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Dankwah AB, Siegrist RB, Wilson IB, McKenzie M, Rich JD. Attitudes of Black American Christian church leaders toward Opioid Use Disorder, overdoses, and harm reduction: a qualitative study. Front Psychiatry 2024; 15:1359826. [PMID: 38633031 PMCID: PMC11021723 DOI: 10.3389/fpsyt.2024.1359826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Black American Christian church leaders are trusted community members and can be invaluable leaders and planners, listeners, and counselors for Opioid Use Disorder (OUD) sufferers in the opioid overdose crisis disproportionately affecting the Black community. This qualitative study examines the extent to which the knowledge, attitudes, practices, and beliefs of Black American church leaders support medical and harm reduction interventions for people with OUD. Methods A semi-structured interview guide was used to conduct in-depth interviews of 30 Black Rhode Island church leaders recruited by convenience and snowball sampling. Results Thematic analysis of the interviews identified four themes: Church leaders are empathetic and knowledgeable, believe that hopelessness and inequity are OUD risk factors, are committed to helping people flourish beyond staying alive, and welcome collaborations between church and state. Conclusion Black American Christian church leaders are a critical resource in providing innovative and culturally sensitive strategies in the opioid overdose crisis affecting the Black American communities. As such, their views should be carefully considered in OUD policies, collaborations, and interventions in the Black American community.
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Affiliation(s)
- Akosua B. Dankwah
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Richard B. Siegrist
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Ira B. Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Michelle McKenzie
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Center for Biomedical Research Excellence (COBRE) on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
| | - Josiah D. Rich
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Center for Biomedical Research Excellence (COBRE) on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
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Favril L, Rich JD, Hard J, Fazel S. Mental and physical health morbidity among people in prisons: an umbrella review. Lancet Public Health 2024; 9:e250-e260. [PMID: 38553144 DOI: 10.1016/s2468-2667(24)00023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. METHODS In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. FINDINGS Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. INTERPRETATION People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. FUNDING Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Josiah D Rich
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
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Clark SA, Green TC, Rich JD. Pharmacy-based expansion of buprenorphine access. J Subst Use Addict Treat 2024; 157:209195. [PMID: 37858795 DOI: 10.1016/j.josat.2023.209195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/28/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Access to evidence-based medication treatment is a challenge for most Americans with opioid use disorder. New models of collaborative care that actively incorporate pharmacists are being trialed. METHODS We author a commentary based on our experiences providing clinical care as part of a randomized controlled trial of pharmacy-based addiction care. RESULTS This commentary describes some of the experiences of working with a Collaborative Practice Agreement between pharmacists and physicians to provide pharmacy-based, low-threshold buprenorphine access. CONCLUSION Given that 87 % of Americans with opioid use disorder are not getting access to buprenorphine or methadone, establishing a pharmacy-based buprenorphine treatment program is a promising strategy to address that gap and should be explored promptly.
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Affiliation(s)
- Seth A Clark
- Psychiatry and Human Behavior and Medicine, Brown University, United States of America; The Miriam and Rhode Island Hospitals, United States of America
| | - Traci C Green
- Opioid Policy Research Collaborative, United States of America; The Heller School of Policy and Management, Brandeis University, United States of America
| | - Josiah D Rich
- Medicine and Epidemiology, Brown University, United States of America; The Miriam and Rhode Island Hospitals, 164 Summit Ave, Providence, RI 02906, United States of America.
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Mambro A, Afshar A, Leone F, Dussault C, Stoové M, Savulescu J, Rich JD, Rowan DH, Sheehan J, Kronfli N. Reimbursing incarcerated individuals for participation in research: A scoping review. Int J Drug Policy 2024; 123:104283. [PMID: 38109837 DOI: 10.1016/j.drugpo.2023.104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/18/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Little is known about global practices regarding the provision of reimbursement for the participation of people who are incarcerated in research. To determine current practices related to the reimbursement of incarcerated populations for research, we aimed to describe international variations in practice across countries and carceral environments to help inform the development of more consistent and equitable practices. METHODS We conducted a scoping review by searching PubMed, Cochrane library, Medline, and Embase, and conducted a grey literature search for English- and French-language articles published until September 30, 2022. All studies evaluating any carceral-based research were included if recruitment of incarcerated participants occurred inside any non-juvenile carceral setting; we excluded studies if recruitment occurred exclusively following release. Where studies failed to indicate the presence or absence of reimbursement, we assumed none was provided. RESULTS A total of 4,328 unique articles were identified, 2,765 were eligible for full text review, and 426 were included. Of these, 295 (69%) did not offer reimbursement to incarcerated individuals. A minority (n = 13; 4%) included reasons explaining the absence of reimbursement, primarily government-level policies (n = 7). Among the 131 (31%) studies that provided reimbursement, the most common form was monetary compensation (n = 122; 93%); five studies (4%) offered possible reduced sentencing. Reimbursement ranged between $3-610 USD in total and 14 studies (11%) explained the reason behind the reimbursements, primarily researchers' discretion (n = 9). CONCLUSIONS The majority of research conducted to date in carceral settings globally has not reimbursed incarcerated participants. Increased transparency regarding reimbursement (or lack thereof) is needed as part of all carceral research and advocacy efforts are required to change policies prohibiting reimbursement of incarcerated individuals. Future work is needed to co-create international standards for the equitable reimbursement of incarcerated populations in research, incorporating the voices of people with lived and living experience of incarceration.
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Affiliation(s)
- Andrea Mambro
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Avideh Afshar
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Frederic Leone
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark Stoové
- Burnet Institute, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Josiah D Rich
- Center for Health and Justice Transformation, The Miriam and Rhode Island Hospitals, Departments of Medicine and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Daniel H Rowan
- Division of Infectious Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.
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Murphy M, White-Hughto J, Rich JD. Cruel and Unusual: Reforming Carceral Systems to Protect and Affirm Transgender and Gender-Diverse Communities. J Urban Health 2023; 100:1190-1192. [PMID: 37783949 PMCID: PMC10728421 DOI: 10.1007/s11524-023-00788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
Transgender and gender-diverse communities are disproportionately incarcerated in the USA. Incarcerated gender minority populations are detained within carceral systems constructed around a cisgender (gender identity matches sex assigned at birth) binary (only male and female identities recognized) understanding of gender. This leads to marginalizing experiences while perpetuating the extreme vulnerability individuals experience in the community. In order to address this cruel and unusual experience, carceral systems should undergo "whole-setting" reforms to protect and affirm transgender and gender-diverse populations. This includes ensuring access to gender-affirming clinical care that aligns with community health standards recommended by medical professional associations. Implementing gender-affirming reforms reduces security issues and will likely improve health outcomes providing mutual benefit for both correctional staff and gender minority populations. Given the current divisive political and social environment for gender minority populations in the USA, evidence-based person-centered reforms in corrections are needed now more than ever.
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Affiliation(s)
- Matthew Murphy
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Jaclyn White-Hughto
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University's School of Public Health, Brown University, Providence, RI, USA
| | - Josiah D Rich
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Langdon KJ, Hitch AE, Collins AB, Beckwith CG, Becker S, Tashima K, Rich JD. Integrating long-acting injectable treatment to improve medication adherence among persons living with HIV and opioid use disorder: study protocol. Addict Sci Clin Pract 2023; 18:60. [PMID: 37838707 PMCID: PMC10576282 DOI: 10.1186/s13722-023-00418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Oral antiretroviral therapy (ART) has been effective at reducing mortality rates of people with HIV. However, despite its effectiveness, people who use drugs face barriers to maintaining ART adherence. Receipt of opioid agonist treatment, in the context of HIV care, is associated with medication adherence and decreased HIV viral loads. Recent pharmacological advancements have led to the development of novel long-acting, injectable, medications for both HIV (cabotegravir co-administered with rilpivirine) and OUD (extended-release buprenorphine). These therapies have the potential to dramatically improve adherence by eliminating the need for daily pill-taking. Despite the extensive evidence base supporting long-acting injectable medications for both HIV and OUD, and clinical guidelines supporting integrated care provision, currently little is known about how these medications may be optimally delivered to this population. This paper presents the study design for the development of a clinical protocol to guide the delivery of combined treatment for HIV and OUD using long-acting injectable medications. METHODS The study aims are to: (1) develop a clinical protocol to guide the delivery of combined LAI for HIV and OUD by conducting in-depth interviews with prospective patients, clinical content experts, and other key stakeholders; and (2) conduct This single group, open pilot trial protocol to assess feasibility, acceptability, and safety among patients diagnosed with HIV and OUD. Throughout all phases of the study, information on patient-, provider-, and organizational-level variables will be collected to inform future implementation. DISCUSSION Findings from this study will inform the development of a future study to conduct a fully-powered Hybrid Type 1 Effectiveness-Implementation design.
