The opioid epidemic is inextricably intertwined with our nation?s criminal justice system. At least 20% of people with opioid use disorder (OUD) were involved in the criminal justice system in 2016, and individuals just released from jail have an eight times higher risk of drug overdose compared with the general population after adjustment for age, gender, race, and residential neighborhood. Given this risk, several jails now treat OUD with medications, but these efforts will be ineffective if they fail to connect people to OUD treatment upon release. Housing instability, food insecurity, lack of social support, mistrust in the health system, and co-morbid physical and mental health conditions threaten a person?s ability to engage and remain in community OUD treatment. Prior work has not identified effective strategies to engage justice-involved individuals in OUD care that are feasible and honor patients? values, preferences, and needs. Until this knowledge gap addressed, it will be difficult to reduce opioid-related morbidity and mortality in the United States. Our long-term goal is to reduce morbidity and mortality from OUD among justice-involved individuals. The overall objective of this study is to assess whether the Transitions Clinic Network (TCN) program, which provides enhanced primary care and OUD treatment for people recently released from incarceration, improves measures in the opioid treatment cascade. In TCN, formerly incarcerated community health workers are embedded within primary care teams and address social determinants of OUD, provide social support, help patients build trust in the health system and advocate in interactions with the criminal justice system. The central hypothesis of Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN PATHS) study is that TCN program participation improves opioid treatment cascade measures among those just released from jails on medications for OUD. The underlying rationale for this study is that social needs must be addressed, in this case through a community health worker, to support OUD treatment engagement, and a primary care home provides an agile structure for people?s shifting priorities, needs, and preferences for OUD treatment following release. We will conduct a hybrid type I effectiveness-implementation trial and randomize 800 people on medications for OUD released from 6 local jails (Minneapolis, MN, Rochester, NY, Bridgeport, CT, Durham, NC, Caguas, PR, and Bronx, NY) to compare the effectiveness of the TCN intervention versus referral to standard primary care on opioid treatment cascade outcomes and whether housing, food access, criminal justice contact, and social support mediate this association. We will also study the cost effectiveness of the TCN, as well as barriers and facilitators to transitioning the care of people with OUD to the TCN. TCN PATHS is highly innovative in its partnership with and prioritization of the values of formerly incarcerated people. Together, the knowledge produced by this proposal will have a positive impact by evaluating the effectiveness of a new primary care-based approach to improving the health of justice-involved individuals with OUD.

Public Health Relevance

The proposed work is relevant to public health given the high rates of opioid use disorder and resultant morbidity and mortality among individuals just released from jails. The project is relevant to NIDA's mission- driven strategic goals to improve opioid use disorder treatment among this high-risk population and to optimize clinical and implementation research to improve health and reduce disease. By building strategic partnerships with individuals with a history of incarceration and community and correctional policymakers, we will improve dissemination and implementation of evidence-based research findings into policy and practice.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Clinical Research Cooperative Agreements - Single Project (UG1)
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Special Emphasis Panel (ZDA1)
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Mulford, Carrie Fried
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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