Developing and Testing Innovative Care Pathways for Screening and Treatment of OUD/PTSD in Jails

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Project Summary Opioid overdose is the leading cause of death among people recently released from incarceration. Yet, while there is growing research on opioid use disorder (OUD) and medications for OUD (MOUD) in jails and prisons, studies find that few people who are referred to post-release community MOUD initiate treatment. Emerging research suggests that therapy for posttraumatic stress disorder (PTSD), a common and deleterious OUD comorbidity, could profoundly increase the likelihood of MOUD engagement; however, this has not been tested in jails and considerable work to first tailor PTSD screening and treatment to jails and to people with OUD/PTSD in this setting would be required. Therefore, this 6-year R61/R33 aims to develop and test innovative approaches to PTSD screening and treatment among people who are eligible for jail-based OUD services. In the R61, we will form a coalition of carceral, community, and academic stakeholders to collaboratively adapt the Screening, Brief Intervention, and Referral to Treatment model to the jail context and to the needs of jailed adults with OUD/PTSD (SBIRT-J). In the R33, we will 1) assess the implementation outcomes of SBIRT-J for linking jailed adults with OUD/PTSD to therapy for PTSD via a summative evaluation guided by the Consolidated Framework for Implementation Research and 2) assess the effectiveness and implementation outcomes of competing models of PTSD therapy timing. To evaluate the latter, we will use a patient-randomized Hybrid type I implementation-effectiveness design in which jailed adults identified as having OUD/PTSD through the SBIRT-J model are randomly assigned to either immediate initiation of therapy for PTSD in jail or initiation of PTSD therapy upon release. Our primary effectiveness outcome will be post- release MOUD initiation at 6-months post-release from jail; secondary outcomes will include MOUD retention, OUD severity, PTSD symptoms, victimization, and additional drug use. Participants in the effectiveness portion of the trial (N = 304; 50% female) will be enrolled from the largest jail in Arkansas. Importantly, our study vision aligns with NIDA's Strategic Plan, as we aim to “support research to scale up the application of evidence- based interventions for SUDs, including in justice settings” (Goal 4.3). Our overall goal is to translate research to practice to increase the provision of high-quality care for justice-involved persons with OUD, consistent with the goals of NIH's HEAL Initiative. Indeed, this study will be the first trial of a treatment for PTSD in jails as a method for improving OUD outcomes, providing foundational information on PTSD as a novel intervention target for meeting the needs of a particularly vulnerable population and providing the implementation data to inform rapid scale-up if effective.