Reducing Overdose After Release from Incarceration (ROAR)

项目概要 吸毒过量是出狱后死亡的主要原因，而且这种风险明显更高 女性与男性相比（Binswanger、Blatchford、Mueller 和 Stern，2013 年；Binswanger 等人，2007 年）。 释放后的前两周内，因服药过量死亡的风险比正常人高出129倍。 一般人群，尽管女性囚犯阿片类药物使用障碍 (OUD) 和服刑后的比例较高 释放药物过量致死率，女性在惩戒人群和 MAT 的研究中代表性不足 干预措施（Lee 等，2016）。我们建议试点和评估跨学科阿片类药物过量 预防计划“减少出狱后服药过量”(ROAR)。咆哮结合 在以下机构的支持下，为阿片类药物使用障碍 (OUD) 提供成瘾治疗 (MAT) 药物 认证康复导师 (CRM) 可降低成年女性囚犯出狱后服药过量的风险 从监狱里。 ROAR 是俄勒冈州公共卫生、刑事司法和医疗部门之间的合作项目 社区。我们的长期目标是减少被释放到监狱的女性因阿片类药物过量死亡的情况 入狱后的社区。 ROAR 有两个具体目标： 具体目标 1：试点 ROAR 干预措施，以降低获释成年女性服药过量的风险 从监狱里。 ROAR 向所有符合条件的女性囚犯提供，这些女性囚犯被释放到俄勒冈州四个最严重的囚犯之一 在 18 个月的招募期内人口稠密的县。试点（预计 n=100）包括一个流程 使用基于《综合框架》的定量和定性措施进行评价 实施研究。 具体目标 2：评估 ROAR 试点对获释成年女性阿片类药物过量的影响 从监狱里。我们评估 ROAR 参与与阿片类药物主要结局之间的关联 药物过量，包括致命或非致命的药物过量事件。致命和非致命阿片类药物过量是 对 18 个月研究期间从 CCCF 释放的所有成年女性进行评估（预计 n=1,000） 无论是否参与 ROAR 干预。使用俄勒冈州提供的行政数据 惩教部（例如监禁日期）和俄勒冈州卫生局（即医疗补助索赔 和遭遇），我们比较了 ROAR 参与者（预期 n=100）与 对照组至少有 100 名在研究期间从监狱释放的女性。 ROAR 干预和评估提供了有关改进干预措施以预防阿片类药物的重要信息 被忽视的高危人群服药过量：被监禁的妇女重新进入社区。的 拟议的全面行政数据链接在我们州尚属首例，并提供了独特的 有机会在获释后的几年内跟踪参与司法的妇女的健康和安全。

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.