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Affiliation(s)
- Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, 139 Point Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA.
- Brown-Lifespan Center for Digital Health, Providence, USA.
| | - Anthony E Hitch
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
- Department of Psychology, University of Cincinnati, Cincinnati, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Curt G Beckwith
- Department of Medicine, Division of Infectious Diseases, Brown University and The Miriam and Rhode Island Hospitals, Providence, USA
| | - Sara Becker
- Center for Dissemination and Implementation Science, Northwestern University, Evanston, USA
| | - Karen Tashima
- Department of Medicine, Division of Infectious Diseases, Brown University and The Miriam and Rhode Island Hospitals, Providence, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
- Department of Medicine, Division of Infectious Diseases, Brown University and The Miriam and Rhode Island Hospitals, Providence, USA
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7
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Harvey LH, Green TC, Park JN, Rich JD. Xylazine in the drug supply: A research agenda. Int J Drug Policy 2023; 120:104190. [PMID: 37708584 PMCID: PMC10664799 DOI: 10.1016/j.drugpo.2023.104190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Leah H Harvey
- Alpert Medical School at Brown University, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906, United States
| | - Traci C Green
- Alpert Medical School at Brown University, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906, United States
| | - Ju Nyeong Park
- Alpert Medical School at Brown University, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906, United States
| | - Josiah D Rich
- Alpert Medical School at Brown University, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906, United States.
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Friedmann PD, Jawa R, Wilson D, Ramsey S, Hoskinson R, McKenzie M, Walley AY, Green TC, Bratberg J, Rich JD. Prescribe to Save Lives: An Intervention to Increase Naloxone Prescribing Among HIV Clinicians. J Addict Med 2023; 17:598-603. [PMID: 37788616 PMCID: PMC10593983 DOI: 10.1097/adm.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Overdose is a major cause of preventable death among persons living with HIV. This study aimed to increase HIV clinicians' naloxone prescribing, which can reduce overdose mortality. METHODS We enrolled 22 Ryan White-funded HIV practices and implemented onsite, peer-to-peer training, posttraining academic detailing, and pharmacy peer-to-peer contact around naloxone prescribing in a nonrandomized stepped wedge design. Human immunodeficiency virus clinicians completed surveys to assess attitudes toward prescribing naloxone at preintervention and 6 and 12 months postintervention. Aggregated electronic health record data measured the number of patients with HIV prescribed and the number of HIV clinicians prescribing naloxone by site over the study period. Models controlled for calendar time and clustering of repeated measures among individuals and sites. RESULTS Of 122 clinicians, 119 (98%) completed a baseline survey, 111 (91%) a 6-month survey, and 93 (76%) a 12-month survey. The intervention was associated with increases in self-reported "high likelihood" to prescribe naloxone (odds ratio [OR], 4.1 [1.7-9.4]; P = 0.001). Of 22 sites, 18 (82%) provided usable electronic health record data that demonstrated a postintervention increase in the total number of clinicians who prescribed naloxone (incidence rate ratio, 2.9 [1.1-7.6]; P = 0.03) and no significant effects on sites having at least one clinician who prescribed naloxone (OR, 4.1 [0.7-23.8]; P = 0.11). The overall proportion of all HIV patients prescribed naloxone modestly increased from 0.97% to 1.6% (OR, 2.2 [0.7-6.8]; P = 0.16). CONCLUSION On-site, practice-based, peer-to-peer training with posttraining academic detailing was a modestly effective strategy to increase HIV clinicians' prescribing of naloxone.
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Affiliation(s)
- Peter D. Friedmann
- University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Raagini Jawa
- Center for Research on Healthcare, Section of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Donna Wilson
- University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Susan Ramsey
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
- The COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
- The Warren Alpert Medical School of Brown University
| | - Randall Hoskinson
- University of Massachusetts Chan Medical School - Baystate, Springfield, MA
| | - Michelle McKenzie
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
- The COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Traci C Green
- The COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
- Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | | | - Josiah D. Rich
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
- The COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
- The Warren Alpert Medical School of Brown University
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Park JN, Green TC, Rich JD. Overdose Detection Technologies-A New Frontier in Preventing Solitary Drug Overdose Deaths. JAMA Psychiatry 2023:2804353. [PMID: 37099309 DOI: 10.1001/jamapsychiatry.2023.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Ju Nyeong Park
- Center for Biomedical Research Excellence (COBRE) on Opioids and Overdose, Rhode Island Hospital, Providence
- Division of General Internal Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Traci C Green
- Center for Biomedical Research Excellence (COBRE) on Opioids and Overdose, Rhode Island Hospital, Providence
- The Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Josiah D Rich
- Center for Biomedical Research Excellence (COBRE) on Opioids and Overdose, Rhode Island Hospital, Providence
- Division of Infectious Diseases, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Affiliation(s)
- Marcella Alsan
- From the Harvard Kennedy School (M.A.), Harvard Law School (C.S.Y.), and the Department of Government (J.R.J.) and the Departments of Sociology and the History of Science (L.T.), Harvard University - all in Cambridge, MA; and the Departments of Medicine and Epidemiology, Brown University, the Miriam Hospital, and Rhode Island Hospital - all in Providence (J.D.R.)
| | - Crystal S Yang
- From the Harvard Kennedy School (M.A.), Harvard Law School (C.S.Y.), and the Department of Government (J.R.J.) and the Departments of Sociology and the History of Science (L.T.), Harvard University - all in Cambridge, MA; and the Departments of Medicine and Epidemiology, Brown University, the Miriam Hospital, and Rhode Island Hospital - all in Providence (J.D.R.)
| | - James R Jolin
- From the Harvard Kennedy School (M.A.), Harvard Law School (C.S.Y.), and the Department of Government (J.R.J.) and the Departments of Sociology and the History of Science (L.T.), Harvard University - all in Cambridge, MA; and the Departments of Medicine and Epidemiology, Brown University, the Miriam Hospital, and Rhode Island Hospital - all in Providence (J.D.R.)
| | - Lucy Tu
- From the Harvard Kennedy School (M.A.), Harvard Law School (C.S.Y.), and the Department of Government (J.R.J.) and the Departments of Sociology and the History of Science (L.T.), Harvard University - all in Cambridge, MA; and the Departments of Medicine and Epidemiology, Brown University, the Miriam Hospital, and Rhode Island Hospital - all in Providence (J.D.R.)
| | - Josiah D Rich
- From the Harvard Kennedy School (M.A.), Harvard Law School (C.S.Y.), and the Department of Government (J.R.J.) and the Departments of Sociology and the History of Science (L.T.), Harvard University - all in Cambridge, MA; and the Departments of Medicine and Epidemiology, Brown University, the Miriam Hospital, and Rhode Island Hospital - all in Providence (J.D.R.)
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Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL, Macmadu A. Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation. Harm Reduct J 2023; 20:14. [PMID: 36739417 PMCID: PMC9898862 DOI: 10.1186/s12954-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic's influence on increased overdose risk behaviors. METHODS From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. RESULTS Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. CONCLUSIONS Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.
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Affiliation(s)
- Lisa Frueh
- grid.166341.70000 0001 2181 3113Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104 USA
| | - Alexandra B. Collins
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Roxxanne Newman
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Nancy P. Barnett
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Josiah D. Rich
- grid.240267.50000 0004 0443 5079The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI USA
| | - Melissa A. Clark
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Brandon D. L. Marshall
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Martin RA, Alexander-Scott N, Berk J, Carpenter RW, Kang A, Hoadley A, Kaplowitz E, Hurley L, Rich JD, Clarke JG. Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study. Lancet Reg Health Am 2023; 18:100419. [PMID: 36844014 PMCID: PMC9950664 DOI: 10.1016/j.lana.2022.100419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Background As opioid overdoses surge, medications for opioid use disorder (MOUD) remain underutilized. MOUD is rarely offered in correctional facilities although individuals involved in the criminal justice system have higher rates of OUD and mortality relative to the general population. Methods A retrospective cohort design examined the effect of MOUD while incarcerated on 12 months post-release treatment engagement and retention, overdose mortality, and recidivism. Individuals (N = 1600) who participated in the Rhode Island Department of Corrections (RIDOC) MOUD program (the United States' first statewide program) and were released from incarceration from December 1, 2016, to December 31, 2018, were included. The sample was 72.6% Male (27.4% female) and 80.8% White (5.8% Black, 11.4% Hispanic, 2.0% another race). Findings 56% were prescribed methadone, 43% buprenorphine, and 1% naltrexone. During incarceration, 61% were continued on MOUD from the community, 30% were inducted onto MOUD upon incarceration, and 9% were inducted pre-release. At 30 days and 12 months post-release, 73% and 86% of participants engaged in MOUD treatment, respectively, and those newly inducted had lower post-release engagement than those who continued from the community. Reincarceration rates (52%) were similar to the general RIDOC population. Twelve overdose deaths occurred during the 12-month follow-up, with only one overdose death during the first two weeks post-release. Interpretations Implementing MOUD in correctional facilities, with seamless linkage to community care is a needed life-saving strategy. Funding Rhode Island General Fund, the NIH of Health HEAL Initiative, the NIGMS, and the NIDA.
