Patient Navigator plus Remote mHealth Adherence Support with Incentives: Understanding Criminal Justice Effects

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PROJECT SUMMARY/ABSTRACT Polysubstance use and mass incarceration are twin epidemics. The rise in combined methamphetamine and opioid use along with the simultaneous creeping of mechanisms to address substance use disorder into the many arms of the criminal legal system from prisons/jails, probation/parole, policing, and court-mandated treatment or diversion programs have imbedded the legal system in the lives of people who use drugs. Combined use is already associated with more medical and psychosocial comorbidities, more stigma, less frequent treatment, and more legal system involvement. Despite mechanisms within the criminal legal system to address substance use, it is often combined with exclusion, punishment, violence, poor health outcomes, and isolation from services. Thus, involvement in the criminal legal system is likely to impact treatment for substance use disorder in complex ways that have not yet been studied. This administrative supplement in response to PA-20-272 proposes to investigate the role of the criminal legal system in the parent R34 grant “Patient Navigator plus Remote mHealth Adherence Support with Incentives to Improve Linkage and Retention among Hospitalized Patients with Opioid and Methamphetamine Use Who Initiate Buprenorphine.” We will conduct qualitative interviews among approximately 20 participants in the parent study, exploring encounters with various arms of the legal system and the effects it has had on their substance use and treatment, focusing specifically on the unique experiences of people who use methamphetamine and opioids. We will then apply the insights from these interviews to improve resources and training for the patient navigator arm of the parent trial so that they can help patients avoid adverse effects of criminal legal system involvement. This study will address gaps in knowledge about the effects of legal system involvement—which is already common in people who use drugs and may be an even greater challenge for people who also use methamphetamine—on linkage to and retention in treatment, helping to better understand the social-structural determinants and develop better treatment and intervention strategies. To that end, it will also apply the knowledge generated from interviews to enhance the parent study objectives of increasing linkage and retention in treatment and improve secondary outcomes of reduced substance use and emergency room visits.