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Berk J, Miller C, James ME, Martin M, Rich J, Kaplowitz E, Brinkley-Rubinstein L. "Yeah, this is not going to work for me"-The impact of federal policy restrictions on methadone continuation upon release from jail or prison. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 168:209538. [PMID: 39393533 DOI: 10.1016/j.josat.2024.209538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 09/12/2024] [Accepted: 10/03/2024] [Indexed: 10/13/2024]
Abstract
INTRODUCTION Individuals impacted by the criminal-legal system face increased risk of opioid overdose. Medications for opioid use disorder (MOUD) provide a life-saving intervention. Multiple barriers prevent access to MOUD, including federal policies regulating opioid treatment programs (OTPs). This study aims to identify how federal policy affects anticipated barriers to methadone treatment access at a high-risk time for opioid mortality: community re-entry after incarceration. METHODS The study used standard qualitative methods to conduct 40 in-depth-interviews with incarcerated individuals enrolled in the Rhode Island Department of Corrections MOUD treatment program. Semi-structured interviews took place between June and August 2018 and focused on participants' experiences with MOUD and anticipated treatment barriers upon re-entry. A deductive coding framework incorporating the SAMHSA "8-point" criteria for take-home methadone as the a priori codebook and additional identified barriers informed further inductive analysis. RESULTS Four themes emerged: (1) logistical hurdles such as transportation and clinic location impeded clinic access; (2) punitive measures within clinics, like dose reduction for rule infractions, discouraged treatment continuation; (3) the environment of methadone clinics often tempted return to use; (4) while the structured nature of methadone treatment provided accountability, it also posed challenges. Federal policies, particularly around daily dosing and "take-home" regulations, exacerbated barriers for those re-entering the community. State and clinic level policies, however, were also identified as direct or exacerbating barriers to treatment access. CONCLUSION Significant hurdles persist for methadone access among individuals released from incarceration. Though the federal 8-point criteria have now been replaced with more flexible take-home policies, our findings highlight critical treatment barriers for individuals during the high-risk period of community re-entry. State and clinic level policies also exacerbate many of the barrier-driven themes identified in this analysis. Future work can explore how to best implement the identified benefits of a structured program without forcing the punitive measures that discourage treatment retention. Additional policy reform can help mitigate the effects of other social determinants of health (including transportation access). Ultimately, the many barriers to community methadone treatment retention also apply to individuals involved in the criminal legal system; they can be exacerbated at the federal, state, and clinic policy level.
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Affiliation(s)
- Justin Berk
- Alpert Medical School at Brown University, Providence, RI 02905, United States.
| | - Cameron Miller
- Alpert Medical School at Brown University, Providence, RI 02905, United States
| | - Michael-Evans James
- Alpert Medical School at Brown University, Providence, RI 02905, United States
| | - Megan Martin
- Alpert Medical School at Brown University, Providence, RI 02905, United States
| | - Josiah Rich
- Alpert Medical School at Brown University, Providence, RI 02905, United States
| | - Eliana Kaplowitz
- Silberman School of Social Worker at Hunter College, United States
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Satcher MF, Belenko S, Coetzer-Liversage A, Wilson KJ, McCart MR, Drazdowski TK, Fallin-Bennett A, Zaller N, Schultheis AM, Hogue A, Vest N, Sheidow AJ, Del Pozo B, Watson DP, Hibbard PF, Stevens R, Stein LAR. Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners. HEALTH & JUSTICE 2024; 12:36. [PMID: 39207608 PMCID: PMC11363440 DOI: 10.1186/s40352-024-00291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.
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Affiliation(s)
- Milan F Satcher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Department of Community & Family Medicine, Dartmouth Health, Lebanon, NH, USA.
