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Vega G, Rivera-Berríos N, Camacho-Martínez V, Marty Lugo R, Albizu-García C. Community Corrections Officers' Perspectives of the Impact of Hurricane Maria on the Participant's Mental Health and Substance Use: A Qualitative Content Analysis. Disaster Med Public Health Prep 2023; 17:e510. [PMID: 37849348 PMCID: PMC10593498 DOI: 10.1017/dmp.2023.153] [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: 10/19/2023]
Abstract
OBJECTIVE This study explored community supervision officers' perceptions of the individual, community, and organizational challenges confronted by program participants after Hurricane María and their recommendations for future emergency management. METHODS A qualitative content analysis was conducted for nine focus group with community supervision officers in Puerto Rico. Participants were asked about their perceptions of how the mental health and drug abuse of persons on parole or probation were affected and the measures taken to address these concerns in disaster response. RESULTS Narratives expose vulnerabilities experienced by those supervised and the aggregated challenges that impact retention in health and rehabilitative services, all of which can detract from successful sentence completion. The disaster response categories call for a more adaptable approach to overseeing procedures in light of the difficulties involved and recognizing the support of the supervised population who have contributed to community initiatives. CONCLUSION Findings will contribute to informing planning, preparedness, and responses that mitigate the adverse consequences this vulnerable population may experience when exposed to future disaster hazards. Addressing emergency preparedness in this setting provides an opportunity to enact reforms in community supervision and improve access to services needed to enable the successful reintegration of individuals into their communities.
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Affiliation(s)
- Graciela Vega
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Nicole Rivera-Berríos
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Vilmary Camacho-Martínez
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - René Marty Lugo
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Carmen Albizu-García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, San Juan, Puerto Rico
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Milano N, Lister JJ, Victor G. Differences in intent to refer buprenorphine among community correctional and treatment staff: A set of cross-lagged models predicting efficacy beliefs and familiarity with buprenorphine for opioid use disorder. Am J Addict 2023; 32:352-359. [PMID: 36751913 DOI: 10.1111/ajad.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite high rates of individuals with opioid use disorder, community correctional agencies underutilize medications for opioid use disorder (MOUD). Knowledge about the mechanisms which motivate correctional employees to refer buprenorphine remains underdeveloped, and differences in these patterns by employee status are unknown. This study has two objectives: (1) investigate the presence of a reciprocal relationship between familiarity with buprenorphine and efficacy beliefs among community corrections and community treatment staff and (2) identify whether this relationship differs by staff status in referral intentions. METHODS Data were used from the Criminal Justice Drug Abuse Treatment Studies 2 (CJ-DATS 2) among correctional and treatment employees (N = 873). Four models investigated whether a reciprocal relationship existed between buprenorphine familiarity and efficacy beliefs. Then, the best fitting model was used to test the influence that prior training had on future referral intention through familiarity and efficacy beliefs among the analytic sample (n = 612), by comparing two separate structural equation models (SEMs) among correctional staff and treatment staff, respectively. RESULTS The fully cross-lagged model provided a significantly better fit to the data than other models (χ diff 2 ${\chi }_{\mathrm{diff}}^{2}$ (1) = 7.189, p < .01). The results of the multigroup SEM show that training had positive, indirect effects on future referral intentions that significantly differed between treatment and community correction staff. DISCUSSION AND CONCLUSIONS Findings show that training may influence correctional staff intent to refer individuals to receive buprenorphine through familiarity. SCIENTIFIC SIGNIFICANCE Tailored training for MOUD treatment for specific staff populations may prove more beneficial than existing approaches.
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Affiliation(s)
- Nicole Milano
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Jamey J Lister
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Grant Victor
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
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Booty MD, Harp K, Batty E, Knudsen HK, Staton M, Oser CB. Barriers and facilitators to the use of medication for opioid use disorder within the criminal justice system: Perspectives from clinicians. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209051. [PMID: 37084815 PMCID: PMC10198928 DOI: 10.1016/j.josat.2023.209051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/09/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION This study examines social service clinicians' (SSCs) perspectives of factors within the criminal justice system that impact justice-involved individuals' use of medications for opioid use disorder (MOUD). Opioid use disorder (OUD) rates are high among justice-involved individuals, and overdose risk is heightened upon release from incarceration. This study is innovative, as it specifically focuses on criminal justice contexts that influence the MOUD continuum of care from the perspective of clinicians working within the criminal justice system. Understanding criminal justice-related facilitators and barriers to MOUD treatment will guide tailored policy intervention to increase MOUD use and promote recovery and remission among justice-involved individuals. METHODS The study completed qualitative interviews with 25 SSCs who are employed by a state department of corrections to provide assessment and referrals to substance use treatment to individuals on community supervision. The study used NVivo software to code the major themes found within each transcribed interview; two research assistants participated in consensus coding to ensure consistency in coding across transcripts. This study focused on the secondary codes that fell under the "Criminal Justice System" primary code, as well as codes that indicated barriers and facilitators to MOUD treatment. RESULTS SSCs cited sentencing time credits as structural facilitators of MOUD treatment; clients sought more information about extended-release naltrexone since time off of their sentence was available if initiated. Support for extended-release naltrexone by officers and judges was often mentioned as an attitudinal facilitator of initiation. Poor intra-agency collaboration among department of corrections agents was an institutional barrier to MOUD. Also, probation and parole officers' stigma surrounding other types of MOUD, specifically buprenorphine and methadone, was an attitudinal barrier to MOUD within the criminal justice system. CONCLUSIONS Future research should examine the effect that time credits have on extended-release naltrexone initiation, considering the wide consensus among SSCs that their clients were motivated to initiate this type of MOUD because of the resulting time off their sentences. Stigma among probation and parole officers and lack of communication within the criminal justice system need to be addressed so that more individuals with OUD may be exposed to life-saving treatments.
