Individuals who have been previously incarcerated have a significantly higher risk of dying from overdose; particularly in the first two weeks after release. More than 4.5 million people is the US are supervised in the community setting and nearly half have a substance use disorder but few receive services. There is a critical need for linkage to medication for opioid use disorder (MOUD) for individuals on community supervision. Providing medication for opioid use disorder (MOUD) to individuals on probation or parole decreases the rate of relapse and recidivism, and increases retention in substance abuse treatment. In 2016, RIDOC introduced the first correctional system-wide MOUD program in the country to initiate a comprehensive program to offer all three FDA approved medications (in all prison or jail settings) to all eligible individuals. As a result of the RIDOC program, we have expanded MOUD linkage to treatment in the community that is associated with a significant drop in statewide overdose deaths post-release. This work is the foundation from which we have built the current proposal. Our proposed research is to rigorously test a systems-change approach for increasing use of MOUD using a randomized type 1 hybrid implementation-effectiveness design in probation and parole sites. We propose a unique network of 7 geographically distinct community supervision (probation and parole) performance sites from Rhode Island, North Carolina, and Pennsylvania. After a 6-month period of baseline for comparison, the Exploration, Preparation, Implementation, Sustainability framework is used to guide systems-change through facilitated local change teams consisting of justice and community service providers. A core set of implementation strategies is provided to all sites. The overall objective is to improve linkage to the continuum of evidence-based care for justice-involved individuals. Organizational assessments are timed with EPIS stages. At the end of Implementation, N=680 probation/parolee clients will be randomly assigned to receive peer support specialists vs. no peer support with follow-up at 3, 6 and 12 months. Implementation outcomes include program acceptability, adoption, penetration, sustainability and costs. Client-level effectiveness outcomes include retention, satisfaction, opioid use, opioid overdoses, recidivism, linkage to OUD treatment, and utilization of recovery services. This research team is uniquely poised to evaluate the implementation and impact of MOUD among justice-involved individuals, to answer questions of urgent public health significance, inform implementation science, and improve service delivery.
Targeting the intersection of justice and community-based care has substantial potential for addressing the opioid crisis. The unprecedented public health opioid crisis among justice-involved individuals necessitates rigorous and well-designed studies to inform interventions and implementation frameworks that produce sustained public health impact. We propose a type 1 hybrid implementation-effectiveness trial targeting the community supervision setting using 7 performance sites in Rhode Island, North Carolina, and Pennsylvania to test probationer/parolee client engagement in MOUD.
