Preventing Overdose Mortality among People Exiting Incarceration

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 DESCRIPTION (provided by applicant): We propose an R34 study to develop pragmatic solutions for implementing overdose education and naloxone distribution (OEND) programs in venues that target people exiting incarceration and their family members. Opioid overdose mortality has increased threefold in the last decade in the United States. OEND programs are an evidence-based biomedical intervention that involves the prescription and provision of naloxone by a licensed medical professional along with brief education about overdose risks and how to use naloxone. A 2007 study found that former inmates had 129 times the risk of overdose death during the 2 weeks immediately following release from prison than the general population. Therefore, there is a dire need for implementation of OEND in venues that specifically target people exiting incarceration and their family members (who may be able to administer naloxone in the event of an overdose). However, these venues pose unique challenges to OEND implementation, such as the need for security clearances for program providers and materials, the current focus on abstinence from drug use, inadequate knowledge of and negative attitudes toward drug users, limited space for programming, and other complexities. We propose: Aim 1: To identify barriers and facilitators to and develop solutions for the implementation of OEND programs in venues that target people exiting incarceration and their family members (e.g., jails, correctional visiting centers, community supervision offices, reentry organizations). Aim 2: To pilot the implementation of OEND in two promising venues identified in Aim 1 with the goal of assessing feasibility and acceptability of the implementation process among venue stakeholders. Aim 3: To develop a manual addressing the key factors and lessons learned about the implementation of OEND in venues that target people exiting incarceration and their family members for use in a subsequent implementation trial. The proposed study will be guided by the Consolidated Framework for Implementation Research. To achieve Aim 1, we will conduct semi- structured interviews with stakeholders in all correctional and re-entry programs in four diverse counties in California. Next, we will present potential implementation strategies to stakeholder focus groups and solicit further input. In Aim 2, we will provide technical assistance to two venues identified in Aim 1 to pilot the implementation of OEND, with the goal of assessing the feasibility and acceptability of the implementation process by stakeholders in these venues. In Aim 3, we will synthesize the knowledge acquired in Aims 1 and 2 to develop an implementation manual to be used in a subsequent R01 study to conduct a large-scale, multi-site implementation trial. For each type of correctional and re-entry based venue, we will delineate the barriers, facilitators, and solutions developed to implementing OEND. The proposed research will provide concrete steps for advancing the implementation of a life-saving program for a high-risk population.