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Affiliation(s)
- Marisa D Booty
- University of Kentucky College of Arts & Sciences, Department of Sociology, 1515 Patterson Office Tower, Lexington, KY 40506, United States of America.
| | - Kathi Harp
- University of Kentucky College of Public Health, Department of Health Management & Policy, 111 Washington Ave, Lexington, KY 40536, United States of America
| | - Evan Batty
- University of Kentucky College of Arts & Sciences, Department of Sociology, 1515 Patterson Office Tower, Lexington, KY 40506, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America
| | - Hannah K Knudsen
- University of Kentucky College of Medicine, Department of Behavioral Science, 109 Medical Behavioral Science Building, Lexington, KY 40536, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America
| | - Michele Staton
- University of Kentucky College of Medicine, Department of Behavioral Science, 109 Medical Behavioral Science Building, Lexington, KY 40536, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America
| | - Carrie B Oser
- University of Kentucky College of Arts & Sciences, Department of Sociology, 1515 Patterson Office Tower, Lexington, KY 40506, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America; University of Kentucky Center for Health Equity Transformation, Suite 460 Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY 40536, United States of America
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Moore KE, Johnson JE, Luoma JB, Taxman F, Pack R, Corrigan P, Hart J, Slone JD. A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol. HEALTH & JUSTICE 2023; 11:24. [PMID: 37184615 PMCID: PMC10184076 DOI: 10.1186/s40352-023-00224-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Stigma associated with substance use and criminal involvement is pervasive and creates a barrier to evidence-based addiction care within the criminal legal system. Research has yet to examine a multi-level stigma intervention which targets the intersection of these stigmas among both criminal legal staff and legally-involved clients. METHODS This paper presents the protocol for a non-randomized trial of a multi-level stigma intervention called Combatting Stigma to Aid Reentry and Recovery (CSTARR) that involves two interventions: (1) training for criminal legal staff to address public stigma and (2) group-based acceptance and commitment therapy to address self-stigma among legally-involved adults enrolled in substance use treatment. Staff and client participants are engaged with a program called the Tennessee Recovery Oriented Compliance Strategy in 6 East Tennessee counties. This study examines the feasibility, acceptability, and preliminary effectiveness of CSTARR using a type 1 hybrid implementation/effectiveness trial with pre to post follow-up. DISCUSSION Stigma must be addressed in the criminal legal system to facilitate the uptake of evidence-based addiction care. This study is the first to evaluate a stigma intervention designed for the criminal legal setting and results will be used to inform a larger, randomized controlled trial. The rationale for this study, research design and measures, as well as potential implications for the field are described. TRIAL REGISTRATION This clinical trial is registered at clinicaltrials.gov with the identifier NCT05152342. Registered 11/5/2021 at https://register. CLINICALTRIALS gov/prs/app/action/SelectProtocol?sid=S000BIN8&selectaction=Edit&uid=U0005X4C&ts=2&cx=-u3wsbx .
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN, 37614, USA.
| | - Jennifer E Johnson
- College of Human Medicine, Division of Public Health, Michigan State University, 200 E. 1St Street, Flint, MI, 48502, USA
| | - Jason B Luoma
- Portland Psychotherapy Institute, 3700 N Williams Ave., Portland, OR, 97227, USA
| | - Faye Taxman
- Schar School of Policy and Government, George Mason University, 3351 Fairfax Drive Van Metre Hall, Arlington, VA, 22201, USA
| | - Robert Pack
- College of Public Health, East Tennessee State University, 277 Lamb Hall, P.O. Box 70623, Johnson City, TN, 37614, USA
| | - Patrick Corrigan
- Department of Psychology, Llinois Institute of Technology, 3424 S State St., Chicago, IL, 60616, USA
| | - Jim Hart
- Tennessee Institute for Public Service, 1610 University Avenue, Knoxville, TN, 37921, USA
| | - Judge Duane Slone
- Fourth Judicial District of Tennessee, 854 South Hwy. 92, P.O. Box 858, Dandridge, TN, 37725, USA
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Staton M, Pike E, Tillson M, Lofwall MR. Facilitating factors and barriers for use of medications to treat opioid use disorder (MOUD) among justice-involved individuals in rural Appalachia. JOURNAL OF COMMUNITY PSYCHOLOGY 2023:10.1002/jcop.23029. [PMID: 36930568 PMCID: PMC10505241 DOI: 10.1002/jcop.23029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this qualitative study is to assess facilitating factors and barriers for medications to treat opioid use disorder (MOUD) initiation among justice-involved individuals in one rural Appalachian community, as well as how those factors may differ across the three types of Food and Drug Administration (FDA) approved medications. Qualitative interviews were conducted with rural justice-involved individuals (N = 10) with a history of opioid use in the target community. Overall, participants demonstrated knowledge of the different types of MOUD and their pharmacological properties, but limited overall health literacy around opioid use disorder and MOUD treatment. Treatment access was hampered by transportation, time burdens, and costs. Findings call for research into improving health literacy education, training, and resources to decrease stigma and increase access to MOUD, particularly in light of the ongoing opioid crisis. State policies also need to increase access to all FDA medications among justice-involved individuals, as well as supporting a care continuum from facility entry, release, and community re-entry.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
| | - Erika Pike
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY 40506-0027, USA
| | - Michelle R. Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
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Bailey A, Evans EA. Holyoke Early Access to Recovery and Treatment (HEART): A case study of a court-based intervention to reduce opioid overdose. J Ethn Subst Abuse 2023:1-23. [PMID: 36715087 PMCID: PMC10387124 DOI: 10.1080/15332640.2023.2172758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The District Court in Holyoke, Massachusetts, is among the first courts nationwide to provide access to medications for opioid use disorder (MOUD) and other treatment. The program uses an innovative multisectoral approach to serve a primarily Latinx population living in communities of concentrated poverty with high opioid overdose rates. We document the origins, adaptations, and current status of program operations, including the use of on-site peer recovery specialists and robust data collection efforts. From August 16, 2021, to February 28, 2022, of the 1040 individuals who entered the court for an arraignment, 47.9% (n = 498) were eligible for program participation. Of those 498 individuals, 54.2% (n = 270) spoke with a recovery specialist. Many self-identified as Latinx (53.0%) and male (69.3%). Over one-fourth (27.0%) were connected to a long-term peer recovery specialist and 11.5% were directly connected to a MOUD provider. Semi-structured interviews with key implementers and participants revealed a shared appreciation for the life-saving efforts of the program. We conclude with practical and theoretical considerations required to offer linkage to MOUD in court-based contexts. Future efforts will assess participant outcomes to determine whether the program is an effective and feasible intervention that can be adopted by other court-based settings.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst
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Medications for Opioid Use Disorder During Incarceration. J Addict Nurs 2022; 33:182-190. [DOI: 10.1097/jan.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moore KE, Siebert SL, Kromash R, Owens MD, Allen DC. Negative attitudes about medications for opioid use disorder among criminal legal staff. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100056. [PMID: 36845981 PMCID: PMC9948914 DOI: 10.1016/j.dadr.2022.100056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Stigma is a barrier to the treatment of opioid use disorder (OUD) in the criminal legal system. Staff sometimes have negative attitudes about medications for OUD (i.e., MOUD), but there is little research on what drives these attitudes. How staff think about criminal involvement and addiction may explain their attitudes toward MOUD. METHODS A convenience sample of U.S. criminal legal staff (e.g., correctional/probation officers, nurses, psychologists, court personnel) were recruited via online methods (N = 152). Participants completed an online survey of their attitudes about justice-involved people and addiction, and these were entered as predictors of an adapted version of the Opinions about Medication Assisted Treatment survey (OAMAT) in a linear regression, controlling for sociodemographics (cross-sectional design). RESULTS At the bivariate level, measures capturing more stigmatizing attitudes toward justice-involved people, believing addiction represents a moral weakness, and believing people with addiction are responsible for their actions and their recovery were related to more negative attitudes about MOUD, whereas higher educational attainment and believing addiction has a genetic basis were related to more positive attitudes about MOUD. In a linear regression, only stigma toward justice-involved people significantly predicted negative attitudes about MOUD (B = -.27, p = .010). CONCLUSION Criminal legal staff's stigmatizing attitudes about justice-involved people, such as believing they are untrustworthy and cannot be rehabilitated, contributed significantly to negative attitudes about MOUD, above their beliefs about addiction. The stigma tied to criminal involvement needs to be addressed in attempts to increase MOUD adoption in the criminal legal system.