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19122, USA
| | | | | | | | | | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, Lexington, KY, USA
- Voices of Hope, Lexington, KY, USA
| | - Nickolas Zaller
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alysse M Schultheis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Aaron Hogue
- Partnership to End Addiction, New York, NY, USA
| | - Noel Vest
- Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Ashli J Sheidow
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, USA
| | - Brandon Del Pozo
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, USA
| | | | - Randy Stevens
- Hope for New Hampshire Recovery, Manchester, NH, USA
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- Department of Behavioral & Social Sciences, Brown University, Providence, RI, USA
- Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, Cranston, RI, USA
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Lee JD, Goldfeld K, Schwartz RP, McDonald R, Xu Y, Chandler R, Hallgren K, Kelly SM, Mitchell SG, Sharma A, Farabee D. Assessing the impact of jail-initiated medication for opioid use disorder: A multisite analysis of the SOMATICS collaborative. PLoS One 2024; 19:e0305165. [PMID: 38885220 PMCID: PMC11182542 DOI: 10.1371/journal.pone.0305165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
The objective of this study was to estimate the associations of jail-initiated medication for opioid use disorder (MOUD) and patient navigation (PN) with opioid use disorder (OUD) at 6 months post-release. Three randomized trials (combined N = 330) were combined to assess whether MOUD (extended-release naltrexone or interim methadone) initiated prior to release from jail with or without PN would reduce the likelihood of a DSM-5 diagnosis of OUD 6 months post-release relative to enhanced treatment-as-usual (ETAU). Across the three studies, assignment to MOUD compared to ETAU was not associated with an OUD diagnosis at 6 months post-release (69% vs. 75%, respectively, OR = 0.67, 95% CI: 0.42 to 1.20). Similarly, PN compared to MOUD without PN was not associated with an OUD diagnosis (63% vs 77%, respectively, OR = 0.61, 95% CI: 0.27 to 1.53). Results underscore the need to further optimize the effectiveness of MOUD for patients initiating treatment in jail, beginning with an emphasis on post-release treatment adherence.
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Affiliation(s)
- Joshua D. Lee
- Department of Population Health, NYU Grossman School of Medicine, New York City, NY, United States of America
| | - Keith Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York City, NY, United States of America
| | | | - Ryan McDonald
- Department of Population Health, NYU Grossman School of Medicine, New York City, NY, United States of America
| | - Yifan Xu
- Department of Population Health, NYU Grossman School of Medicine, New York City, NY, United States of America
| | - Redonna Chandler
- National Institute on Drug Abuse, Bethesda, MD, United States of America
| | - Kevin Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Sharon M. Kelly
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | | | - Anjalee Sharma
- Friends Research Institute, Baltimore, MD, United States of America
| | - David Farabee
- Department of Population Health, NYU Grossman School of Medicine, New York City, NY, United States of America
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Cheng VS, Lapto FK. The Impact of Later Life Events on Cessation Motivation of Older Adults with Substance Use Disorder in Hong Kong. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:1362-1382. [PMID: 37085989 DOI: 10.1177/0306624x231165421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Life-course researchers have found that age-graded life events, such as marriage and employment, may provoke a turning point in the trajectories of substance use and motivate young adults with substance use disorder (SUD) to seek addiction treatment and cease illegal drug use. However, few studies have focused on the impact of the life events experienced by older adults with SUD in their later life on these trajectories. Even less is known about this phenomenon in non-Western contexts. Thus, we conducted interviews with 34 older individuals with SUD in Hong Kong and explored how later life events affected their motivation to cease illegal drug use. Our findings highlight the influence of age on how life events are experienced and the need for age-specific academic studies of substance use trajectories. The results also have implications for policymakers, as the criminalization and stigmatization of drug use may have a negative impact on the trajectories of substance use among older populations.
