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

马里兰州法律要求监狱为最近被监禁的人提供阿片类药物使用障碍药物的影响。

• 批准号: 10735020
• 负责人: BRENDAN K SALONER
• 金额: $ 77.62万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735020
• 关键词: Adopted; Affect; Area; Black race; Buprenorphine; Caring; Communities; Complex; Counseling; Data; Diffuse; Disparity; Ensure; Environment; Ethnic Origin; Ethnic Population; Evaluation; Exposure to; Future; Goals; Grant; Health; Health Benefit; Health Personnel; Health Services Accessibility; Healthcare; Hispanic; Hospitalization; Hospitals; Imprisonment; Incentives; Individual; Interruption; Intervention; Interview; Jail; Laws; Life; Link; Maryland; Measures; Medical Examiners; Medical Staff; Methadone; Methods; Minority Groups; Modeling; Naltrexone; Natural experiment; Not Hispanic or Latino; Opioid; Outcome; Overdose; Overdose reduction; Patients; Persons; Pharmaceutical Preparations; Phase; Policies; Policy Analysis; Population; Prisons; Provider; Public Health; Race; Records; Reporting; Resources; Risk; Risk Reduction; Role; Rural; Rural Community; Series; Shapes; Statutes and Laws; Structure; Subgroup; System; Time; Treatment outcome; Vital Statistics; Withdrawal; access disparities; behavioral health; community reentry; community setting; comparative; data warehouse; ethnic disparity; experience; implementation evaluation; implementation measures; implementation process; improved; innovation; insight; medication for opioid use disorder; opioid use disorder; outcome disparities; overdose death; overdose risk; prescription monitoring program; programs; racial disparity; racial population; recidivism; scale up; screening; social stressor; structural determinants; tool; treatment program

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.

抽象的 由于缺乏阿片类药物使用障碍，患者在监禁期间常常被迫戒断药物。 在押期间接受阿片类药物治疗，导致药物过量和其他负面健康的风险增加 释放后几周内的结果。为阿片类药物使用障碍 (MOUD) 患者提供药物治疗 惩教机构是降低服药过量风险的一种很有前景的策略，但监狱尚未广泛采用这种策略 战略。实现最大的公共卫生效益需要在地方范围内采用 MOUD 计划 监狱的资源和容量差异很大，其好处广泛分布于不同种族/族裔 团体，并确保监狱确保释放后过渡到周围社区的治疗提供者。在 2019年，马里兰州立法机关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 MOUD 并在发布后建立关怀联系。该立法分阶段实施 计划于 2020 年开始。交错实施提供了一个自然的实验来评估 监狱中方案的实施会影响总体和跨领域的各种监禁后结果 不同的设施和当地环境。我们建议对马里兰州法律进行混合方法评估。目标 1 和 2 将分析一个链接全州惩教记录、医院、处方的数据仓库 监测计划、行为健康和体检数据。目标 1 将考虑总体影响 使用非实验方法接触监狱 MOUD 程序，比较发布后的变化 监狱实施该计划之前和之后的结果。目标 1B 将使用报告给的实施措施 国家根据执行程度高低的监狱来评估结果是否不同 计划参与情况的月度报告。目标 2 将审查政策影响中的种族/民族差异， 评估个人、监狱和社区层面变量的贡献（例如，社会压力源、 获得治疗）的不公平结果。我们假设服药过量和其他住院治疗会 离开接受 MOUD 计划的设施的个人的减少和 MOUD 的使用将得到改善。我们也 假设对于在高（相对于低）水平的项目中接受治疗的人来说，影响将是最强的 执行。我们假设来自少数族裔背景的人不会从 由于在监狱和监狱后获取资源方面普遍存在不平等，因此政策与非西班牙裔白人一样 发布。目标 3 将提供针对 8 个监狱的补充实施证据。我们将进行—— 对 40 名项目负责人（例如监狱工作人员、社区服务提供者）和 40 名项目负责人进行深度、半结构化访谈 前被监禁的个人探索在监狱中和释放后提供 MOUD 的障碍和促进因素。 总之，研究 Aims 将提供新的证据，说明全州监狱举措如何提高 MOUD 和 改善出狱人员的健康。这些信息可以指导马里兰州监狱的未来工作 其他州采用 MOUD 治疗计划并使这些计划适应当地环境。