal justice system increased as intensity of opioid use increased (no use, 15.9% [19 562 158 of 123 319 911]; 95% CI, 15.4%-16.4%; prescription opioid use, 22.4% [13 712 162 of 61 204 541]; 95% CI, 21.7%-23.1%; prescription opioid misuse, 33.2% [2 793 391 of 8 410 638]; 95% CI, 30.9%-35.6%; prescription opioid use disorder, 51.7% [762 189 of 1 473 552]; 95% CI, 45.4%-58.0%; and heroin use, 76.8% [668 453 of 870 250]; 95% CI, 70.6%-82.1%). In adjusted models, any level of opioid use was associated with involvement in the criminal justice system in the past year compared with no opioid use. CONCLUSIONS AND RELEVANCE Individuals who use opioids have complicated health profiles and high levels of involvement in the criminal justice system. Combating the opioid epidemic will require public health interventions that involve criminal justice systems, as well as policies that reduce involvement in the criminal justice system among individuals with substance use disorders.
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Affiliation(s)
- Tyler N.A. Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- Center for Patient and Provider Experience, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Virginia W. Chang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York
- Department of Population Health, School of Medicine, New York University, New York
| | - Ingrid A. Binswanger
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Institute for Health Research, Kaiser Permanente Colorado, Denver
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Volkow ND. Medications for opioid use disorder: bridging the gap in care. Lancet 2018; 391:285-287. [PMID: 29150199 DOI: 10.1016/s0140-6736(17)32893-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892-9589, USA.
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Raja AS, Miller ES, Flores EJ, Wakeman SE, Eng G. Case 37-2017. A 36-Year-Old Man with Unintentional Opioid Overdose. N Engl J Med 2017; 377:2181-2188. [PMID: 29171813 DOI: 10.1056/nejmcpc1710563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ali S Raja
- From the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (A.S.R., E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Emily S Miller
- From the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (A.S.R., E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Efrén J Flores
- From the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (A.S.R., E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Sarah E Wakeman
- From the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (A.S.R., E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - George Eng
- From the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Emergency Medicine (A.S.R., E.S.M.), Radiology (A.S.R., E.J.F.), Medicine (S.E.W.), and Pathology (G.E.), Harvard Medical School - both in Boston
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