Sprunger Joel, Brown Jennifer, Rubi Sofia, Papp Joan, Lyons Michael, Winhusen T John
Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
University of Cincinnati Center for Addiction Research, Cincinnati, Ohio, USA.
Health Justice. 2024 Dec 5;12(1):48. doi: 10.1186/s40352-024-00307-3.
Opioid-related overdose is a leading cause of death for criminal legal-involved individuals and, although naloxone distribution and medications for opioid use disorder (MOUD) are effective means for reducing post-release overdose death risk, jail-based availability is limited. This case report describes the challenges faced by three Ohio communities as they implemented evidence-based practices (EBPs) in jails to combat post-release opioid overdose deaths.
We present case examples of how barriers were overcome to implement jail-based EBPs in three Ohio communities (two urban and one rural) as part of the HEALing Communities Study (UM1DA049417; ClinicalTrials.gov Identifier: NCT04111939). Of the 18 participating Ohio HEALing Communities Study counties, we highlight 3 communities for the novelty of their EBPs implemented, the challenges that they faced, and their rural/urban status. We present descriptive data regarding the EBPs that they implemented and discuss the challenges identified by HEALing Communities Study staff with first-hand experience facilitating their implementation.
Newly implemented interventions included overdose education and direct provision of naloxone to incarcerated individuals upon release (2 of 3 communities), initiating MOUD prior to release (3 of 3), linkage to ongoing MOUD treatment in the community (2 of 3), peer support-facilitated treatment retention efforts (2 of 3) and emergency housing (1 of 3) in the immediate post-incarceration period. Common challenges that emerged included skepticism about the need and feasibility of implementing EBPs to reduce overdose and death, lack of knowledge about the options available and whether external agencies may assist, and difficulty engaging stakeholders to overcome inertia.
Creative flexibility, calm persistence, technical facilitation, and collaboration with community service providers were assets that helped these Ohio jails implement evidence-based strategies that combat the opioid epidemic and reduce the likelihood of post-incarceration overdose and death in a high risk, formerly incarcerated population.
阿片类药物相关过量用药是涉及刑事司法人群的主要死因，尽管纳洛酮分发和阿片类药物使用障碍治疗药物（MOUD）是降低释放后过量用药死亡风险的有效手段，但监狱内的可及性有限。本病例报告描述了俄亥俄州三个社区在监狱实施循证实践（EBP）以应对释放后阿片类药物过量用药死亡所面临的挑战。
我们展示了作为“治愈社区研究”（UM1DA049417；ClinicalTrials.gov标识符：NCT04111939）的一部分，俄亥俄州三个社区（两个城市社区和一个农村社区）如何克服障碍在监狱实施基于EBP的案例。在参与“治愈社区研究”的18个俄亥俄州县中，我们突出了3个社区，因其实施的EBP具有新颖性、面临的挑战以及它们的农村/城市地位。我们呈现了关于它们实施的EBP的描述性数据，并讨论了有促进其实施的第一手经验的“治愈社区研究”工作人员所确定的挑战。
新实施的干预措施包括过量用药教育以及在释放时直接向被监禁者提供纳洛酮（3个社区中的2个）、在释放前启动MOUD（3个社区中的3个）、与社区中正在进行的MOUD治疗建立联系（3个社区中的2个）、同伴支持促进治疗维持努力（3个社区中的2个）以及在监禁后立即提供紧急住房（3个社区中的1个）。出现的常见挑战包括对实施EBP以减少过量用药和死亡必要性及可行性的怀疑、对可用选项以及外部机构是否可提供协助缺乏了解，以及难以促使利益相关者克服惰性。
创造性的灵活性、冷静的坚持、技术促进以及与社区服务提供者的合作是有助于这些俄亥俄州监狱实施循证策略的资产，这些策略可对抗阿片类药物流行，并降低高风险的曾被监禁人群监禁后过量用药和死亡的可能性。
