Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

INTRODUCTION

Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada.

METHODS

This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants' release. Data were thematically analyzed.

RESULTS

The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of 'take-home' OAT medications were common barriers.

CONCLUSIONS

Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

Peer recovery services for persons returning from prison: Pilot randomized clinical trial investigation of SUPPORT

Previously incarcerated persons with substance use disorder (SUD) need recovery supports, given the overrepresentation of this population in prison and community supervision. Peer support programs have the potential to fill gaps in postrelease support for persons with SUD. To assess the effectiveness of peer support approaches, this pilot study randomized access to peer recovery coaches within a well-established community reentry program. We examined several proximal outcomes to determine potential mechanisms of action, along with several exploratory outcomes. While attrition due to re-incarceration, death, and program disengagement was high, our findings suggest that those who received peer recovery coach support in the reentry program had recovery-based improvements, including improved self-reported mental and physical health and reductions in substance use behaviors. The treatment group also saw improvements in measures of treatment motivation and self-efficacy. Both groups saw similar positive trends in some outcomes, likely due to the relative success of the well-established reentry program regardless of the inclusion of peer support coaches. This study contributes lessons learned and potential mechanisms of action to limited research on the effectiveness of peer recovery supports for reentry populations with SUD.

Designing and implementing an intervention for returning citizens living with substance use disorder: discovering the benefits of peer recovery coach involvement in pilot clinical trial decision-making

Peer-facilitated services in behavioral health care remain underutilized within criminal justice-involved community organizations, and there is little guidance for how to best involve peer workers in behavioral health-focused research activities. This paper described lessons learned regarding implementation of peer recovery coaches (PRCs) as part of development and pilot research on Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT), a peer-facilitated substance use disorder (SUD) intervention for returning citizens. Qualitative data were collected from learning meetings with key stakeholders and group interviews with SUPPORT clinical trial participants and PRCs. Transcripts were analyzed to identify key decisions made impacting the development, implementation, and/or revision of the SUPPORT intervention and pilot clinical trial protocols. Analysis demonstrated that PRC involvement drove many of the decisions made regarding modifications to the original intervention and trial protocols, while benefitting client-level interactions and by influencing the non-profit agency and its connection to stakeholders. Moreover, PRCs improved the research design by refining the incentive structure and data collection plans. PRC involvement also contributed to the development of more recovery-oriented resources and catering support services to the unique needs of justice-involved individuals. Discussed were the implications for the role of PRCs in justice-involved behavioral health research and treatment.