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Affiliation(s)
- Rosemarie A. Martin
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA
| | - Nicole Alexander-Scott
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Justin Berk
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ryan W. Carpenter
- Department of Psychological Science, University of Missouri, St. Louis, MO, USA
| | - Augustine Kang
- Stanford University School of Medicine, Stanford, CA, USA
| | - Ariel Hoadley
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
| | - Linda Hurley
- CODAC Behavioral Healthcare Inc., Providence, RI, USA
| | - Josiah D. Rich
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer G. Clarke
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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13
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Affiliation(s)
- Traci C Green
- COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
| | - Rachel Serafinski
- COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
| | - Seth A Clark
- COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
| | - Josiah D Rich
- COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI
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14
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Lombardi AR, Arya R, Rosen JG, Thompson E, Welwean R, Tardif J, Rich JD, Park JN. Overdose Detection Technologies to Reduce Solitary Overdose Deaths: A Literature Review. Int J Environ Res Public Health 2023; 20:1230. [PMID: 36673987 PMCID: PMC9859116 DOI: 10.3390/ijerph20021230] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 05/06/2023]
Abstract
Drug overdoses were a leading cause of injury and death in the United States in 2021. Solitary drug use and solitary overdose deaths have remained persistent challenges warranting additional attention throughout the overdose epidemic. The goal of this narrative review is to describe recent global innovations in overdose detection technologies (ODT) enabling rapid responses to overdose events, especially for people who use drugs alone. We found that only a small number of technologies designed to assist in overdose detection and response are currently commercially available, though several are in the early stages of development. Research, development, and scale-up of practical, cost-effective ODTs remains a public health imperative. Equipping places where people live, learn, work, worship, and play with the necessary tools to detect and prevent overdose deaths could complement ongoing overdose prevention efforts.
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Affiliation(s)
| | - Ritikraj Arya
- Division of Biology and Medicine, Brown University, Providence, RI 02912, USA
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ralph Welwean
- School of Public Health, Brown University, Providence, RI 02912, USA
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI 02903, USA
| | - Josiah D. Rich
- School of Public Health, Brown University, Providence, RI 02912, USA
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI 02903, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI 02903, USA
- School of Public Health, Brown University, Providence, RI 02912, USA
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI 02903, USA
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
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15
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Martin RA, Berk J, Rich JD, Kang A, Fritsche J, Clarke JG. Use of long-acting injectable buprenorphine in the correctional setting. J Subst Abuse Treat 2022; 142:108851. [PMID: 35939914 PMCID: PMC9743485 DOI: 10.1016/j.jsat.2022.108851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND As overdoses due to opioids rise, medications for opioid use disorder (MOUD) continue to be underemployed, resulting in limited access to potentially life-saving treatment. Substance use disorders are prevalent in individuals who are incarcerated, and these individuals are at increased risk for death postrelease due to overdose. Few jails and prisons offer MOUD and most limit access. Extended-release buprenorphine (XR-BUP), a novel monthly injectable MOUD formulation, could be uniquely poised to address treatment access in correctional settings. METHODS This study linked a retrospective cohort design of statewide datasets to evaluate the real-world use of XR-BUP. The study included individuals (N = 54) who received XR-BUP while incarcerated from January 2019 through February 2022. The study was conducted at the Rhode Island Department of Corrections, with the nation's first comprehensive statewide correctional MOUD program. RESULTS Fifty-four individuals received a combined total of 162 injections during the study period. The study found no evidence of tampering with the injection site, indicating no attempts by participants to remove, hoard, or divert the medication. Sixty-one percent reported at least one adverse effect after injections were received, with an average of 2.8 side effects. Sixty-one percent of those released on XR-BUP engaged in MOUD after release, 30 % continued with XR-BUP. CONCLUSIONS XR-BUP is feasible and acceptable in correctional settings. XR-BUP addresses administrative concerns of diversion that obstruct lifesaving MOUD and offers another safe and effective treatment option. Further studies and trials should continue to assess this novel medication's ability to treat opioid addiction in the correctional setting and upon release to the community.
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Affiliation(s)
- Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA.
| | - Justin Berk
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; Rhode Island Department of Corrections, 40 Howard Avenue, Cranston, RI 02920, USA
| | - Josiah D Rich
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Health and Justice Transformation, The Miriam Hospital, 1125 N. Main Street Providence, RI 02904, USA; Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA
| | - Augustine Kang
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA; Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - John Fritsche
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
| | - Jennifer G Clarke
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA
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16
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Skarha J, Dominick A, Spangler K, Dosa D, Rich JD, Savitz DA, Zanobetti A. Provision of Air Conditioning and Heat-Related Mortality in Texas Prisons. JAMA Netw Open 2022; 5:e2239849. [PMID: 36322085 PMCID: PMC9631100 DOI: 10.1001/jamanetworkopen.2022.39849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
IMPORTANCE There is a large body of epidemiologic evidence that heat is associated with increased risk of mortality. One of the most effective strategies to mitigate the effects of heat is through air conditioning (AC); Texas regulates the internal temperature of jails to stay between 65 and 85 °F degrees, but these same standards do not apply to state and private prisons. OBJECTIVE To analyze whether heat during warm months is associated with an increased risk of mortality in Texas prisons without AC. DESIGN, SETTING, AND PARTICIPANTS This case-crossover study included individuals who died in Texas prisons between 2001 and 2019. The association of heat in warm months with mortality in Texas prisons with and without AC was estimated. Data analysis was conducted from January to April 2022. EXPOSURES Increasing daily heat index above 85 °F and extreme heat days (days above the 90th percentile heat index for the prison location). MAIN OUTCOMES AND MEASURES Daily mortality in Texas prisons. RESULTS There were 2083 and 1381 deaths in prisons without and with AC, respectively, during warm months from 2001 to 2019. Most of the deceased were male (3339 of 3464 [96%]) and the median (IQR) age at death was 54 (45-62) years. A 1-degree increase above 85 °F heat index and an extreme heat day were associated with a 0.7% (95% CI, 0.1%-1.3%) and a 15.1% (95% CI, 1.3%-30.8%) increase in the risk of mortality in prisons without AC, respectively. Approximately 13% of mortality or 271 deaths may be attributable to extreme heat during warm months between 2001 to 2019 in Texas prison facilities without AC. In prisons with AC, a negative percentage change in mortality risk was observed, although the 95% CI crossed zero (percentage change in mortality risk: -0.6%; 95% CI, -1.6% to 0.5%). The estimates in prisons without AC were statistically different than the estimates in prisons with AC (P = .05). CONCLUSIONS AND RELEVANCE This study found an average of 14 deaths per year between 2001 to 2019 were associated with heat in Texas prisons without AC vs no deaths associated with heat in prisons with AC. Adopting an AC policy in Texas prisons may be important for protecting the health of one of our most vulnerable populations.
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Affiliation(s)
- Julianne Skarha
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | - Keith Spangler
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - David Dosa
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Providence VAMC, Department of Primary Care, Providence, Rhode Island
| | - Josiah D. Rich
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
- Center for Health and Justice Transformation, Providence, Rhode Island
| | - David A. Savitz
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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17
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Bernstein MH, Rosenfield MN, Blease C, Magill M, Terek RM, Savulescu J, Beaudoin FL, Rich JD, Wartolowska K. How do US orthopaedic surgeons view placebo-controlled surgical trials? A pilot online survey study. J Med Ethics 2022:medethics-2022-108221. [PMID: 36175126 PMCID: PMC10050223 DOI: 10.1136/jme-2022-108221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as 'completely' or 'mostly' unethical. Participants were also asked to rank-order the value of five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7 .% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects.
