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.

摘要 患有阿片类药物使用障碍的人经常被迫在监禁期间戒断， 在拘留期间接受阿片类药物治疗，导致他们吸毒过量和其他负面健康风险增加 在释放后的几周内。为阿片类药物使用障碍（MOUD）提供药物治疗， 矫正环境是减少过量风险的一种有希望的策略，但监狱尚未广泛采用这一策略。 战略实现最大的公共卫生效益将需要在当地采用MOUD计划 监狱的资源和容量差异很大，其好处在种族/族裔之间广泛分布 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形式的 的MOUD和创建链接，以照顾释放后。该立法规定分阶段实施 计划从2020年开始。交错实现提供了一个自然的实验，以评估 在监狱中实施这些方案会影响各种监禁后的结果， 不同的设施和当地环境。我们提出了一个混合的方法评估的马里兰州的法律。旨在 1和2将分析一个数据仓库，链接全州的惩教记录，医院，处方 监测程序、行为健康和法医数据。目标1将考虑 使用非实验方法比较释放后的变化， 监狱实施方案前后的结果。目标1B将使用向下列机构报告的执行措施： 国家评估执行程度高的监狱与执行程度低的监狱的结果是否不同， 参与计划的月度报告。目标2将审查政策影响中的种族/族裔差异， 并评估个人、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。我们假设药物过量和其他住院治疗 减少和MOUD的使用将提高个人离开设施与MOUD计划。我们也 假设在高（与低）水平的项目中接受治疗的人的影响最大 实施.我们假设，来自少数民族背景的人不会从 政策作为非西班牙裔白色人，由于普遍存在的不平等，在获得资源的监狱和后， release.目标3将提供以8所监狱为重点的补充执行证据。我们将进行- 对40名项目负责人进行了深度半结构化访谈（例如，监狱工作人员、社区提供者）和40名 以前被监禁的个人，探索障碍和促进者提供MOUD在监狱和释放后。 总之，研究目标将提供新的证据，说明全州监狱的举措如何增加MOUD， 改善出狱者的健康状况。这些信息可以指导马里兰州监狱的未来工作， 其他国家，因为他们采用MOUD治疗方案，并使这些方案适应当地环境。