Substance use treatment and county incarceration: Reducing inequities in substance use treatment need, availability, use, and outcomes

项目总结：物质使用障碍（SUD）治疗的可用性和使用仍然很低，尽管 在美国持续的药物过量流行。2019年，1930万非机构化成年人符合 虽然有260万人符合SUD的标准，但只有260万人接受了专科治疗服务。接受SUD治疗的人 通过刑事法律的系统获得循证服务的可能性较小（例如，阿片类药物 使用障碍）比那些谁自我指的专业治疗。因为种族/民族少数群体 比他们的白色同行更容易被定罪，就像男性对女性一样， 转诊可能导致SUD治疗使用和结果中的种族和性别不平等。实质性 关于刑事法律的制度，特别是县级监禁如何影响 社区一级SUD治疗需求，可用性，使用和相关结果。这些差距加剧了 医疗保健提供系统和刑事法律的系统数据的孤立。为了填补这些空白，我们将 2004-2023年所有50个州各县的综合多层次数据。我们将量化县监狱 和监狱监禁率与：（目标1）社区SUD治疗需求（与毒品有关 死亡率、药物相关急诊就诊率、SUD患病率）;（目标2）SUD治疗 可用性（可用治疗服务的数量和类型）;以及（目标3）SUD治疗使用（自我报告， 入学率）和治疗结果（完成、保留）。我们 假设更大县监禁与更大的SUD治疗需求相关（反之亦然）， 治疗可用性较低，治疗使用增加较少，治疗结果较差。我们预计 这些关系将具有重要的空间依赖性，并因种族/民族和性别而改变。 我们假设的路径是基于卫生服务研究的社会文化框架 差异;我们的研究过程是由公共卫生关键种族实践和疾病预防控制中心政策分析 适应系统思维的框架。我们的团队由早期研究人员领导，拥有以下方面的专业知识： 药物使用流行病学和治疗、犯罪学、刑事法律的制度、保健政策和保健 系统，结构歧视，少数群体，生物统计学和空间方法。我们将应用这个 专门知识，研究刑事法律的制度，重点是可修改的改革目标， 随着时间的推移，SUD治疗的不公平性加剧。我们的研究解决了NIDA的特别利益通知（NOT-DA- 19-037）呼吁对弱势群体的SUD治疗进行多层次的卫生服务研究。通过 利用多层次的数据源和利益相关者的参与，这一创新的R 01研究如何多个 系统汇聚影响社区健康。我们将吸收专家和有生活经验的人， 研究过程。我们的多管齐下的传播计划将确保调查结果到达目标受众， 告知反种族主义健康政策和计划，以改善社区为基础的SUD治疗相关的结果。

PROJECT SUMMARY: Substance use disorder (SUD) treatment availability and use remain low despite an ongoing drug overdose epidemic in the United States. In 2019, 19.3 million non-institutionalized adults met the criteria for SUD, but only 2.6 million received specialty treatment services. People referred to SUD treatment through the criminal legal system are less likely to receive evidence-based services (e.g., medication for opioid use disorder) than those who self-refer to specialty treatment. Because racial/ethnic minoritized groups are more likely to be criminalized than their white counterparts, as are men versus women, criminal-legal-system-based referrals may contribute to racialized and gendered inequities in SUD treatment use and outcomes. Substantial knowledge gaps remain about how the criminal legal system, specifically county-level incarceration, affects community-level SUD treatment need, availability, use, and related outcomes. These gaps are exacerbated by the siloing of healthcare delivery system and criminal legal system data. To fill these gaps, we will link comprehensive multi-level data from counties in all 50 states from 2004-2023. We will quantify how county jail and prison incarceration rates are associated with: (Aim 1) community SUD treatment need (drug-related mortality rate, drug-related emergency department visit rate, SUD prevalence); (Aim 2) SUD treatment availability (number and types of available treatment services); and (Aim 3) SUD treatment use (self-reported, admission rates) and treatment outcomes (completion, retention) across communities and individuals. We hypothesize that greater county incarceration is associated with greater SUD treatment need (and vice versa), lower treatment availability, smaller increases in treatment use, and worse treatment outcomes. We anticipate that these relationships will have important spatial dependencies and be modified by race/ethnicity and gender. Our hypothesized pathways are grounded in the Socio-Cultural Framework for the Study of Health Service Disparities; our research process is informed by Public Health Critical Race Praxis and the CDC Policy Analytical Framework adapted for systems thinking. Our team, led by an Early-Stage Investigator, has expertise in substance use epidemiology and treatment, criminology, criminal legal systems, health policy and health systems, structural discrimination, minoritized populations, biostatistics, and spatial methods. We will apply this expertise to study the criminal legal system, focusing on modifiable reform targets that can perpetuate and worsen inequities in SUD treatment over time. Our study addresses NIDA’s Notice of Special Interest (NOT-DA- 19-037) calling for multi-level health services research on SUD treatment for vulnerable populations. By leveraging multi-level data sources and engaging with stakeholders, this innovative R01 examines how multiple systems converge to affect community health. We will incorporate experts and people with lived experience in the research process. Our multi-pronged dissemination plan will ensure that findings reach target audiences and inform antiracist health policies and programs that improve community-based SUD treatment-related outcomes.