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Affiliation(s)
- Vincent S Cheng
- School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong Kong
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Grella CE, Scott CK, Dennis ML, LaVallee RA. Access to Services for Pregnant People With Opioid Use Disorder in Jails in the United States. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:299-307. [PMID: 37252747 PMCID: PMC10494905 DOI: 10.1089/jchc.22.03.0023] [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] [Indexed: 05/31/2023]
Abstract
The aim of this study was to assess the availability of medications for opioid use disorder (MOUD) and other services for pregnant people in jails in counties heavily impacted by opioid overdose in the United States. Counties were selected based on absolute number and population rate of opioid-overdose fatalities. Structured interviews were completed with representatives from 174 jails that house pregnant women. Descriptive statistics examine MOUD availability and differences in service provision and community-level characteristics based on MOUD availability. Most jails in the study sample (84.5%) had MOUD available for pregnant people; however, less than half of these jails ensured continuity of care. Jails without MOUD available are more likely to provide non-MOUD substance use services. These jails are more often located in smaller, rural counties in the Midwest and have higher rates of White residents and lower rates of Hispanic and African American residents. Gaps in MOUD availability in jails and continuity of care violate medical guidelines for treatment of pregnant patients with opioid use disorder and increase their risk of overdose. In addition, there are disparities across communities in access to MOUD for pregnant people in jails.
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Affiliation(s)
| | - Christy K. Scott
- Chestnut Health Systems, Lighthouse Institute, Chicago, Illinois, USA
| | - Michael L. Dennis
- Chestnut Health Systems, Lighthouse Institute, Normal, Illinois, USA
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Enich M, Treitler P, Swarbrick M, Belsky L, Hillis M, Crystal S. Peer Health Navigation Experiences Before and After Prison Release Among People With Opioid Use Disorder. Psychiatr Serv 2023; 74:737-745. [PMID: 36820527 DOI: 10.1176/appi.ps.20220310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Recently incarcerated people with opioid use disorder are at high risk of overdose and adverse outcomes as a result of biopsychosocial risk factors. Peer support models aiming to improve these outcomes have expanded in recent years. This qualitative study aimed to document participants' experiences with peer health navigation before and after prison release, examine participants' perspectives on the role of peer health navigators, and understand participants' views on service improvements. METHODS The authors conducted in-depth, semistructured interviews with 39 recipients of peer health navigation at release, 30 of whom also completed a follow-up interview 3 months later. Interviews were analyzed via cross-case analysis. RESULTS Interviewees differently valued the various types of support they received. Participants appreciated working with someone with shared lived experience with whom they could establish a trusting relationship. Nevertheless, structural and policy barriers meant that certain key needs-such as housing and employment-could not always be met. CONCLUSIONS Peer health navigators can connect participants to evidence-based treatment and help them address their psychosocial needs and develop skills to support long-term wellness. Further research is needed to assess the impact of peer health navigation on participant outcomes, such as overdose reduction, treatment engagement, and sustained recovery.
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Affiliation(s)
- Michael Enich
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Peter Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Margaret Swarbrick
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Leigh Belsky
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Micah Hillis
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
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Hoffman KA, Thompson E, Gaeta Gazzola M, Oberleitner LMS, Eller A, Madden LM, Marcus R, Oberleitner DE, Beitel M, Barry DT. "Just fighting for my life to stay alive": a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories. Addict Sci Clin Pract 2023; 18:16. [PMID: 36944998 PMCID: PMC10031976 DOI: 10.1186/s13722-023-00377-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND During the period of community re-entry immediately following release from jail or prison, individuals with opioid use disorder (OUD) face structural barriers to successful re-entry and high risk of overdose. Few published studies investigate experiences in the immediate period (i.e., first 24 h) of re-entry among people with OUD. AIM To understand the barriers and facilitators to treatment and reintegration of people with OUD during the initial transition from carceral settings back into the community. METHODS From January-December 2017, we conducted 42 semi-structured qualitative interviews with patients with a history of incarceration who were receiving methadone at a not-for-profit, low-barrier opioid treatment program. Interviews probed participants' community re-entry experiences immediately following incarceration. Interviews were transcribed and analyzed using a Thematic Analysis approach. RESULTS The main themes described the experiences during the 24 h following release, reacclimating and navigating re-entry barriers, and re-entry preparedness and planning. Participants noted the initial 24 h to be a period of risk for returning to substance use or an opportunity to engage with OUD treatment as well as a tenuous period where many lacked basic resources such as shelter or money. When discussing the subsequent re-entry period, participants noted social challenges and persistent barriers to stable housing and employment. Participants overall described feeling unprepared for release and suggested improvements including formal transition programs, improved education, and support to combat the risk of overdose and return to substance use after incarceration. CONCLUSIONS In this study that qualitatively examines the experiences of people with incarceration histories and OUD enrolled in methadone treatment, we found that participants faced many barriers to community re-entry, particularly surrounding basic resources and treatment engagement. Participants reported feeling unprepared for release but made concrete suggestions for interventions that might improve the barriers they encountered. Future work should examine the incorporation of these perspectives of people with lived experience into the development of transition programs or re-entry classes.
