Impact of a Maryland Law Requiring Jails to Provide Medications for Opioid Use Disorder on Recently Incarcerated People.

摘要 有阿片类药物使用障碍的人在监禁期间经常因为缺乏药物而被迫戒断 在拘留期间接受阿片类药物治疗，导致他们服药过量和其他不利健康的风险增加 在发布后的几周内的结果。提供阿片类药物使用障碍(Moud)的药物 惩教环境是降低服药过量风险的一个有希望的策略，但监狱还没有广泛采用这一策略 策略。要实现最大的公共卫生利益，将需要在当地范围内采用Moud计划 资源和容量差异很大的监狱，其好处广泛分布在种族/民族之间 监狱确保在获释后向周围社区的治疗提供者过渡。在……里面 2019年，马里兰州立法机构通过了美国第一部法律，要求该州所有地方监狱提供所有表格 并在出院后建立与护理的联系。这项立法创造了分阶段实施 计划将于2020年开始。交错实现提供了一个自然的实验来评估 这些方案在监狱中的实施影响到各种监禁后的总体和跨领域的结果 不同的设施和当地环境。我们建议对马里兰州的法律进行混合方法评估。目标 1和2将分析一个数据仓库，该数据仓库链接全州的矫正记录、医院、处方 监控程序、行为健康和法医数据。目标1将考虑以下方面的总体影响 使用非实验方法比较释放后的变化，接触到监狱Moud计划 监狱实施该计划前后的结果。目标1B将使用报告给 国家根据以下情况评估执行水平高和执行水平低的监狱的结果是否不同 项目参与情况月报。目标2将审查该政策影响中的种族/民族差异， 并评估在个人、监狱和社区层面的变量的贡献(例如，社会压力源， 获得治疗)对不公平结果的影响。我们假设过量用药和其他住院治疗将 减少和使用Moud将改善离开设施的Moud计划的个人。我们也 假设对接受高水平(而不是低水平) 实施。我们假设，来自小规模背景的人不会从 由于在监狱和监狱后获得资源方面普遍存在的不平等，政策被视为非西班牙裔白人 放手。目标3将提供补充执行证据，重点是8所监狱。我们将在- 对40名方案负责人(例如，监狱工作人员、社区提供者)和40名方案负责人进行了深入的半结构化访谈 以前被监禁的人探索障碍和促进者，在监狱和释放后提供穆德。 总之，研究目标将为全州监狱倡议如何增加Moud和Moud提供新的证据 改善出狱人员的健康状况。这些信息可以指导未来在马里兰州监狱和 其他州正在采用穆德治疗方案，并使这些方案适应当地环境。

ABSTRACT People with opioid use disorder are often forced to undergo withdrawal during incarceration due to lack of opioid treatment in custody, contributing to their elevated risk of drug overdose and other negative health outcomes in the weeks after release. Providing access to medications for opioid use disorder (MOUD) in correctional settings is a promising strategy to reduce overdose risk, but jails have not widely adopted this strategy. Achieving maximal public health benefits will require that MOUD programs are adopted across local jails that vary substantially in their resources and capacity, that benefits diffuse widely across racial/ethnic groups, and that jails ensure transition to treatment providers in the surrounding community after release. In 2019, the Maryland legislature passed the first U.S. law requiring all local jails in the state to provide all forms of MOUD and create linkages to care after release. The legislation created a phased implementation of the program starting in 2020. The staggered implementation presents a natural experiment to evaluate how the implementation of the programs in jails affect a variety of post-incarceration outcomes overall, and across different facilities and local environments. We propose a mixed-methods evaluation of the Maryland law. Aims 1 and 2 will analyze a data warehouse that links statewide correctional records, hospital, prescription monitoring program, behavioral health, and medical examiner data. Aim 1 will consider overall impacts of exposure to the jail MOUD program using non-experimental methods that compare changes in post-release outcome before and after jails implement the program. Aim 1B will use implementation measures reported to the state to assess whether outcomes differ in jails with high versus low levels of implementation based on monthly reports of program participation. Aim 2 will examine racial/ethnic disparities in the impact of the policy, and assess the contribution of variables at the individual, jail, and community level (e.g., social stressors, access to treatment) on inequitable outcomes. We hypothesize that overdose and other hospitalizations will decrease and MOUD use will improve among individuals leaving facilities with MOUD programs. We also hypothesize that impacts will be strongest for people treated at programs with high (versus low) levels of implementation. We hypothesize that people from minoritized backgrounds will not gain as much from the policy as non-Hispanic white people due to pervasive inequities in access to resources in jails and post- release. Aim 3 will provide complementary implementation evidence focusing on 8 jails. We will conduct in- depth, semi-structured interviews with 40 program leaders (e.g., jail staff, community providers) and 40 formerly incarcerated individuals to explore barriers and facilitators to providing MOUD in jail and post-release. Together, study Aims will provide new evidence about how statewide jail initiatives may increase MOUD and improve health among people leaving jails. This information can guide future efforts in jails in Maryland and other states as they adopt MOUD treatment programs and adapt these programs to their local environments.