Randomized trial of methadone treatment of arrestees: 24-month post-release outcomes

BACKGROUND

We report on the 24-month post-release outcomes of arrestees with opioid use disorder (OUD) enrolled in a randomized trial comparing three treatment approaches initiated in jail.

METHODS

Adults (N = 225) receiving medically supervised withdrawal from opioids in the Baltimore Detention Center within a few days of arrest were randomly assigned to: (1) interim methadone treatment plus patient navigation (IM + PN) started in the Detention Center; (2) IM; or (3) Enhanced Treatment-as-Usual (ETAU) consisting of detoxification with methadone and referral to treatment in the community. Participants in both methadone conditions could transfer to standard methadone treatment following release. Participants were interviewed at baseline, and 1, 3, 6, 12, and 24 months post-release. Urine was drug tested at follow-up and official arrest records were obtained.

RESULTS

On an intention-to-treat basis, there were no significant differences among the three conditions over the 24-month post-release period in terms of opioid- or cocaine-positive urine test results or self-reported opioid or cocaine use, meeting opioid or cocaine use disorder criteria, self-reported criminal behavior, or the number of official arrests. There were 9 fatal overdoses, none occurring during methadone treatment, and 109 hospitalizations unrelated to the study.

CONCLUSIONS

Given the high morbidity and mortality found in this population of arrestees and costs to society associated with their health care utilization and continued crime and arrests, research aimed at finding more effective interventions should be continued.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT02334215.

Identifying demographic and health profiles of young adults with frequent jail incarceration in New York City during 2011-2017

PURPOSE

The purpose of this study was to investigate incarceration patterns among young adults in New York City jails from mid-2011 through 2017, with an aim that identification of frequently incarcerated young "hot spotters" may inform early interventions.

METHODS

We examined electronic health records for 3114 individuals with no known prior jail admission and admitted within 4.5 years after turning age 18 years. We used group-based trajectory analysis to identify hot spotters and compared their characteristics with those of other trajectory groups. We repeated the analysis for three older adult groups for additional comparison.

RESULTS

Five percent of the young individuals became hot spotters (mean = 7.7 incarcerations). They were more likely to be homeless (27.1% vs. 7.2%-16.4% in other trajectory groups), have substance use disorders (95.2% vs. 73.2%-89.8%), and mental health needs (65.7% vs. 28.5%-53.3%), and be incarcerated for theft-related charges (52.7% vs. 32.0%-49.6%) and misdemeanors (34.8 vs. 25.5%-29.4%). They differed in charge profile and homelessness compared with older hot spotters.

CONCLUSIONS

Some young adults are at risk of frequent incarceration. Tailored health- and behavior-related interventions may preclude cyclical incarceration and address barriers to well-being and stability.

A prospective study of behavioral health indicators and repeat jail admissions among rural inmates

BACKGROUND

Approximately three quarters of a million adults are detained in US jails, and rural detention centers are responsible for the largest recent increases in this population. It is estimated that two thirds of jail inmates meet criteria for a substance use disorder (SUD), nearly half present symptoms consistent with a mental health condition (MHC), and the vast majority of adults in jails have been arrested and booked into these facilities in the past. It is critical to examine the link between SUDs, MHCs, and readmissions to help inform better approaches.

METHODS

This prospective study examined the associations between SUDs, MHCs, and jail readmissions in a random sample of 224 adults collected from a rural correctional facility in North Carolina. The Comprehensive Addiction and Psychological Evaluation-5 (CAAPE-5) was administered to participants within 24 to 96 h of admission to the jail. Information consistent with DSM-5 designations for SUDs and several MHCs was evaluated in conjunction with 12-month jail readmission data.

RESULTS

Bivariate analyses demonstrated the disproportionality of SUDs and several MHCs (including depressive episode, posttraumatic stress, and antisocial personality) among adults who were readmitted to the jail. Binary multivariate logistic regression analyses showed SUDs nor MHCs to be associated with any jail readmissions, but multinomial regression results indicated SUDs were the most robust indicator of multiple 12-month jail readmissions.

CONCLUSIONS

Local jails need to implement systems capable of conducting behavioral health assessments, with a special focus on SUDs as one of the strongest indicators of readmission. This information will allow jail administrators to better manage detainees while they are incarcerated, but it can also enhance the ability to connect adults with appropriate programming options to address the condition and reduce the likelihood of reentering the detention center.