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Shania L Siebert
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Rachelle Kromash
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Mandy D Owens
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Diamond C Allen
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
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Pivovarova E, Evans EA, Stopka TJ, Santelices C, Ferguson WJ, Friedmann PD. Legislatively mandated implementation of medications for opioid use disorders in jails: A qualitative study of clinical, correctional, and jail administrator perspectives. Drug Alcohol Depend 2022; 234:109394. [PMID: 35349918 PMCID: PMC9169252 DOI: 10.1016/j.drugalcdep.2022.109394] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with legal involvement and opioid use disorders (OUD) are at an increased risk of overdose and premature death. Yet, few correctional systems provide all FDA approved medications for OUD (MOUD) to all qualifying incarcerated individuals. We report on the implementation of MOUD in seven Massachusetts' jails following a state legislative mandate to provide access to all FDA-approved MOUD and to connect with treatment upon release. METHODS/PARTICIPANTS Based on the Exploration, Preparation, Implementation, and Sustainment framework, 61 clinical, corrections, and senior jail administrators participated in semi-structured interviews and focus groups between December 2019 and January 2020. Qualitative analyses focused on external and internal contexts and bridging factors. FINDINGS Participants detailed how the outer context (i.e., legislative mandate) drove acceptance of MOUD and assisted with continuity of care. Salient inner context factors included decision-making around administration of agonist medications, staff perceptions and training, and changes to infrastructure and daily routines. Leadership was critical in flattening standard hierarchies and advocating for flexibility. System-based characteristics of incarcerated individuals, specifically those who were pre-sentenced, presented challenges with treatment initiation. Inter- and intra-agency bridging factors reduced duplication of effort and led to quick, innovative solutions. CONCLUSIONS Implementation of MOUD in jails requires collaboration with and reliance on external agencies. Preparation for implementation should involve systematic reviews of available resources and connections. Implementation requires flexibility from institutional systems that are inherently rigid. Accordingly, leaders and policymakers must recognize the cultural shift inherent in such programs and allow for resources and education to assure program success.
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Affiliation(s)
- Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Claudia Santelices
- Claudia Santelices, Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Boston MA, 02115, USA
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School (UMCMS) - Baystate and Baystate Health, 3601 Main Street, Springfield, MA 01107, 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 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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Andraka-Christou B, Clark MH, Atkins DN, del Pozo B. Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder. Subst Abuse 2022; 43:425-432. [PMID: 34236297 PMCID: PMC9518695 DOI: 10.1080/08897077.2021.1944958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Criminal problem-solving courts and civil dependency courts often have participants with substance use disorder (SUD), including opioid use disorder (OUD). These courts refer participants to treatment and set treatment-related requirements for court participants to avoid incarceration or to regain custody of children. Medications for opioid use disorder (MOUD) are the most effective treatment for OUD but are underutilized by court system participants. Little is known about variation in court policies for different MOUDs. Also, more information is needed about types of policies for each MOUD, including whether participants may begin MOUD, continue previously begun MOUD, or complete the court program with MOUD. Methods: An online survey was distributed to criminal problem-solving and civil dependency judges in Florida in 2019 and 2020, yielding data from 58 judges (a 24% response rate). We used nonparametric statistics to test hypotheses with ordinal data. A Friedman's test for related samples or Cochran's Q was used to make within-group comparisons between policies and MOUDs. Results: We found considerable policy variation, with more permissive policies for naltrexone than buprenorphine or methadone, and more permissive policies for continuing MOUD than for initiating MOUD or completing a court program with MOUD. For each medication, less than one quarter of judges indicated their court always permits MOUD, with most indicating that MOUD is permitted sometimes or usually. Conclusion: Because respondents rarely chose "never" or "always" for any MOUD policy, most courts appear to be making MOUD decisions on a case-by-case basis. A clearer understanding of this decision-making process is needed. Some court participants may be required to discontinue MOUD before completing a court program, even if they were permitted to start or continue MOUD treatment. Discontinuation of MOUD without medical justification is contrary to the standard of care for individuals with OUD and increases their risk of overdose.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA,Department of Internal Medicine (Joint Secondary Appointment), University of Central Florida, Orlando, FL, USA
| | - MH Clark
- Department of Learning Sciences and Educational Research, University of Central Florida, Orlando, FL, USA
| | - Danielle N. Atkins
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| | - Brandon del Pozo
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Shin SH, Bouchard LM, Montemayor B. An Exploration of Practitioners' Perceptions and Beliefs About Trauma-Informed Youth Drug Prevention Programs: a Qualitative Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:636-647. [PMID: 34714501 DOI: 10.1007/s11121-021-01300-0] [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] [Accepted: 09/14/2021] [Indexed: 01/14/2023]
Abstract
Adverse childhood experiences (ACEs), such as childhood maltreatment and household dysfunction, have been linked to adolescent substance use. As a result, there exists a pressing need for trauma-informed, substance use preventive intervention for adolescents with a history of ACEs. The primary aim of this qualitative study is to increase our understanding of practitioners' perceptions of substance use among ACE-exposed youth and their views on trauma-informed adolescent substance use prevention programs. The present study conducted six focus groups (N = 32) among current child and adolescent health and human service providers in a mid-Atlantic urban area. The focus groups explored the practitioners' views on the main reasons that youth with a history of ACEs use illicit substances and suggestions on components, constructs, or techniques of trauma-informed substance use prevention programs and perceived barriers in implementing such programs. Transcripts of the focus groups were analyzed using open coding and subsequent axial coding, which was followed by thematic analysis. Thematic analysis identified ten themes within three categories, including the etiology of substance use among ACE-exposed youth, barriers to preventing substance use among ACEs-exposed youth, and suggested program components for trauma-informed prevention programs. These findings provide support for developing a preventive intervention that addresses trauma symptoms and overall skill buildings to prevent substance use among ACE-exposed youth. Teaching skills to cope with trauma symptoms, enhancing knowledge about the signs and symptoms of trauma, and improving key social and emotional learning competencies might be important and effective strategies to curb substance use among ACE-exposed youth.