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Affiliation(s)
- Kim A Hoffman
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
- APT Foundation, New Haven, CT, USA.
| | - Emma Thompson
- APT Foundation, New Haven, CT, USA
- Rutgers New Jersey Medical School, Rutgers, Newark, NJ, USA
| | - Marina Gaeta Gazzola
- APT Foundation, New Haven, CT, USA
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Lindsay M S Oberleitner
- APT Foundation, New Haven, CT, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Anthony Eller
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ruthanne Marcus
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David E Oberleitner
- APT Foundation, New Haven, CT, USA
- Department of Psychology, University of Bridgeport, Bridgeport, CT, USA
| | - Mark Beitel
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration. J Addict Med 2023; 17:54-59. [PMID: 35916404 PMCID: PMC9892350 DOI: 10.1097/adm.0000000000001029] [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: 02/07/2023]
Abstract
BACKGROUND Although the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist. METHODS We conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12. RESULTS Participants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release. CONCLUSION Our findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.
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Scott CK, Grella CE, Dennis ML, Carnevale J, LaVallee R. Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S. HEALTH & JUSTICE 2022; 10:36. [PMID: 36538121 PMCID: PMC9763789 DOI: 10.1186/s40352-022-00197-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Jails are optimal settings in which to screen individuals for opioid use disorders (OUD) and provide needed services, especially medications for OUD (MOUD). This study sought to assess the availability of OUD "best practices" in jails located in counties heavily impacted by opioid overdose in the U.S. and their related training and resource needs. Counties were selected for study inclusion using two indicators of OUD severity: the absolute number and population rate of opioid overdose deaths. Structured interviews were completed with representatives from 185/244 (76%) of targeted counties and 185/250 (74%) of targeted jails in these counties. Ten OUD best practices were identified based on current treatment and practice guidelines. These include: screening for OUD; clinical assessment; medically managed withdrawal; MOUD administration; MOUD for pregnant people; counseling and wrap-around services; collaboration with community providers; assistance with Medicaid/insurance; re-entry services; and overdose prevention. Descriptive analyses examined the provision of any services and average percentage of services endorsed within best-practice categories, association of best-practice availability with community and jail characteristics, and related needs for training and resources. RESULTS Over 70% of jail respondents indicated that some aspects of each of the ten OUD best practices were available within their jails, ranging from 71% using clinical assessment to 96% providing overdose prevention. However, there was considerable variability in the average percentage of items endorsed within each best-practice category, ranging from 38% of items regarding re-entry services to 88% of items regarding medically managed withdrawal. Availability of OUD best practices in jails also varied by community and jail characteristics. Jails reported the highest needs for funding for medication and clinical staff. CONCLUSIONS Policies are needed to address the identified gaps in availability of OUD best practices within jails. Training, technical assistance, and funding are needed to improve clinical capacity of jails to administer MOUD and to ensure continuity of care from jail to community, which are essential to reducing the risk of opioid-related overdose following release.