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Affiliation(s)
- Michael H Bernstein
- School of Public Health, Brown University, Center for Alcohol & Addiction Studies, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Department of Diagnostic Imaging, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Maayan N Rosenfield
- School of Public Health, Brown University, Center for Alcohol & Addiction Studies, Providence, Rhode Island, USA
| | - Charlotte Blease
- General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Molly Magill
- School of Public Health, Brown University, Center for Alcohol & Addiction Studies, Providence, Rhode Island, USA
| | - Richard M Terek
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Julian Savulescu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Law School, Carlton, Victoria, Australia
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Josiah D Rich
- Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- The Miriam Hospital, Providence, Rhode Island, USA
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18
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Macmadu A, Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL. Drug use behaviors, trauma, and emotional affect following the overdose of a social network member: A qualitative investigation. Int J Drug Policy 2022; 107:103792. [PMID: 35816791 PMCID: PMC9462427 DOI: 10.1016/j.drugpo.2022.103792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Scant research has examined the influence of overdoses occurring in social networks (i.e., knowing someone who has overdosed) on individual overdose risk. We sought to characterize drug use behaviors of individuals following the overdose of someone in their social network. METHODS We conducted semi-structured interviews with 25 people who use drugs and knew someone who overdosed in the prior 90 days. All interviews were conducted in person in Rhode Island from July to October 2021. Data were stratified by drug use behaviors following the overdose of a network member (i.e., risk behaviors, protective behaviors, no change; selected a priori) and analyzed using a thematic analysis variation to identify salient themes. RESULTS We identified variation in the effect of knowing someone who overdosed on subsequent drug use behaviors and emotional affect. Several participants described increasing their drug use or using more types of drugs than usual to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and increased suicidal ideations following the overdose event. Other participants described reducing their drug use and engaging in protective behaviors in response to heightened perceived overdose risk, protection motivation (i.e., increased motivation to protect oneself), and concern for others. Additionally, some participants reported no change in drug use behaviors, and these participants described already engaging in harm reduction practices, feeling desensitized due to frequent or repeated exposure to overdose, and ambivalence about living. CONCLUSIONS Findings suggest a need for enhanced investment in network-based overdose prevention interventions, as well as more robust integration of bereavement support and mental health services in settings that serve people who use drugs. The findings also suggest a need for future research to identify mediators of the effect of overdose occurring in social networks on individual overdose risk.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Lisa Frueh
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Roxxanne Newman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Josiah D Rich
- The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
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19
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Jawa R, Walley AY, Wilson DJ, Green TC, McKenzie M, Hoskinson R, Bratberg J, Ramsey S, Rich JD, Friedmann PD. Prescribe to Save Lives: Improving Buprenorphine Prescribing Among HIV Clinicians. J Acquir Immune Defic Syndr 2022; 90:546-552. [PMID: 35587832 PMCID: PMC9283214 DOI: 10.1097/qai.0000000000003001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV clinicians are uniquely positioned to treat their patients with opioid use disorder using buprenorphine to prevent overdose death. The Prescribe to Save Lives (PtSL) study aimed to increase HIV clinicians' buprenorphine prescribing via an overdose prevention intervention. METHODS The quasi-experimental stepped-wedge study enrolled 22 Ryan White-funded HIV clinics and delivered a peer-to-peer training to clinicians with follow-up academic detailing that included overdose prevention education and introduced buprenorphine prescribing. Site-aggregated electronic medical record (EMR) data measured with the change in X-waivered clinicians and patients prescribed buprenorphine. Clinicians completed surveys preintervention and at 6- and 12-month postintervention that assessed buprenorphine training, prescribing, and attitudes. Analyses applied generalized estimating equation models, adjusting for time and clustering of repeated measures among individuals and sites. RESULTS Nineteen sites provided EMR prescribing data, and 122 clinicians returned surveys. Of the total patients with HIV across all sites, EMR data showed 0.38% were prescribed buprenorphine pre-intervention and 0.52% were prescribed buprenorphine postintervention. The intervention increased completion of a buprenorphine training course (adjusted odds ratio 2.54, 95% confidence interval: 1.38 to 4.68, P = 0.003) and obtaining an X-waiver (adjusted odds ratio 2.11, 95% confidence interval: 1.12 to 3.95, P = 0.02). There were nonsignificant increases at the clinic level, as well. CONCLUSIONS Although the PtSL intervention resulted in increases in buprenorphine training and prescriber certification, there was no meaningful increase in buprenorphine prescribing. Engaging and teaching HIV clinicians about overdose and naloxone rescue may facilitate training in buprenorphine prescribing but will not result in more treatment with buprenorphine without additional interventions.
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Affiliation(s)
- Raagini Jawa
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
- Boston University School of Medicine, Boston, MA, USA
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
- Boston University School of Medicine, Boston, MA, USA
| | - Donna J. Wilson
- University of Massachusetts Medical School- Baystate and Baystate Health, 3601 Main Street, 3 Floor, Springfield, MA
| | - Traci C. Green
- Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Michelle McKenzie
- The Center for Health + Justice Transformation, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Randall Hoskinson
- University of Massachusetts Medical School- Baystate and Baystate Health, 3601 Main Street, 3 Floor, Springfield, MA
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, 7 Greenhouse Rd, Kingston, RI 02881
| | - Susan Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Josiah D. Rich
- The Center for Health + Justice Transformation, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Peter D. Friedmann
- University of Massachusetts Medical School- Baystate and Baystate Health, 3601 Main Street, 3 Floor, Springfield, MA
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20
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Affiliation(s)
- Hannan M. Braun
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI USA
- Division of General Internal Medicine, Rhode Island Hospital, Providence, RI USA
| | - Josiah D. Rich
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI USA
- The Center for Health and Justice Transformation, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
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21
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Kaplowitz E, Macmadu A, Green TC, Berk J, Rich JD, Brinkley-Rubinstein L. "It's probably going to save my life;" attitudes towards treatment among people incarcerated in the era of fentanyl. Drug Alcohol Depend 2022; 232:109325. [PMID: 35114617 PMCID: PMC9042078 DOI: 10.1016/j.drugalcdep.2022.109325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In recent years, there has been a dramatic increase in overdose deaths involving illicitly manufactured fentanyl. The risk of death due to fentanyl exposure is far higher for people without adequate tolerance, such as those being released from incarceration. However, little is known about knowledge and perceptions of fentanyl among people who are incarcerated. METHODS We conducted 40 semi-structured qualitative interviews with people who were incarcerated at the Rhode Island Department of Corrections (RIDOC). We explored the impressions of, preferences for and experiences with fentanyl among these people. Analysis employed a general, inductive approach using NVivo 12. RESULTS We found that a majority of the participants were familiar with fentanyl, sought to avoid it and utilized harm reduction techniques when using drugs and taking treatment with medication for opioid use disorder (MOUD) to reduce their risk of overdose. DISCUSSION Our findings suggest that broad access to MOUD, especially for incarcerated people, is increasingly necessary in the era of fentanyl, both to aid people seeking recovery due to the increased overdose risk of drug use and to reduce overdose morbidity for people who use drugs.