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Affiliation(s)
- Sunny H Shin
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA. .,Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
| | - Leah M Bouchard
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
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Kennedy-Hendricks A, Bandara S, Merritt S, Barry CL, Saloner B. Structural and organizational factors shaping access to medication treatment for opioid use disorder in community supervision. Drug Alcohol Depend 2021; 226:108881. [PMID: 34218008 DOI: 10.1016/j.drugalcdep.2021.108881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Four million individuals in the U.S. criminal-legal system are supervised in the community under probation or parole. Sentences to community supervision often mandate participation in substance use treatment. Yet evidence-based treatment with medication (i.e., methadone, buprenorphine, or naltrexone) is rarely offered to people under community supervision with opioid use disorder (OUD). This qualitative study explores the structural and organizational factors shaping OUD medication treatment use in community supervision. METHODS We conducted in-depth interviews with 31 community supervision professionals. Thematic analysis characterized interview participants' perceptions of the key factors shaping use of OUD medications in community supervision. FINDINGS Findings indicate that authorities making decisions about OUD treatment include community supervision agencies, treatment providers, judges and courts, and jails and prisons. Agencies with more rehabilitative cultural orientations are more forgiving of relapse and supportive of OUD medications. Punishment/enforcement orientations align with an emphasis on surveillance and drug testing, which can inhibit medication treatment and interrupt continuity of care. Community supervision agencies generally reported deference to the recommendations of substance use treatment providers regarding the details of treatment, including the use of medication. Given that most treatment providers do not offer OUD medication, community supervision agencies must develop a sophisticated understanding of the various services offered by local treatment providers to tailor referrals accordingly, a responsibility for which they may be inadequately trained. CONCLUSIONS Efforts to improve engagement with medication treatment in U.S. community supervision settings could have a significant impact on reincarceration, morbidity, and mortality among individuals with OUD under supervision.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA; Johns Hopkins Center for Mental Health and Addiction Policy, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Sachini Bandara
- Johns Hopkins Center for Mental Health and Addiction Policy, 624 North Broadway, Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Sydney Merritt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Colleen L Barry
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA; Johns Hopkins Center for Mental Health and Addiction Policy, 624 North Broadway, Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA; Johns Hopkins Center for Mental Health and Addiction Policy, 624 North Broadway, Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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Scott CK, Dennis ML, Grella CE, Mischel AF, Carnevale J. The impact of the opioid crisis on U.S. state prison systems. HEALTH & JUSTICE 2021; 9:17. [PMID: 34304335 PMCID: PMC8310396 DOI: 10.1186/s40352-021-00143-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/28/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). METHODS A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. RESULTS MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. CONCLUSION Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.
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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
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15
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Wen H, Druss BG, Saloner B. Self-Help Groups And Medication Use In Opioid Addiction Treatment: A National Analysis. Health Aff (Millwood) 2021; 39:740-746. [PMID: 32364856 DOI: 10.1377/hlthaff.2019.01021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Self-help groups and medications (buprenorphine, methadone, and naltrexone) both play important roles in opioid addiction treatment. The relative use of these two treatment modalities has not been characterized in a national study. Using national treatment data, we found that self-help groups were rarely provided in conjunction with medication treatment: Among all adult discharges from opioid addiction treatment in the period 2015-17, 10.4 percent used both self-help groups and medications, 29.2 percent used only medications, 29.8 percent used only self-help groups, and 30.5 percent used neither self-help groups nor medications. Use of self-help groups without medication is most common in residential facilities, among those with criminal justice referrals, and among uninsured or privately insured patients, as well as in the South and West regions of the US. These subgroups may be important targets for future efforts to identify and overcome barriers to medication treatment and create multimodal paths to recovery.
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Affiliation(s)
- Hefei Wen
- Hefei Wen ( hefei_wen@hphci. harvard. edu ) is a faculty member in the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts
| | - Benjamin G Druss
- Benjamin G. Druss is the Rosalynn Carter Chair and a professor in the Department of Health Policy and Management, Emory University Rollins School of Public Health, in Atlanta, Georgia
| | - Brendan Saloner
- Brendan Saloner is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
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16
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Grella CE, Ostlie E, Scott CK, Dennis ML, Carnevale J, Watson DP. A scoping review of factors that influence opioid overdose prevention for justice-involved populations. Subst Abuse Treat Prev Policy 2021; 16:19. [PMID: 33618744 PMCID: PMC7898779 DOI: 10.1186/s13011-021-00346-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a high risk of death from opioid overdose following release from prison. Efforts to develop and implement overdose prevention programs for justice-involved populations have increased in recent years. An understanding of the gaps in knowledge on prevention interventions is needed to accelerate development, implementation, and dissemination of effective strategies. METHODS A systematic search process identified 43 published papers addressing opioid overdose prevention in criminal justice settings or among justice-involved populations from 2010 to February 2020. Cross-cutting themes were identified, coded and qualitatively analyzed. RESULTS Papers were coded into five categories: acceptability (n = 8), accessibility (n = 4), effectiveness (n = 5), feasibility (n = 7), and participant overdose risk (n = 19). Common themes were: (1) Acceptability of naloxone is associated with injection drug use, overdose history, and perceived risk within the situational context; (2) Accessibility of naloxone is a function of the interface between corrections and community; (3) Evaluations of overdose prevention interventions are few, but generally show increases in knowledge or reductions in opioid overdose; (4) Coordinated efforts are needed to implement prevention interventions, address logistical challenges, and develop linkages between corrections and community providers; (5) Overdose is highest immediately following release from prison or jail, often preceded by service-system interactions, and associated with drug-use severity, injection use, and mental health disorders, as well as risks in the post-release environment. CONCLUSION Study findings can inform the development of overdose prevention interventions that target justice-involved individuals and policies to support their implementation across criminal justice and community-based service systems.
