Reducing Overdose After Release from Incarceration (ROAR)

项目总结 服药过量是出狱后死亡的首要原因，而且这种风险明显更高 女性与男性之间的差异(Binswanger，Blatchford，Mueller，&Stern，2013；Binswanger等人，2007年)。 在获释后的头两周内，死于药物过量的风险是 普通人群，尽管女性囚犯阿片使用障碍(OUD)和后阿片使用障碍的发生率较高 释放过量药物致死率，女性在矫正人群和垫子研究中代表性不足 干预措施(Lee等人，2016年)。我们建议对跨学科阿片类药物过量进行试点和评估 预防方案“出狱后减少服药过量”(Roar)。轰鸣联合收割机 在以下机构的支持下提供阿片类药物使用障碍成瘾治疗药物(MAT) 认证康复导师(CRM)，以降低成年女性囚犯出狱时服药过量的风险 从监狱出来的。咆哮是俄勒冈州公共卫生、刑事司法和医疗 社区。我们的长期目标是减少被释放的妇女中阿片类药物过量死亡 被监禁后的社区。Roar有两个具体目标： 具体目标1：试行咆哮干预，以降低成年女性服药过量的风险 从监狱出来的。向所有符合条件的女性囚犯提供咆哮，这些女性囚犯将被释放到俄勒冈州四个最 在18个月的招聘期内，人口稠密的县。试点(预期n=100)包括一个进程 使用以综合框架为基础的定量和定性措施进行评价 实施研究。 具体目标2：评估Roar Pilot对释放的成年女性阿片类药物过量的影响 从监狱出来的。我们评估了参与咆哮与阿片类药物的主要结局之间的关系 服药过量，包括致命或非致命的服药过量事件。致命性和非致命性阿片类药物过量 在18个月的研究期间对所有从CCCF释放的成年女性进行评估(预计n=1,000) 无论是否参与咆哮干预。使用俄勒冈州政府提供的管理数据 惩教部(例如，监禁日期)和俄勒冈州卫生局(即，医疗补助申请 和遭遇)，我们比较了咆哮参与者(预期n=100)和 对照组至少有100名女性在研究期间获释。 咆哮干预和评估提供了关于改进预防阿片类药物干预措施的关键信息 在被忽视的高危人群中服药过量：被监禁的妇女重新进入社区。这个 提出的综合行政数据链接在我们州是第一个，并提供了一个独特的 在获释后的几年里，有机会跟踪涉及司法的妇女的健康和安全情况。

PROJECT SUMMARY Drug overdose is the leading cause of death after release from prison, and this risk is significantly higher among women compared to men (Binswanger, Blatchford, Mueller, & Stern, 2013; Binswanger et al., 2007). Within the first two weeks after release, the risk of death from drug overdose is 129 times higher than the general population, and although female inmates have higher rates of opioid use disorder (OUD) and post- release overdose fatality, females are underrepresented in studies of corrections populations and MAT interventions (Lee et al., 2016). We propose to pilot and evaluate the cross-disciplinary opioid overdose prevention program “Reducing Overdose After Release from Incarceration” (ROAR). ROAR combines provision of medications for addiction treatment (MAT) for opioid use disorder (OUD) with support from Certified Recovery Mentors (CRMs) to reduce overdose risk in adult female inmates when they are released from prison. ROAR is a collaboration between Oregon's public health, criminal justice, and medical communities. Our long-term goal is to reduce opioid overdose deaths among women released to the community following incarceration. ROAR has two specific aims: Specific Aim 1: Pilot the ROAR intervention to reduce risk of overdose among adult women released from prison. ROAR is offered to all eligible female inmates being released to one of Oregon's four most populated counties over the 18-month recruitment period. The pilot (expected n=100) includes a process evaluation using quantitative and qualitative measures grounded in the Consolidated Framework for Implementation Research. Specific Aim 2: Evaluate the effect of the ROAR pilot on opioid overdose among adult women released from prison. We evaluate the association between ROAR participation and the primary outcome of opioid overdose, including either a fatal or non-fatal overdose event. Fatal and non-fatal opioid overdoses are assessed for all adult females released from CCCF during the 18 month study period (expected n=1,000) regardless of participation in the ROAR intervention. Using administrative data provided by the Oregon Department of Corrections (e.g., dates of incarceration) and Oregon Health Authority (i.e., Medicaid claims and encounters), we compare the odds of overdose among ROAR participants (expected n=100) versus a comparison group of at least 100 females released from prison during the study period. The ROAR intervention and evaluation provide critical information on improving interventions to prevent opioid overdose in an overlooked, high-risk population: incarcerated women re-entering the community. The proposed comprehensive administrative data linkage is the first of its kind in our state and offers a unique opportunity to follow the health and safety of justice-involved women in the years following release.