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Affiliation(s)
- Christy K. Scott
- Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | | | | | - John Carnevale
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
| | - Robin LaVallee
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
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Stopka TJ, Rottapel RE, Ferguson WJ, Pivovarova E, Toro-Mejias LD, Friedmann PD, Evans EA. Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103803. [PMID: 35965159 PMCID: PMC10117037 DOI: 10.1016/j.drugpo.2022.103803] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People released from jail are at elevated opioid overdose risk. Medications for opioid use disorder (MOUD) are effective in reducing overdoses. MOUD treatment was recently mandated in seven Massachusetts jails, but little is known about barriers and facilitators to treatment continuity post-release. We aimed to assess MOUD provider perspectives on treatment continuity among people released from jail. METHODS We conducted qualitative interviews with 36 medical, supervisory, and administrative staff at MOUD programs that serve jail-referred patients. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide development of instruments, codes, and analyses. We employed deductive and inductive coding, and a grounded theory analytical approach to identify salient themes. RESULTS Inner context findings highlighted necessary adjustments among jail staff to approve MOUD treatment, especially with agonist medications that were previously considered contraband. Participants perceived that some staff within jails favored abstinence-based recovery, viewing agonists as a crutch. Bridging results highlighted the importance of inter-agency communication and coordination to ensure information transfer for seamless treatment continuity in the community post-release. Pre-release planning, release on pre-scheduled dates, medication provision to cover gaps between jail release and intake at community MOUD sites, and exchange of treatment information across agencies were viewed as paramount to success. Unexpected early releases and releases from court were viewed as barriers to treatment coordination. Outer context domains were largely tied to social determinants of health. Substantial barriers to treatment continuity included shelter, food security, employment, transportation, and insurance reactivation. CONCLUSION Through qualitative interviews with community-based MOUD staff, we identified salient barriers and facilitators to treatment continuity post-release from jails. Findings point to needed investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to continuity, and decreasing opioid overdose deaths during this high-risk transition.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States.
| | - Rebecca E Rottapel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Lizbeth Del Toro-Mejias
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, United States
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Barenie RE, Cernasev A, Jasmin H, Knight P, Chisholm-Burns M. A Qualitative Systematic Review of Access to Substance Use Disorder Care in the United States Criminal Justice System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12647. [PMID: 36231947 PMCID: PMC9566712 DOI: 10.3390/ijerph191912647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/18/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The majority of patients with a substance use disorder (SUD) in the United States do not receive evidence-based treatment. Research has also demonstrated challenges to accessing SUD care in the US criminal justice system. We conducted a systematic review of access to SUD care in the US criminal justice system. METHODS We searched for comprehensive qualitative studies in multiple databases through April 2021, and two researchers reviewed 6858 studies using pre-selected inclusion criteria. Once eligibility was determined, themes were extracted from the data. This review provides a thematic overview of the US qualitative studies to inform future research-based interventions. This review was conducted in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS There were 6858 unique abstract results identified for review, and seven qualitative studies met the inclusion criteria. Two themes were identified from these results: (1) managing withdrawal from medication-assisted treatment, and (2) facilitators and barriers to treatment programs in the criminal justice system. CONCLUSIONS Qualitative research evaluating access to SUD care in the US criminal justice system varied, with some interventions reported not rooted in evidence-based medicine. An opportunity may exist to develop best practices to ensure evidence-based treatment for SUDs is delivered to patients who need it in the US criminal justice system.