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Affiliation(s)
| | - Erika Ostlie
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 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
| | - Dennis P. Watson
- Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
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17
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Staton M, Knudsen HK, Walsh SL, Oser C, Pike E, Lofwall M. Adaptation of a standard extended-release naltrexone (XR-NTX) protocol for rural re-entering offenders with OUD. HEALTH & JUSTICE 2021; 9:4. [PMID: 33547578 PMCID: PMC7864137 DOI: 10.1186/s40352-021-00130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite a growing body of empirical support for the effectiveness of extended-release naltrexone (XR-NTX) to reduce opioid relapse among people with opioid use disorder (OUD) transitioning from a correctional facility to the community, continuity of care following release remains challenging. This paper describes a research-based adaptation of a state's standard of care XR-NTX protocol using the ADAPT-ITT framework for delivery in a non-traditional, non-treatment, community criminal justice setting (P&P office), as well as the expansion of services by a local Federally Qualified Health Center (FQHC) provider who would, for the first time, be going to the jail and P&P office to provide XR-NTX and related treatment. METHOD The present study focuses on the first seven phases (Assessment through Training) of the ADAPT-ITT framework in the adaptation of the Department of Corrections (DOC) protocol in preparation for a pilot trial for induction in a rural jail and during the transition to a rural community. Expert clinical review and focus groups with key stakeholders in criminal justice supervision and the local providers in the FQHC informed the needed adaptations to the existing XR-NTX protocol for initiation at the jail and ongoing administrations in the community. RESULTS Findings from stakeholder focus groups, study team review, topical expert review, and a theater test suggested that there were critical adaptations needed in both content and context at the patient and clinic level. CONCLUSION Health and justice officials should consider the need to tailor and adapt evidence-based approaches for real-world locations that high-risk, justice-involved individuals visit in order to reduce barriers and increase access to critically needed treatment for OUD.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA.
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA.
| | - Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - Carrie Oser
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY, 40506-0027, USA
| | - Erika Pike
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - Michelle Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY, 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
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18
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Teeters JB, Woodward MJ, Meshesha LZ, Tripp JC. Cannabis use in civilian college students and college student service members/veterans: the moderating effect of anxiety. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:777-783. [PMID: 32469609 DOI: 10.1080/00952990.2020.1753758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Cannabis is the most commonly used illicit drug on college campuses. Research suggests that Student Service Members/Veterans (SSM/V) may be more likely to use alcohol than civilian students, but little research has focused on cannabis use in these two samples. Objectives: The purpose of the current study was to compare cannabis use frequency, cannabis use disorder (CUD) symptoms, and cannabis-related problems between civilian students and SSM/V. A second aim was to determine if group differences in these outcomes were moderated by symptoms of depression, stress, or anxiety. Methods: The sample included 164 college SSM/V (80.4% female, 19.6% male) and 456 civilian (78% female, 22% male) college students. Participants completed an online survey assessing demographics, number of days of past month cannabis use, cannabis-related problems, CUD symptoms, and a measure of anxiety, depression, and stress. Results: Negative binomial regressions indicated no significant differences in number of days of past-month cannabis use or past-year cannabis-related problems between civilian students and SSM/V, although SSM/V reported more past-year CUD symptoms. Moderation analyses revealed that at elevated levels of anxiety, SSM/V students used cannabis more frequently than civilian students. Conclusion: These findings indicate that when experiencing elevated levels of anxiety, SSM/V use cannabis more frequently than civilian students, suggesting that anxiety may be a more prominent risk factor for frequency of cannabis use for SSM/V compared to civilian students. Education, prevention, and intervention efforts specifically addressing anxiety in this demographic are needed.
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Affiliation(s)
- Jenni B Teeters
- Department of Psychological Sciences, aWestern Kentucky University , Bowling Green, KY, USA
| | - Matthew J Woodward
- Department of Psychological Sciences, aWestern Kentucky University , Bowling Green, KY, USA
| | - Lidia Z Meshesha
- Center for Alcohol and Addiction Studies, Brown University School of Public Health , Providence, RI, USA
| | - Jessica C Tripp
- VA San Diego Healthcare System , San Diego, CA, USA.,School of Medicine, University of California , San Diego, CA, USA
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19
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Pivovarova E, Min HS, Friedmann PD. Impact of extended release naltrexone on health-related quality of life in individuals with legal involvement and opioid use disorders. Subst Abus 2020; 42:618-624. [PMID: 32870122 DOI: 10.1080/08897077.2020.1809603] [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: 10/23/2022]
Abstract
BACKGROUND Understanding the impact of medications for opioid use disorder on health related quality of life (QOL) may help to explain why few individuals with legal involvement remain in treatment, specifically those receiving opioid antagonists. QOL is an established predictor of treatment retention and has been shown to improve with some treatment for opioid use disorder. Yet limited research has examined QOL with opioid antagonists. We examined the impact of extended release naltrexone (XR-NTX) on QOL and retention in treatment in a randomized, multi-site trial of individuals with legal involvement. Methods: The participants were 308 community-dwelling adults with current or recent legal involvement with opioid dependence at five site across United States. They were randomized to receive XR-NTX or treatment as usual for 6 months. QOL was measured every 2 weeks using Euro QOL individual items, summary index score, and health state today metric. Results: No significant difference in QOL scores were observed between the two groups at the completion of active treatment or on follow up at 52 and 78 weeks. There were no time effects of treatment on scores. Contrary to expectation, baseline and average QOL did not predict retention in treatment. Conclusion: In contrast to prior research, our findings did not demonstrate significant changes (improvements or decreases) in QOL associated with XR-NTX treatment. Clinicians may consider that individuals receiving XR-NTX may not experience changes in perceived well-being in response to treatment and consider discussing with patients that they may not necessarily perceive improvement in their QOL. This may help to ground patient's expectations about the effects of treatment and potentially reduce attrition from treatment with opioid antagonists.