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Affiliation(s)
- Eliana Kaplowitz
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA; Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Alexandria Macmadu
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C. Green
- Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA,The Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA,Brown University School of Medicine, Providence, RI, USA
| | - Justin Berk
- Brown University School of Medicine, Providence, RI, USA,Rhode Island Department of Correction, Providence, RI, USA
| | - Josiah D. Rich
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA,Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA,Brown University School of Medicine, Providence, RI, USA
| | - Lauren Brinkley-Rubinstein
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA,Department of Social Medicine, University of North Carolina at Chapel Hill, USA
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22
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del Pozo B, Rich JD, Carroll JJ. Reports of accidental fentanyl overdose among police in the field: Toward correcting a harmful culture-bound syndrome. Int J Drug Policy 2022; 100:103520. [PMID: 34785420 PMCID: PMC8810663 DOI: 10.1016/j.drugpo.2021.103520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | - Josiah D. Rich
- The Miriam Hospital/Warren Alpert Medical School of Brown University
| | - Jennifer J. Carroll
- North Carolina State University/Warren Alpert Medical School of Brown University
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23
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Berk J, Rich JD, Brinkley-Rubinstein L. What are the greatest health challenges facing people who are incarcerated? We need to ask them. Lancet Public Health 2021; 6:e703-e704. [PMID: 34115973 PMCID: PMC9814888 DOI: 10.1016/s2468-2667(21)00074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Justin Berk
- Department of Medicine, Alpert Medical School of Brown University,
Providence, RI, USA
| | - Josiah D Rich
- Department of Medicine, Alpert Medical School of Brown University,
Providence, RI, USA; Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA; The Miriam and Rhode Island Hospitals,
Providence, RI, USA; The Center for Health and Justice Transformation,
Providence, RI, USA
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Howell BA, Martin RA, Lebeau R, Truong AQ, Wang EA, Rich JD, Clarke JG. Changes In Health Services Use After Receipt Of Medications For Opioid Use Disorder In A Statewide Correctional System. Health Aff (Millwood) 2021; 40:1304-1311. [PMID: 34339247 DOI: 10.1377/hlthaff.2020.02156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To decrease opioid overdose mortality, prisons and jails in the US are increasingly offering medications for opioid use disorder (OUD) to incarcerated people. It is unknown how receipt of these medications in a correctional setting affects health services use after release. In this article we analyze changes in postrelease health care use after the implementation of a statewide medications for OUD program in the unified jail and prison system of the Rhode Island Department of Corrections. Using Medicaid claims data, we examined individual health care use in the community before and after receipt of medications for OUD while incarcerated. We found that inpatient admissions did not change, emergency department visits decreased, and both nonacute outpatient services and pharmacy claims increased after people received medications for OUD while incarcerated. There was no change in total health care costs paid by Medicaid. Our findings provide evidence that people's use of health care services paid for by Medicaid did not increase after they started medications for OUD in correctional settings. Given the frequent interaction of people with OUD with the criminal justice system, offering evidence-based treatment of OUD in correctional settings is an important opportunity to initiate addiction treatment.
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Affiliation(s)
- Benjamin A Howell
- Benjamin A. Howell is an instructor in the section of General Internal Medicine and the SEICHE Center at Yale School of Medicine, in New Haven, Connecticut
| | - Rosemarie A Martin
- Rosemarie A. Martin is an associate professor in the Department of Behavioral and Social Sciences, Brown University School of Public Health, in Providence, Rhode Island
| | - Rebecca Lebeau
- Rebecca Lebeau is the chief health program evaluator in the Rhode Island Executive Office of Health and Human Services, in Cranston, Rhode Island
| | - Ashley Q Truong
- Ashley Q. Truong is a PhD candidate in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Emily A Wang
- Emily A. Wang is an associate professor in the Section of General Internal Medicine, Yale School of Medicine
| | - Josiah D Rich
- Josiah D. Rich is a professor of medicine and epidemiology in the Division of Infectious Diseases at Brown University and director and cofounder of the Center for Prisoner Health and Human Rights, the Miriam Hospital, in Providence, Rhode Island
| | - Jennifer G Clarke
- Jennifer G. Clarke is the medical programs director at the Rhode Island Department of Corrections, in Cranston, Rhode Island
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Barnett BS, Wakeman SE, Davis CS, Favaro J, Rich JD. Expanding Mail-Based Distribution of Drug-Related Harm Reduction Supplies Amid COVID-19 and Beyond. Am J Public Health 2021; 111:1013-1017. [PMID: 33950718 PMCID: PMC8101586 DOI: 10.2105/ajph.2021.306228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Brian S Barnett
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Sarah E Wakeman
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Corey S Davis
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Jamie Favaro
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
| | - Josiah D Rich
- Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI
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Kaplowitz E, Truong AQ, Macmadu A, Peterson M, Brinkley-Rubinstein L, Potter N, Green TC, Clarke JG, Rich JD. Fentanyl-related overdose during incarceration: a comprehensive review. Health Justice 2021; 9:13. [PMID: 34013442 PMCID: PMC8133055 DOI: 10.1186/s40352-021-00138-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/05/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration. METHODS We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021. RESULTS Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country. CONCLUSIONS Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives.
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Affiliation(s)
- Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA.
| | - Ashley Q Truong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandria Macmadu
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Meghan Peterson
- Division of General Internal Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Lauren Brinkley-Rubinstein
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Traci C Green
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA
- The Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA
- Department of Emergency Medicine , Brown School of Medicine , RI, Providence, USA
| | | | - Josiah D Rich
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Winetsky D, Fox A, Nijhawan A, Rich JD. Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System. Infect Dis Clin North Am 2021; 34:585-603. [PMID: 32782103 DOI: 10.1016/j.idc.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an overview of the diagnosis and management of opioid use disorder and its infectious complications among populations with criminal justice involvement. Opioid use disorder and chronic infections such as human immunodeficiency virus and hepatitis C virus are highly prevalent among incarcerated individuals and some of the unique features of correctional facilities present challenges for their appropriate medical management. We outline evidence-based strategies for integrated, patient-centered treatment during incarceration and the potentially hazardous transition back to the community upon release.
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Affiliation(s)
- Daniel Winetsky
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 8 W-876, New York, NY 10032, USA; HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Fox
- Department of Internal Medicine, Montefiore Medical Center, 305 East 161th Street, Room 4, Bronx, NY, USA
| | - Ank Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Josiah D Rich
- Department of Medicine, Brown University, 164 Summit Avenue, Providence, RI 02906, USA; Department of Epidemiology, Brown University, 164 Summit Avenue, Providence, RI 02906, USA
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Wu JH, Rich JD, Adashi EY. Addiction Medicine After COVID-19: The Imperative of a Trained Workforce. Am J Prev Med 2021; 60:729-731. [PMID: 33581936 PMCID: PMC7794594 DOI: 10.1016/j.amepre.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph H Wu
- Warren Alpert Medical School, Brown University, Providence, Rhode Island.
| | - Josiah D Rich
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Affiliation(s)
- Justin Berk
- Rhode Island Department of Health, United States
- Warren Alpert School of Medicine at Brown, United States
| | - Josiah D. Rich
- The Center for Health and Justice Transformation at the Miriam, United States
- Medicine and Epidemiology Brown, United States
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Crable EL, Blue TR, McKenzie M, Rich JD, Gordon MS. Effect of Case Management on HIV Outcomes for Community Corrections Population: Results of an 18-Month Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 87:755-762. [PMID: 33492021 PMCID: PMC8026504 DOI: 10.1097/qai.0000000000002624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based interventions that engage community-dwelling, justice-involved, people living with HIV (PLWH) in care are urgently needed. Project Bridge, an intensive case management intervention, has demonstrated efficacy for linking PLWH to care transitioning from prison to the community. We assessed whether a modified Project Bridge model was effective for increasing rates of HIV treatment engagement, antiretroviral therapy receipt, and adherence for community-dwelling individuals supervised on probation and parole. SETTING Baltimore, Maryland. METHODS In this study, the 18-month outcomes of a randomized controlled trial in which PLWH were also on probation or parole received either Project Bridge (n = 50) or treatment as usual (n = 50) were assessed. HIV treatment engagement (primary outcome), antiretroviral therapy prescription, and adherence (secondary outcomes) are evaluated using the intent-to-treat approach. RESULTS There were no statistically significant differences in rates of HIV treatment engagement, antiretroviral therapy prescription receipt, or adherence between groups over the 18-month study period. Across groups, participants were 5.6 times more likely to receive HIV care, 5.8 times more likely to receive an antiretroviral therapy prescription, and 4 times more likely to report antiretroviral therapy adherence at each follow-up period. CONCLUSIONS Future research is needed to identify potentially less-intensive interventions that target the unique needs of PLWH under community supervision.
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Affiliation(s)
- Erika L. Crable
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | | | - Michelle McKenzie
- The Miriam Hospital, Providence, RI, USA
- Center for Prisoner Health and Human Rights, Brown University, Providence, RI, USA
| | - Josiah D. Rich
- The Miriam Hospital, Providence, RI, USA
- Center for Prisoner Health and Human Rights, Brown University, Providence, RI, USA
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Papp MA, Leff JA, Murphy SM, Yang A, Crane HM, Metsch LR, Del Rio C, Feaster DJ, Rich JD, Schackman BR, McCollister KE. Harmonizing healthcare and other resource measures for evaluating economic costs in substance use disorder research. Subst Abuse Treat Prev Policy 2021; 16:32. [PMID: 33832483 PMCID: PMC8033702 DOI: 10.1186/s13011-021-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Standardization and harmonization of healthcare resource utilization data can improve evaluations of the economic impact of treating people with substance use disorder (SUD), including reductions in use of expensive hospital and emergency department (ED) services, and can ensure consistency with current cost-effectiveness and cost-benefit analysis guidelines. METHODS We examined self-reported healthcare and other resource utilization data collected at baseline from three National Institute on Drug Abuse (NIDA)-funded Seek, Test, Treat, and Retain intervention studies of individuals living with/at risk for HIV with SUD. Costs were calculated by multiplying mean healthcare resource utilization measures by monetary conversion factors reflecting cost per unit of care. We normalized baseline recall timeframes to past 30 days and evaluated for missing data. RESULTS We identified measures that are feasible and appropriate for estimating healthcare sector costs including ED visits, inpatient hospital and residential facility stays, and outpatient encounters. We also identified two self-reported measures to inform societal costs (days experiencing SUD problems, participant spending on substances). Missingness was 8% or less for all study measures and was lower for single questions measuring utilization in a recall period. CONCLUSIONS We recommend including measures representing units of service with specific recall periods (e.g., 6 months vs. lifetime), and collecting healthcare resource utilization data using single-question measures to reduce missingness.