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Affiliation(s)
- Rachel E. Barenie
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Hilary Jasmin
- Department of Clinical Pharmacy and Translational Science, Health Sciences Library, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Phillip Knight
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Marie Chisholm-Burns
- School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
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Grella CE, Ostlie E, Watson DP, Scott CK, Carnevale J, Dennis ML. Scoping review of interventions to link individuals to substance use services at discharge from jail. J Subst Abuse Treat 2022; 138:108718. [PMID: 35012792 PMCID: PMC9167253 DOI: 10.1016/j.jsat.2021.108718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Individuals with substance use disorders (SUD) must be linked to community-based SUD treatment and other services upon their release from jail, given their high service needs and risks for relapse, recidivism, and opioid-related overdose following release. METHOD This scoping review identified 14 studies (28 affiliated publications) that used experimental or quasi-experimental designs to evaluate jail re-entry interventions for individuals with SUD. The team coded intervention components, study characteristics, and study outcomes based on a service continuum for treatment linkage and retention and for post-release substance use and criminal justice outcomes. RESULTS This review included 4 randomized controlled trials (RCT) for linkage to treatment with medications for opioid use disorder (MOUD); 4 RCTs and 4 quasi-experimental studies for linkage to non-specific SUD treatment; and 2 RCTs for linkage to HIV + SUD services. Most studies (9/14) used case management and/or peer or patient navigation as the core intervention; 2 studies provided medical management for MOUD induction and/or facilitated referral to MOUD in the community; and 3 studies used motivational-based linkage interventions. A qualitative analysis of study outcomes found evidence to support the effectiveness of a diverse range of interventions to link individuals to community-based SUD treatment, MOUD, and other services at re-entry, but limited support for intervention effects on longer-term outcomes, including treatment retention, medication adherence, recidivism, and substance use. CONCLUSION Future controlled trials and implementation studies should help to unpack and examine core components of jail re-entry interventions and their successful implementation to enhance treatment retention and improve post-release outcomes.
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Affiliation(s)
| | - Erika Ostlie
- Carnevale Associates LLC, 4 Belinder Rd., Gaithersburg, MD 20878, USA..
| | - Dennis P Watson
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA..
| | - Christy K Scott
- Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA..
| | - John Carnevale
- Carnevale Associates LLC, 4 Belinder Rd., Gaithersburg, MD 20878, USA..
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Taylor JL, Laks J, Christine PJ, Kehoe J, Evans J, Kim TW, Farrell NM, White CS, Weinstein ZM, Walley AY. Bridge clinic implementation of "72-hour rule" methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care. Drug Alcohol Depend 2022; 236:109497. [PMID: 35607834 DOI: 10.1016/j.drugalcdep.2022.109497] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Methadone for opioid use disorder (OUD) treatment is restricted to licensed opioid treatment programs (OTPs) with substantial barriers to entry. Underutilized regulations allow non-OTP providers to administer methadone for opioid withdrawal for up to 72 h while arranging ongoing care. Our low-barrier bridge clinic implemented a new pathway to treat opioid withdrawal and facilitate OTP linkage utilizing the "72-hour rule." METHODS Patients presenting to a hospital-based bridge clinic were evaluated for OUD, opioid withdrawal, and treatment goals. Eligible patients were offered methadone opioid withdrawal management with rapid OTP referral. OTPs accepted patients as direct admissions. We described bridge clinic patients who received at least one dose of methadone between March-August 2021 and key clinical outcomes including OTP referral completion within 72 h. For the subset of patients referred to our two primary OTP partners, we described OTP linkage (i.e., attended at least one OTP visit within one month) and OTP retention at one month. RESULTS Methadone was administered during 150 episodes of care for 142 unique patients, the majority of whom were male (73%), white (67%), and used fentanyl (85%). In 92% of episodes (138/150), a plan for ongoing care was in place within 72 h. Among 121 referrals to two primary OTP partners, 87% (105/121) linked and 58% (70/121) were retained at one month. CONCLUSIONS Methadone administration for opioid withdrawal with direct OTP admission under the "72-hour rule" is feasible in an outpatient bridge clinic and resulted in high OTP linkage and 1-month retention rates. This model has the potential to improve methadone access.
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Affiliation(s)
- Jessica L Taylor
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Jordana Laks
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Paul J Christine
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Jessica Kehoe
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - James Evans
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Theresa W Kim
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Natalija M Farrell
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA; Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Cedric S White
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
| | - Zoe M Weinstein
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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