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Affiliation(s)
- Ekaterina Pivovarova
- Department of Family Medicine & Community Health and Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Massachusetts Center of Excellence for Specialty Courts, Shrewsbury, Massachusetts, USA
| | - Hye Sung Min
- Department of Population Health and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Peter D Friedmann
- Department of Population Health and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA.,Baystate Health, Springfield, Massachusetts, USA
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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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Böhmer K, Schecke H, Render I, Scherbaum N. Implementation of opioid maintenance treatment in prisons in North Rhine-Westphalia, Germany - a top down approach. Subst Abuse Treat Prev Policy 2020; 15:21. [PMID: 32156295 PMCID: PMC7065365 DOI: 10.1186/s13011-020-00262-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid Maintenance Treatment (OMT) is a well-evaluated treatment of opioid use disorder (OUD). Especially, under the condition of imprisonment, OMT is a preventive measure regarding infectious diseases such as hepatitis C. However, only a minority of prisoners with OUD are currently in OMT in numerous countries. In 2009, the Ministry of Justice of the federal state of North Rhine-Westphalia (NRW), Germany, launched the process of implementing OMT in prisons with various elements (e.g. development of recommendations regarding the treatment of prisoners with OUD, monitoring the number of prisoners in OMT, education of prison doctors). In the recommendations OMT was defined as the gold standard of treatment of OUD. METHODS To assess the effectiveness of the implementation strategy a survey on the prevalence of OMT in prisons in NRW was carried out twice a year by the Ministry of Justice between 2008 and 2016. Participants were prisoners in NRW, Germany. The diagnosis of OUD at admission to prison and the treatment state on survey dates was measured. RESULTS The number of prisoners in NRW dropped from 17,301 in 2008 to 16,432 in 2016. In the same period, the number of prisoners with OUD (mainly males) dropped from 4201 persons to 3650 persons and the number of prisoners in OMT increased from 139 persons (3.3%) to 1415 (38.7%) persons. DISCUSSION Currently, the percentage of prisoners with OUD in OMT in NRW is almost reaching the treatment rate outside prisons in Germany (45-50%). However, after release from prison there is still a high risk for a discontinuation of OMT. CONCLUSIONS Overall, the top-down approach of implementing OMT in prisons in the federal state of NRW was effective.
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Affiliation(s)
- Kathrin Böhmer
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45 147, Essen, Germany.
| | - Henrike Schecke
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45 147, Essen, Germany
| | - Irmgard Render
- Ministry of Justice of North-Rhine Westphalia, Düsseldorf, Germany
| | - Norbert Scherbaum
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45 147, Essen, Germany
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22
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State criminal justice policy context and opioid agonist treatment delivery among opioid treatment admissions, 2015. Drug Alcohol Depend 2020; 206:107654. [PMID: 31735533 PMCID: PMC7377924 DOI: 10.1016/j.drugalcdep.2019.107654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Criminal justice referral to treatment is associated with reduced odds of receiving opioid agonist treatment (OAT), the gold-standard treatment for opioid use disorder. States vary substantially in the extent of criminal justice system involvement in opioid treatment; however, the effects on treatment provision are not clear. We examined whether state-level criminal justice involvement in the substance use treatment system modified the association between criminal justice referral to treatment and OAT provision among opioid treatment admissions. METHODS We conducted a random effects logistic regression to investigate how the effects of criminal justice referral to treatment on OAT provision differed in states with high vs. low state-level criminal justice involvement in opioid treatment, adjusting for individual and state-level covariates, among 22 states in the 2015 Treatment Episode Dataset-Admissions. RESULTS Criminal justice referral to treatment was associated with an 85% reduction in the odds of receiving OAT, compared to other sources of treatment referral (OR = 0.15; 95% CI: 0.15, 0.16). Among opioid treatment admissions resulting from criminal justice referral in 2015, receiving treatment in high criminal justice involvement states was associated with a 63% reduction in the odds of OAT provision, compared to opioid treatment received in low criminal justice involvement states (interaction OR = 0.37, 95% CI: 0.11, 0.89). CONCLUSION The effects of criminal justice referral to treatment on OAT provision varied by criminal justice involvement in opioid treatment at the state level. Targeted interventions should increase access to OAT in states that rely on the criminal justice system for opioid treatment referrals.
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23
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Buadze A, Baggio S, Schleifer R, Aeberhard E, Wolff H, Schneeberger A, Liebrenz M. The Accessibility of Opioid Agonist Treatment and Its Forced Discontinuation in Swiss Prisons-Attitudes, Perceptions and Experiences of Defense Lawyers in Dealing With Detained Persons Using Opioids. Front Psychiatry 2020; 11:395. [PMID: 32477183 PMCID: PMC7240251 DOI: 10.3389/fpsyt.2020.00395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opioid agonist treatment (OAT) is an important pillar in the treatment of individuals using opioids and its continuation during imprisonment is recommended. Despite this knowledge access to and continuation of OAT is still limited in many countries. The forced discontinuation during pre-trial detention can cause severe withdrawal symptoms, which in turn may significantly impair the defendant's ability to exercise granted procedural participation rights. Furthermore, it can be argued that forced discontinuation of a desired treatment represents a form of a compulsory intervention. AIMS The present study was developed against the backdrop of a recent ruling by the European Court of Human Rights (Wenner vs. Germany). It intended to examine how defense lawyers dealing with detained persons using opioids view and assess the accessibility of OAT in pre-trial detention as well as during imprisonment in different parts of Switzerland. METHODS Using a qualitative approach, we interviewed 11 defense lawyers from three different cantons of Switzerland with multiple years of experience in providing legal representation to more than 220 defendants using heroin. The interviews were analyzed with QSR NVIVO 11 for Windows. A qualitative content analysis approach was used to evaluate findings. RESULTS Defenders who had been exposed to the opioid crisis during the course of their legal career had adopted a positive attitude towards OAT and associated it with a stabilizing influence on their clients, an improvement in criminal prognosis, and a reduction in recidivism. They were generally of the opinion that access to OAT had improved, however identified a considerable variance in different penitentiaries, which were mediated by attitudes of staff and authorities. Based on the assessments of the defense lawyers, it can be estimated that the initiation of OAT especially during pre-trial detention is challenging. The predominant aim of OAT in a variety of Swiss prisons still seems to focus on a discontinuation, mediated by a forced reduction of medication. Some of the interventions reported are not in line with the principle of equivalence and strongly contrast the recommendations of the Council of Europe.