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Affiliation(s)
- Michelle A. Papp
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - Jared A. Leff
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - April Yang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136 USA
| | - Heidi M. Crane
- Department of Infectious Diseases, University of Washington School of Medicine, Box 359931, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104 USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 168th St, New York, NY 10032 USA
| | - Carlos Del Rio
- Emory University School of Medicine, Grady Memorial Hospital, Emory Center for AIDS Research, 201 Dowman Drive, Atlanta, GA 30322 USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136 USA
| | - Josiah D. Rich
- The Miriam Hospital, Brown University, 164 Summit Ave, Providence, RI 02906 USA
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065 USA
| | - Kathryn E. McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136 USA
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Aroke HA, Buchanan AL, Bratberg J, Hogan JW, Rich JD, Wen X, Kogut SJ. Initial Patterns of Prescription Opioid Supply and Risk of Mortality Among Insured Adults in the United States. J Addict Med 2021; 15:99-108. [PMID: 32769771 PMCID: PMC8288109 DOI: 10.1097/adm.0000000000000701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine the association between initial patterns of prescription opioid supply (POS) and risk of all-cause mortality among an insured opioid-naïve patient population in the United States (US). METHODS This retrospective observational cohort study used de-identified, administrative health care claims data from a large national insurer (Optum Clinformatics Data Mart) from 2010 to 2015. Participants included insured, cancer-free adults prescribed opioid analgesics. Prescription opioids received during the first 6 months of therapy were used to categorize initial patterns of POS as daily or nondaily. Cox regression was used to estimate the association of initial patterns of POS with all-cause mortality within one year of follow-up, adjusting for baseline covariates to control for confounding. RESULTS A total of 4,054,417 patients were included, of which 2.75% had incident daily POS; 54.8% were female; median age was 50 years; mean Charlson comorbidity index (CCI) was 0.21 (standard deviation = 0.77); and mean daily morphine milligram equivalent was 34.61 (95% confidence intervals: 34.59, 34.63). There were 2068 more deaths per 100,000 person-years among patients who were prescribed opioids daily than nondaily. After adjusting for baseline covariates, the hazard of all-cause mortality among patients with incident daily POS was nearly twice that among those prescribed nondaily (hazard ratio [HR] = 1.94; 95% confidence intervals: 1.84, 2.04). CONCLUSIONS Among insured adult patients with noncancer pain, incident chronic POS was associated with a significantly increased risk of all-cause mortality over at most 1 year of follow-up. Because these results may be susceptible to bias, more research is needed to establish causality.
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Affiliation(s)
- Hilary A Aroke
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA (HAA, ALB, JB, XW, SJK); Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA (JWH); The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (JDR)
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Macmadu A, Rich JD. Commentary on Richardson et al. : Strategies to mitigate payment-coincident drug-related harms are urgently needed. Addiction 2021; 116:546-547. [PMID: 33269510 DOI: 10.1111/add.15325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
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Affiliation(s)
- Brandon Del Pozo
- Miriam Hospital
- The Warren Alpert Medical School of Brown University
| | - Josiah D Rich
- Miriam Hospital
- The Warren Alpert Medical School of Brown University
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Blue TR, Gordon MS, Crable EL, Rich JD. Long-term follow-up of individuals under community supervision who refused rapid HIV testing. J Offender Rehabil 2021; 60:329-340. [PMID: 37206630 PMCID: PMC10195011 DOI: 10.1080/10509674.2021.1931625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Many criminal justice-involved persons on probation or parole do not receive HIV testing despite being at an increased risk for infection and transmission. Between April, 2011 and May, 2012 in Baltimore, MD and Providence, RI, a two-group randomized controlled trial was conducted in order to examine the uptake of on-site rapid HIV testing compared to off-site referral-based HIV testing at a community clinic. Adults under community supervision were recruited to complete baseline assessments and then offered optional, free rapid-HIV testing. Of the 1263 participants who completed baseline measures, 566 declined HIV testing prior to randomization to the on-site testing at the Probation/Parole office or referral to off-site testing in a community health clinic. Follow-up data from 50 individuals who declined HIV testing were collected from September 2016-June 2017 and are examined in the present study. We describe the long-term outcomes of these 50 individuals in terms of HIV testing, HIV status, and frequencies of drug and sex risk behaviors.
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Affiliation(s)
- Thomas R. Blue
- Friends Research Institute, Baltimore MD, USA
- , Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201
| | | | - Erika L. Crable
- Department of Health Law, Policy and Management, Boston University, Boston, MA, USA
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Macmadu A, Berk J, Kaplowitz E, Mercedes M, Rich JD, Brinkley-Rubinstein L. COVID-19 and mass incarceration: a call for urgent action. Lancet Public Health 2020; 5:e571-e572. [PMID: 33045186 PMCID: PMC7547322 DOI: 10.1016/s2468-2667(20)30231-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University, Providence, RI 02912, USA; The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.
| | - Justin Berk
- School of Public Health, and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
| | - Marquisele Mercedes
- Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University, Providence, RI 02912, USA; School of Public Health, and Warren Alpert Medical School, Brown University, Providence, RI 02912, USA; The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine and Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Del Pozo B, Rich JD. Revising our attitudes towards agonist medications and their diversion in a time of pandemic. J Subst Abuse Treat 2020; 119:108139. [PMID: 33138924 PMCID: PMC7505066 DOI: 10.1016/j.jsat.2020.108139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis. COVID-19 resulted in the significant relaxation of critical MOUD prescribing rules. Retention in treatment was prioritized over preventing MOUD misuse and diversion. Diverted and prescribed agonist MOUDs may both serve as a means of overdose prophylaxis during the pandemic. These prescribing changes offer an opportunity to reconsider our attitudes towards agonist medications and their diversion.
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Affiliation(s)
- Brandon Del Pozo
- The Miriam Hospital, Warren Alpert Medical School of Brown University, 1125 N Main St., Providence, RI 02904, United States of America.
| | - Josiah D Rich
- The Miriam Hospital, Warren Alpert Medical School of Brown University, United States of America
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Ohiomoba RO, Youmans QR, Akanyirige PW, Ezema AU, Anderson AS, Bryant A, Jackson K, Mandieka E, Pham DT, Raza Y, Rich JD, Yancy CW, Okwuosa IS. History of cigarette smoking and heart transplant outcomes. Int J Cardiol Heart Vasc 2020; 30:100599. [PMID: 32775604 PMCID: PMC7398935 DOI: 10.1016/j.ijcha.2020.100599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022]
Abstract
Background: Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT) with a recommendation that HT candidates be free from CS for at minimum 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection, but few studies have examined the association of past CS and HT outcomes. Methods: Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Adults aged 18–79 who underwent HT from 1987 to 2018 and with data for all covariates (N = 32,260) were included in this study. The cohort was categorized by past smoking history (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated rejection, malignancy and hospitalization for infection. Baseline characteristics were compared between the two groups using the chi-squared analysis. Unadjusted associations between CS and patient survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Results: HT recipients with a history of CS were older (55 vs 50, p = <0.0001), more likely to be Caucasian (75.7 vs 62.3, p = <0.0001), male (81.7 vs 68.2, p =< 0.0001), and diabetic (27.4 vs 24.4, p =< 0.0001). CS was associated with significantly worse survival (HR: 1.23, p < 0.0001). A history of CS was also associated with increased risk of acute rejection (OR: 1.20, p < 0.0001), hospitalization for infection (OR:1.24, p < 0.0001), graft failure (OR:1.23, p < 0.0001) and post-transplant malignancy (OR:1.43, p < 0.0001). Conclusion: A history of CS is associated with increased risk of adverse events post OHT.
