Reducing Overdose After Release from Incarceration (ROAR)

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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.