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Affiliation(s)
- Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Baggio
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.,Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Office of Corrections, Canton of Zurich, Zurich, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Eveline Aeberhard
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Andres Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Psychiatrische Dienste Graubuenden, Chur, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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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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Reichert J, Gleicher L. Probation clients' barriers to access and use of opioid use disorder medications. HEALTH & JUSTICE 2019; 7:10. [PMID: 31139961 PMCID: PMC6717960 DOI: 10.1186/s40352-019-0089-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/30/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND There is a gap between evidence-based treatment with medications for opioid use disorders (OUDs) and current practices of probation departments who supervise individuals with OUDs. Many probationers with OUDs cannot access FDA-approved medications to treat their disorders despite the strong evidence of their effectiveness. The barriers to medications for those under probation supervision include practitioners' negative attitudes toward medications, costs, stigma, and diversion risk. Probation officers have an ethical obligation to help their clients reduce barriers to access the care they need which in turn can improve their outcomes and increase public safety. RESULTS The current study explores how probation departments respond to probationers with OUDs, focusing on the barriers to accessing OUD medications based on a survey of probation department directors/administrators (hereafter referred to as probation department leaders) in Illinois (N = 26). A majority of probation department leaders reported perceived staff barriers to their clients accessing medications. Reasons included lack of medical personnel experience, cost, need for guidance on medications, and regulations set by their organization or jurisdiction that prohibit client use of medications. Probation department leaders reported knowing less about the use of methadone and how it is administered, compared to buprenorphine and naltrexone. In addition, probation department leaders were generally more open to referring clients for treatment that include buprenorphine or naltrexone compared to methadone. Despite slightly less training or familiarity with methadone than the other medications, the number of probation department leaders who knew where to refer someone for each of the three FDA-approved medications was similar. CONCLUSIONS The current study found probation department leaders perceive some barriers to their staff linking or referring their clients to OUD medications. Study findings indicate a need for administration- and staff-level training, interagency collaboration, and policy changes to increase access to, education on, and use of, medications for probation clients. Such efforts will ultimately help probation clients with OUDs stabilize and adhere to other probation requirements and engage in behavioral therapy, which may result in positive outcomes such as reduced recidivism, increased quality of life, and reduced mortality.
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Affiliation(s)
- Jessica Reichert
- Illinois Criminal Justice Information Authority, Center for Justice Research and Evaluation, 300 W. Adams St., Suite 200, Chicago, IL 60606 USA
| | - Lily Gleicher
- Illinois Criminal Justice Information Authority, Center for Justice Research and Evaluation, 300 W. Adams St., Suite 200, Chicago, IL 60606 USA
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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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Streisel SE. Intent to Refer: Exploring Bias Toward Specific Medication-Assisted Treatments by Community Corrections Employees. Subst Use Misuse 2018; 53:2421-2430. [PMID: 29958042 DOI: 10.1080/10826084.2018.1482346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND As opioid use increases in the United States, especially in the correctional population, the most effective treatment approaches need to be utilized. Research has shown that medication-assisted treatment (MAT) provides better outcomes than traditional treatment approaches alone, but is underutilized among correctional-supervised populations. OBJECTIVE This article looks at how previously identified barriers to implementing MAT can create potential biases regarding the intent to refer individuals to either buprenorphine or methadone among treatment and correctional staff within community corrections. The varying advantages of each medication are discussed to highlight the importance of individualized treatment planning. METHODS Data were collected from 959 treatment specialists and community-corrections officers between 2010 and 2013. The participants were employed by one of 20 community corrections agencies that were selected and randomized within a cluster design. The data were part of a larger study that tested how the experimental condition of organizational linkages impacted the use of MAT in the criminal justice system. In order to analyze the data, multinomial logistic regression was used. RESULTS Results showed that some community corrections employees were likely to refer clients to use methadone, but not buprenorphine (or vice versa) which was influenced by work setting, level of education, training, and negative perceptions of MAT as a substitute addiction. However, these biases could be minimized by proper training. CONCLUSION These findings suggest that proper training should be mandatory for these employees and include information about various MATs while also addressing the negative perception that MAT is a substitute addiction.
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Affiliation(s)
- S E Streisel
- a Department of Sociology and Criminal Justice , University of Delaware , Newark , Delaware , USA
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28
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Schwartz RP, Mitchell MM, O’Grady KE, Kelly SM, Gryczynski J, Mitchell SG, Gordon MS, Jaffe JH. Pharmacotherapy for opioid addiction in community corrections. Int Rev Psychiatry 2018; 30:117-135. [PMID: 30522370 PMCID: PMC6551322 DOI: 10.1080/09540261.2018.1524373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/11/2018] [Indexed: 10/27/2022]
Abstract
Pharmacotherapy for opioid addiction with methadone, buprenorphine, and naltrexone has proven efficacy in reducing illicit opioid use. These treatments are under-utilized among opioid-addicted individuals on parole, probation, or in drug courts. This paper examines the peer-reviewed literature on the effectiveness of pharmacotherapy for opioid addiction of adults under community-based criminal justice supervision in the US. Compared to general populations, there are relatively few papers addressing the separate impact of pharmacotherapy on individuals under community supervision. Tentative conclusions can be drawn from the extant literature. Reasonable evidence exists that illicit opioid use and self-reported criminal behaviour decline after treatment entry, and that these outcomes are as favourable among individuals under criminal justice supervision as the general treatment population. Surprisingly, there is no conclusive evidence regarding the extent to which pharmacotherapy impacts the likelihood of arrest and incarceration among individuals under supervision. However, given the proven efficacy of these three medications in reducing illicit opioid use and the evidence that, in the general population, methadone and buprenorphine treatment are associated with reduction in overdose mortality, the use of all three pharmacotherapies among patients under criminal justice supervision should be expanded while more data are collected on their impact on arrest and incarceration.
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Affiliation(s)
| | | | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Bhugra D. Italian psychiatry. Int Rev Psychiatry 2018; 30:117. [PMID: 29757030 DOI: 10.1080/09540261.2018.1435761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Dinesh Bhugra
- a Institute of Psychiatry , King's College London , London , UK.,b Past President of World Psychiatric Association , Switzerland
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30
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Extended-release naltrexone and drug treatment courts: Policy and evidence for implementing an evidence-based treatment. J Subst Abuse Treat 2018; 85:101-104. [DOI: 10.1016/j.jsat.2017.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 11/20/2022]
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Sharma A, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Schwartz RP. Update on Barriers to Pharmacotherapy for Opioid Use Disorders. Curr Psychiatry Rep 2017; 19:35. [PMID: 28526967 PMCID: PMC7075636 DOI: 10.1007/s11920-017-0783-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The recent heroin and prescription opioid misuse epidemic has led to a sharp increase in the number of opioid overdose deaths in the USA. Notwithstanding the availability of three FDA-approved medications (methadone, buprenorphine, and naltrexone) to treat opioid use disorder, these medications are underutilized. This paper provides an update from the recent peer-reviewed literature on barriers to the use of these medications. FINDINGS These barriers are interrelated and can be categorized as financial, regulatory, geographic, attitudinal, and logistic. While financial barriers are common to all three medications, other barriers are medication-specific. The adverse impact of the current opioid epidemic on public health can be reduced by increasing access to effective pharmacotherapy for opioid use disorder.