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Affiliation(s)
- R O Ohiomoba
- Northwestern University, Feinberg School of Medicine, United States
| | - Q R Youmans
- Northwestern University, Division of Cardiology, United States
| | - P W Akanyirige
- Northwestern University, Feinberg School of Medicine, United States
| | - A U Ezema
- Northwestern University, Feinberg School of Medicine, United States
| | - A S Anderson
- University of Texas San Antonio, Division of Cardiology, United States
| | - A Bryant
- Mehary Medical College, United States
| | - K Jackson
- Northwestern University, Department of Medicine, United States
| | - E Mandieka
- Northwestern University, Department of Medicine, United States
| | - D T Pham
- Northwestern University, Department of Cardiac Surgery, United States
| | - Y Raza
- Northwestern University, Division of Cardiology, United States
| | - J D Rich
- Northwestern University, Division of Cardiology, United States
| | - C W Yancy
- Northwestern University, Division of Cardiology, United States
| | - I S Okwuosa
- Northwestern University, Division of Cardiology, United States
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Tiruneh YM, Li X, Bovell-Ammon B, Iroh P, Flanigan TP, Montague BT, Rich JD, Nijhawan AE. Falling Through the Cracks: Risk Factors for Becoming Lost to HIV Care After Incarceration in a Southern Jail. AIDS Behav 2020; 24:2430-2441. [PMID: 32006154 PMCID: PMC10411387 DOI: 10.1007/s10461-020-02803-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Using a retrospective cohort analysis of inmates released from Dallas County Jail between January 2011 and November 2013, this study characterizes people living with HIV/AIDS (PLWHA) who are lost to care after release from jail. We used Kaplan-Meier analysis to estimate the risk of becoming lost to post-release HIV care and a Cox proportional hazards regression model to identify associated factors. The majority of individuals (78.2%) were men and 65.5% were black. Of the incarcerations that ended with release to the community, approximately 43% failed to link to community HIV care. Non-Hispanic Whites were more likely than Hispanics or Blacks to drop out of care after release. Individuals with histories of substance use or severe mental illness were more likely to become lost, while those under HIV care prior to incarceration and/or who had adhered to antiretroviral therapy (ART) were more likely to resume care upon release. Targeted efforts such as rapid linkage to care and re-entry residence programs could encourage formerly incarcerated individuals to re-engage in care.
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Affiliation(s)
- Yordanos M Tiruneh
- Department of Community Health, School of Community and Rural Health, The University of Texas Health Science Center at Tyler, 11937 US Hwy 271, Tyler, TX, 75708, USA.
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Xilong Li
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Princess Iroh
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy P Flanigan
- Departments of Medicine and Health Services, Policy, Practice, Brown University, Providence, RI, USA
| | - Brian T Montague
- Department of Internal Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Josiah D Rich
- Departments of Medicine and Epidemiology, Brown University, Providence, RI, USA
| | - Ank E Nijhawan
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
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40
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Truong AQ, Patil S, Rich JD. Prescribers and Naloxone Pharmacy Claims. J Gen Intern Med 2020; 35:2474. [PMID: 32193816 PMCID: PMC7403247 DOI: 10.1007/s11606-020-05760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ashley Q Truong
- The Center for Prisoner Health and Human Rights, Providence, RI, USA.
| | - Shruti Patil
- The University of Texas at Austin, Austin, TX, USA
| | - Josiah D Rich
- Brown University School of Public Health, Providence, RI, USA
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Macmadu A, Adams JW, Bessey SE, Brinkley-Rubinstein L, Martin RA, Clarke JG, Green TC, Rich JD, Marshall BDL. Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: A microsimulation modeling study. Int J Drug Policy 2020; 91:102841. [PMID: 32712165 DOI: 10.1016/j.drugpo.2020.102841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. METHODS We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD). RESULTS In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. CONCLUSIONS Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Joëlla W Adams
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - S E Bessey
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 South Columbia Street, Chapel Hill, NC 27514, USA
| | - Rosemarie A Martin
- Department of Behavioral and Social Science, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - Jennifer G Clarke
- Rhode Island Department of Corrections, 40 Howard Avenue, Cranston, RI 02920, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
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Stone AC, Carroll JJ, Rich JD, Green TC. One year of methadone maintenance treatment in a fentanyl endemic area: Safety, repeated exposure, retention, and remission. J Subst Abuse Treat 2020; 115:108031. [PMID: 32600619 DOI: 10.1016/j.jsat.2020.108031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fentanyl is a potent synthetic opioid that has contributed to increasing overdose deaths in the United States in recent years. Concern over safety and efficacy of agonist treatment for fentanyl use may limit access to treatment. This study sought to address these potential concerns in a naturalistic setting. OBJECTIVES Measure 12-month treatment outcomes for methadone maintenance treatment (MMT) in a fentanyl endemic area. OUTCOMES Primary: 1) Treatment retention; 2) sustained remission (defined as 3 consecutive negative screens); 3) return to use; 4) methadone dosage required; and 5) number of days to achieve remission. Secondary: Mortality. METHODS A naturalistic follow-up study and retrospective review of consecutive patients newly admitted to a single methadone maintenance treatment program in Rhode Island. RESULTS We observed 154 unique intake events (representing 151 patients). Eighty percent (n = 121) tested positive for fentanyl at intake. Seventy-five percent of patients achieved remission within the 12-month study period. One-year retention was 53% for fentanyl-exposed individuals and 47% for those not exposed. The majority (99%) of patients who remained in treatment at 12 months achieved remission. We saw prolonged, sustained remission in 44% of patients exposed to fentanyl at intake and 47% of those who were not. Dose and time to remission were similar. Unfortunately, 4 patients died after leaving MMT prematurely. CONCLUSIONS This study suggests MMT is safe despite repeated exposure to fentanyl while taking methadone. Remission is achievable, and MMT is protective against death among fentanyl-exposed patients while in treatment.
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Affiliation(s)
- Andrew C Stone
- Discovery House CTC, 1625 Diamond Hill Road, Woonsocket, RI 02895, USA.
| | - Jennifer J Carroll
- Department of Sociology & Anthropology, Elon University, 100 Campus Drive, Elon, NC 27244, USA
| | - Josiah D Rich
- The Warren Alpert School of Medicine of Brown University, The Miriam Hospital, 164 Summit Ave, Providence, RI 02903, USA
| | - Traci C Green
- The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
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Salisbury-Afshar EM, Rich JD, Adashi EY. Vulnerable Populations: Weathering the Pandemic Storm. Am J Prev Med 2020; 58:892-894. [PMID: 32371018 PMCID: PMC7174188 DOI: 10.1016/j.amepre.2020.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Elizabeth M Salisbury-Afshar
- Center for Addiction Research and Effective Solutions, American Institutes for Research, Chicago, Illinois; Heartland Alliance Health, Chicago, Illinois.
| | - Josiah D Rich
- Department of Medicine and Epidemiology, Brown University, Providence, Rhode Island; Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island
| | - Eli Y Adashi
- Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Affiliation(s)
- Matthew J Akiyama
- From the Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (M.J.A.); the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta (A.C.S.); and the Departments of Medicine and Epidemiology, Division of Infectious Diseases, Brown University and the Miriam Hospital, Providence, RI (J.D.R.)
| | - Anne C Spaulding
- From the Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (M.J.A.); the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta (A.C.S.); and the Departments of Medicine and Epidemiology, Division of Infectious Diseases, Brown University and the Miriam Hospital, Providence, RI (J.D.R.)
| | - Josiah D Rich
- From the Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (M.J.A.); the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta (A.C.S.); and the Departments of Medicine and Epidemiology, Division of Infectious Diseases, Brown University and the Miriam Hospital, Providence, RI (J.D.R.)
