Waddell Elizabeth Needham, Baker Robin, Hartung Daniel M, Hildebran Christi J, Nguyen Thuan, Collins Deza'Rae M, Larsen Jessica E, Stack Erin
Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd, CB669, Portland, OR, 97239, USA.
College of Pharmacy - Oregon State University/Oregon Health & Science University, Robertson Collaborative Life Sciences Building (RLSB), 2730 SW Moody Ave., CL5CP, Portland, OR, 97201-5042, USA.
Health Justice. 2020 Jul 10;8(1):18. doi: 10.1186/s40352-020-00113-7.
Drug overdose is the leading cause of death after release from prison, and this risk is significantly higher among women compared to men. Within the first 2 weeks after release, the risk of death from drug overdose is 12.7 times higher than the general population, with risk of death further elevated among females. Although female inmates have higher rates of opioid use disorder and post-release overdose fatality, justice-involved women are under-represented in studies of medications for opioid use disorder. The Reducing Overdose After Release from Incarceration (ROAR) pilot intervention and evaluation (recruitment June 2019 through December 2020) aims to reduce opioid overdose among women released to the community following incarceration in state prison. The evaluation further assesses induction, acceptance and effectiveness of extended release naltrexone in a female post-prison population.
METHODS/DESIGN: In the week prior to their release, female adults in custody with moderate to severe opioid use disorder start treatment with extended release naltrexone, an injectable opioid antagonist that blocks the effects of opioids for up to 1 month. All ROAR participants receive training to use naloxone rescue kits and are provided nasal naloxone at release. Ongoing support from a certified recovery mentor to facilitate sustained engagement with treatment for substance use disorders begins in the month prior to release from prison and continues for 6 months in community. We evaluate the association between ROAR participation and the primary outcome of opioid overdose. Using administrative data provided by the Oregon Department of Corrections and the Oregon Health Authority, we compare the odds of overdose among ROAR participants versus a comparison group of females released from prison during the study period. Evaluation activities in community includes survey and qualitative interviews for 6 months post release, as well as a review of clinic records to assess retention on medication among the pilot cohort (N = 100).
ROAR is a collaboration between Oregon's public health, criminal justice, and medical communities. The ROAR intervention and evaluation provide critical information on improving interventions to prevent opioid overdose and improve retention on treatment in community in an overlooked, high-risk population: incarcerated women re-entering the community.
Clinical Trials.gov TRN: NCT03902821 .
药物过量是出狱后死亡的主要原因，女性的这一风险显著高于男性。在出狱后的头两周内，药物过量致死风险比普通人群高12.7倍，女性的死亡风险更高。尽管女性囚犯中阿片类药物使用障碍和出狱后过量用药致死率较高，但在阿片类药物使用障碍药物研究中，涉及司法问题的女性代表性不足。“减少监禁释放后的过量用药”（ROAR）试点干预与评估（2019年6月至2020年12月招募）旨在降低州立监狱监禁后获释女性中的阿片类药物过量用药情况。该评估还进一步评估了缓释纳曲酮在女性出狱后人群中的诱导、接受情况及有效性。
方法/设计：在即将获释前一周，患有中度至重度阿片类药物使用障碍的成年女性被羁押者开始使用缓释纳曲酮进行治疗，缓释纳曲酮是一种注射用阿片类拮抗剂，可在长达1个月的时间内阻断阿片类药物的作用。所有ROAR参与者均接受使用纳洛酮急救包的培训，并在获释时获得鼻用纳洛酮。从出狱前一个月开始，由一名获得认证的康复指导者提供持续支持，以促进对物质使用障碍治疗的持续参与，并在社区中持续6个月。我们评估ROAR参与情况与阿片类药物过量用药这一主要结局之间的关联。利用俄勒冈州惩教部和俄勒冈州卫生局提供的行政数据，我们比较了ROAR参与者与研究期间出狱的女性对照组中过量用药的几率。社区中的评估活动包括在获释后6个月进行调查和定性访谈，以及审查诊所记录以评估试点队列（N = 100）中的药物留存情况。
ROAR是俄勒冈州公共卫生、刑事司法和医疗界之间的合作。ROAR干预与评估提供了关键信息，有助于改进干预措施，以预防阿片类药物过量用药，并提高对一个被忽视的高风险人群（即重新进入社区的被监禁女性）的社区治疗留存率。
ClinicalTrials.gov试验注册号：NCT03902821 。