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Affiliation(s)
- Anjalee Sharma
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Sharon M Kelly
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Jan Gryczynski
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.
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Blum K, Febo M, Fried L, Li M, Dushaj K, Braverman ER, McLaughlin T, Steinberg B, Badgaiyan RD. Hypothesizing That Neuropharmacological and Neuroimaging Studies of Glutaminergic-Dopaminergic Optimization Complex (KB220Z) Are Associated With "Dopamine Homeostasis" in Reward Deficiency Syndrome (RDS). Subst Use Misuse 2017; 52:535-547. [PMID: 28033474 PMCID: PMC5589271 DOI: 10.1080/10826084.2016.1244551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is need for better treatments of addictive behaviors, both substance and non-substance related, termed Reward Deficiency Syndrome (RDS). While the FDA has approved pharmaceuticals under the umbrella term Medication Assisted Treatment (MAT), these drugs are not optimal. OBJECTIVES It is our contention that these drugs work well in the short-term by blocking dopamine function leading to psychological extinction. However, use of buprenorphine/Naloxone over a long period of time results in unwanted addiction liability, reduced emotional affect, and mood changes including suicidal ideation. METHODS We are thus proposing a paradigm shift in addiction treatment, with the long-term goal of achieving "Dopamine Homeostasis." While this may be a laudable goal, it is very difficult to achieve. Nevertheless, this commentary briefly reviews past history of developing and subsequently, utilizing a glutaminergic-dopaminergic optimization complex [Kb220Z] shown to be beneficial in at least 20 human clinical trials and in a number of published and unpublished studies. RESULTS It is our opinion that, while additional required studies could confirm these findings to date, the cited studies are indicative of achieving enhanced resting state functional connectivity, connectivity volume, and possibly, neuroplasticity. Conclusions/Importance: We are proposing a Reward Deficiency Solution System (RDSS) that includes: Genetic Addiction Risk Score (GARS); Comprehensive Analysis of Reported Drugs (CARD); and a glutaminergic-dopaminergic optimization complex (Kb220Z). Continued investigation of this novel strategy may lead to a better-targeted approach in the long-term, causing dopamine regulation by balancing the glutaminergic-dopaminergic pathways. This may potentially change the landscape of treating all addictions leading us to the promised land.
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Affiliation(s)
- Kenneth Blum
- a Department of Psychiatry & McKnight Brain Institute , University of Florida College of Medicine , Gainesville , Florida , USA.,b Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA.,c Department of Clinical Neurology , PATH Foundation NY , New York , New York , USA.,d Human Integrated Services Unit , University of Vermont Centre for Clinical & Translational Science , Burlington , Vermont , USA.,e Division of Addiction Services , Dominion Diagnostics, LLC , North Kingstown , Rhode Island , USA.,f Division of Neuroscience-Based Therapy , Summit Estate Recovery Center , Los Gatos , California , USA.,g Division of Neuroscience Research and Addiction Therapy , The Shores Treatment and Recovery Center , Port Saint Lucie , Florida , USA.,h Institute of Psychology , Eötvös Loránd University , Budapest , Hungary.,i Department of Psychiatry , Wright State University Boonshoft School of Medicine , Dayton , Ohio, USA
| | - Marcelo Febo
- a Department of Psychiatry & McKnight Brain Institute , University of Florida College of Medicine , Gainesville , Florida , USA
| | - Lyle Fried
- g Division of Neuroscience Research and Addiction Therapy , The Shores Treatment and Recovery Center , Port Saint Lucie , Florida , USA
| | - Mona Li
- b Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA
| | - Kristina Dushaj
- b Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA
| | - Eric R Braverman
- b Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA
| | - Thomas McLaughlin
- j Center for Psychiatric Medicine , North Andover , Massachusetts , USA
| | - Bruce Steinberg
- k Department of Psychology , Curry College , Milton , Massachusetts , USA
| | - Rajendra D Badgaiyan
- i Department of Psychiatry , Wright State University Boonshoft School of Medicine , Dayton , Ohio, USA
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Mukherjee TI, Wickersham JA, Desai MM, Pillai V, Kamarulzaman A, Altice FL. Factors associated with interest in receiving prison-based methadone maintenance therapy in Malaysia. Drug Alcohol Depend 2016; 164:120-127. [PMID: 27207155 PMCID: PMC5592792 DOI: 10.1016/j.drugalcdep.2016.04.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Methadone maintenance therapy (MMT) is crucial for HIV prevention and treatment in people who inject opioids. In Malaysia, a large proportion of the prison population is affected by both HIV and opioid use disorders. This study assessed individual preferences and factors associated with interest in receiving MMT among male prisoners meeting criteria for opioid dependence in Malaysia. METHODS A convenience sample of 96 HIV-positive and 104 HIV-negative incarcerated men who met pre-incarceration criteria for opioid dependence was interviewed using a structured questionnaire to examine participant characteristics and attitudes toward MMT. Factors associated with interest in prison-based MMT initiation were identified using logistic regression analysis. RESULTS Among all participants, 85 (42.5%) were interested in receiving MMT within prison. Independent correlates of interest in prison-based MMT were being previously married (AOR=4.15, 95% CI: 1.15, 15.02), previously incarcerated (AOR=5.68, 95% CI: 1.54, 21.02), depression (AOR=3.66, 95% CI: 1.68, 7.98), daily heroin use in the 30days prior to incarceration (AOR=5.53, 95% CI: 1.65, 18.58), and more favorable attitudes toward MMT (AOR=19.82, 95% CI: 6.07, 64.74). CONCLUSIONS Overall, interest in receiving prison-based MMT was low, and was associated with adverse social, mental health, and drug use consequences. Incarceration provides a unique opportunity to initiate MMT for those who need it, however, optimal scale-up efforts must be systemic and address modifiable factors like improving attitudes toward and motivation for MMT. Informed or shared decision-making tools may be useful in improving expectations and acceptability of MMT.
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Affiliation(s)
- Trena I. Mukherjee
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | - Jeffrey A. Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mayur M. Desai
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L. Altice
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA,Corresponding author at: Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College St., Suite 323, New Haven, CT, USA., (F.L. Altice)
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