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45
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Goldman JE, Samuels EA, Rich JD, Marshall BDL. Correlates of death during outpatient treatment for opioid use disorder: A national study. J Subst Abuse Treat 2020; 112:76-85. [PMID: 32199549 PMCID: PMC10395190 DOI: 10.1016/j.jsat.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND As the burden of opioid use disorder (OUD) increases in the United States, manifold federal and state initiatives have sought to increase access to treatment for OUD, which includes behavioral and pharmaceutical treatment modalities. Although the evidence base for outpatient treatment for OUD-including medications for opioid use disorder-is substantial, few studies have examined the risk factors for fatality during treatment for OUD. METHODS Treatment Episode Data Set-Discharges (TEDS-D) data were used to evaluate correlates of death during outpatient treatment for OUD in 2016. To determine the correlates of mortality during an outpatient treatment for OUD, we constructed a pooled logistic regression model, stratified by use of medication for opioid use disorder (MOUD), to control for the duration of time in treatment and to identify the independent characteristics that may lead to differences in the odds of mortality during treatment. FINDINGS 1861 (0.8%) of 235,745 outpatient treatment episodes for OUD included in our analysis resulted in fatality. Many factors correlated with death during treatment were similar for individuals who did and did not receive MOUD. However, non-White race was only significantly associated with decreases in fatality in non-MOUD treatment episodes. Male sex and reported intravenous drug use at admission were associated with fatality only for treatment episodes that did not involve MOUD. CONCLUSIONS In this national study of outpatient treatment episodes for OUD, we found differences in age, sex, region, drug use history, treatment setting, and treatment history significantly affected the risk of death during treatment. As more people become engaged with treatment, facilities should work toward delivering optimal treatment for all patients regardless of personal characteristics.
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Affiliation(s)
- Jacqueline E Goldman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Warren Alpert School Medical School of Brown University, Providence, RI, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA; Center for Prisoner Health and Human Rights, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA.
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Carroll JJ, Rich JD, Green TC. The protective effect of trusted dealers against opioid overdose in the U.S. Int J Drug Policy 2020; 78:102695. [PMID: 32143185 DOI: 10.1016/j.drugpo.2020.102695] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Opioid overdose has become the leading cause of death among adults between 25 and 54 years old in the U.S. The purpose of this study is to explore the social and relational factors that shape the current opioid overdose epidemic. METHODS Between January 2016 and February 2017, adults in Providence, Rhode Island, who use opioids were recruited to complete structured survey and semi-structured interview about the social context of their substance use. RESULTS A total of 92 individuals completed a survey and an interview. Of those, 51 individuals (68.6% male, 49.0% white) discussed their relationships with drug suppliers in their interview and were included in this sub-study. Many of these participants indicated that long-term relationships with trusted dealers represent a key strategy for reducing the risk of substance use-related harm due to suppliers' alleged adoption of consumer protection strategies (e.g. refusing to sell fentanyl) and quality assurance measures (e.g. testing batches of drugs for fentanyl prior to sale). CONCLUSION Interpersonal relationships between individuals who use drugs and their suppliers strongly influence the risk and protective factors experienced by people who use drugs in today's opioid overdose epidemic. Evidence-based prevention strategies that are based on an awareness of-or even designed to harness-those positive and/or protective relationships that people who use drugs have already constructed for themselves are likely merited.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, Elon University, 100 Campus Dr. 2035 Campus Box, Elon, NC 27244, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA.
| | - Josiah D Rich
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Ave. Providence, RI 02906, United States; Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third St. Second Floor, Providence, RI 02906, USA
| | - Traci C Green
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Emergency Medicine, Boston University School of Medicine, 771 Albany St, Room 1208, Boston, MA 02118, USA
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Macmadu A, Goedel WC, Adams JW, Brinkley-Rubinstein L, Green TC, Clarke JG, Martin RA, Rich JD, Marshall BDL. Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails. Drug Alcohol Depend 2020; 208:107858. [PMID: 32050112 PMCID: PMC7075016 DOI: 10.1016/j.drugalcdep.2020.107858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. METHODS We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. RESULTS Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 - 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 - 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 - 1812) and 1609 (95% SI: 972 - 2037) lives saved per 10,000 persons incarcerated, respectively. CONCLUSIONS Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI, USA
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Joëlla W Adams
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 South Columbia Street, Chapel Hill, NC, 27514, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; Department of Emergency Medicine, Boston University Medical Center, 725 Albany Street, Boston, MA, 02118, USA
| | - Jennifer G Clarke
- Rhode Island Department of Corrections, 40 Howard Avenue, Cranston, RI, 02920, USA
| | - Rosemarie A Martin
- Department of Behavioral and Social Science, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
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Affiliation(s)
- Julianne Skarha
- Julianne Skarha and Meghan Peterson are with the School of Public Health, Brown University, Providence, RI. Josiah D. Rich is with the Warren Alpert Medical School of Brown University and the Miriam Hospital, Providence, RI. David Dosa is with the Veterans Affairs Medical Center and the Center for Gerontology and HealthCare Research of Brown University, Providence, RI
| | - Meghan Peterson
- Julianne Skarha and Meghan Peterson are with the School of Public Health, Brown University, Providence, RI. Josiah D. Rich is with the Warren Alpert Medical School of Brown University and the Miriam Hospital, Providence, RI. David Dosa is with the Veterans Affairs Medical Center and the Center for Gerontology and HealthCare Research of Brown University, Providence, RI
| | - Josiah D Rich
- Julianne Skarha and Meghan Peterson are with the School of Public Health, Brown University, Providence, RI. Josiah D. Rich is with the Warren Alpert Medical School of Brown University and the Miriam Hospital, Providence, RI. David Dosa is with the Veterans Affairs Medical Center and the Center for Gerontology and HealthCare Research of Brown University, Providence, RI
| | - David Dosa
- Julianne Skarha and Meghan Peterson are with the School of Public Health, Brown University, Providence, RI. Josiah D. Rich is with the Warren Alpert Medical School of Brown University and the Miriam Hospital, Providence, RI. David Dosa is with the Veterans Affairs Medical Center and the Center for Gerontology and HealthCare Research of Brown University, Providence, RI
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Brinkley-Rubinstein L, Allen SA, Rich JD. Incarceration and the health of detained children. Lancet Public Health 2020; 5:e76-e77. [PMID: 31954436 DOI: 10.1016/s2468-2667(19)30250-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity Research, The University of North Carolina, Chapel Hill, NC, USA
| | - Scott A Allen
- Department of Medicine, University of California, Riverside, CA, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI 0290, USA
| | - Josiah D Rich
- The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI 0290, USA; Departments of Medicine and Epidemiology, Brown University, Providence, RI, USA.
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Brinkley-Rubinstein L, Peterson M, Clarke J, Macmadu A, Truong A, Pognon K, Parker M, Marshall BDL, Green T, Martin R, Stein L, Rich JD. The benefits and implementation challenges of the first state-wide comprehensive medication for addictions program in a unified jail and prison setting. Drug Alcohol Depend 2019; 205:107514. [PMID: 31614328 DOI: 10.1016/j.drugalcdep.2019.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/17/2022]
Abstract
The prevalence of opioid use disorders among people who are incarcerated is high. People who are released from incarceration are at increased risk for overdose. The current study details the first year of implementation of a state-wide medications for addiction treatment (MAT) program in a unified jail and prison setting at the Rhode Island Department of Corrections in Cranston, Rhode Island. We conducted 40 semi-structured, qualitative interviews with people who were incarcerated and concurrently enrolled in the MAT program. Analysis employed a general, inductive approach in NVivo 12. We found that a majority of participants discussed program benefits such as reduced withdrawal symptoms, decreased prevalence of illicit drug use in the facility, improved general environment at the RIDOC, and increased post-release intentions to continue MAT. Suggested areas of improvement include reducing delays to first dose, increasing access to other recovery services in combination with MAT, improving staff training on stigma, and earlier access to medical discharge planning information prior to release. Our findings suggest that correctional MAT programs are acceptable to targeted populations and are a feasible intervention that may be transferable to other states.
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Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 S. Columbia Street, Chapel Hill, NC 27514, USA.
| | - Meghan Peterson
- Center for Prisoner Health and Human Rights, Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Jennifer Clarke
- Rhode Island Department of Corrections, 40 Howard Ave., Cranston, RI 02920, USA
| | - Alexandra Macmadu
- Department of Epidemiology, Brown University, 121 S. Main Street, Providence, RI 02903, USA
| | - Ashley Truong
- Center for Prisoner Health and Human Rights, Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Kimberly Pognon
- Center for Prisoner Health and Human Rights, Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
| | - Morgan Parker
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC 27516, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill, 335 S. Columbia Street, Chapel Hill, NC 27514, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University, 121 S. Main Street, Providence, RI 02903, USA
| | - Traci Green
- Department of Emergency Medicine, Boston University Medical Center, Boston, MA 02118, USA
| | - Rosemarie Martin
- Department of Behavioral and Social Science, Brown University, 121 S. Main Street, Providence, RI 02903, USA
| | - Lynda Stein
- Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, USA
| | - Josiah D Rich
- Center for Prisoner Health and Human Rights, Miriam Hospital, 8 Third Street, Providence, RI 02906, USA
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