Reducing overdose after release from incarceration (ROAR): study protocol for an intervention to reduce risk of fatal and non-fatal opioid overdose among women after release from prison

Abstract

Background: 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, justiceinvolved 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).

Service Needs for Corrections-Involved Parents With a History of Problematic Opioid Use: A Community Needs Assessment

“…In terms of problematic opioid use, community service providers suggested many evidence-based supports and treatments. For example, several of our participants listed the importance of MAT for CIO parents, echoing research demonstrating the value of such treatment for reentering individuals in preventing use and potential overdose (Gisev et al, 2015 ; McDonald et al, 2016 ; Marsden et al, 2017 ; Friedmann et al, 2018 ; Waddell et al, 2020 ). Additionally, community service providers stressed the importance of specific individualized treatment, consistent with findings that such treatment can be beneficial for reentering individuals struggling with problematic opioid use (Miller et al, 2016 ).…”

“…Research on supportive interventions for corrections-involved adults who struggle with opioid use is becoming more prevalent (e.g., Parmar et al, 2016 ; Marsden et al, 2017 ; Friedmann et al, 2018 ). The majority of intervention research points to the importance of medication-assisted treatments (MAT), such as naltrexone at reentry (Gisev et al, 2015 ; McDonald et al, 2016 ; Parmar et al, 2016 ; Marsden et al, 2017 ; Friedmann et al, 2018 ; Waddell et al, 2020 ). Evidence also supports the benefits of individualized treatment and case management for reentering individuals with substance use disorders (Miller et al, 2016 ; Kendall et al, 2018 ).…”

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

“…The use of progressive initiatives such as peer-support/case management and community transition programs have been associated with a number of benefits. These include improved health outcomes and decreased risk for substance use and criminogenic behaviours, as well as greater linkages to health care and treatment among individuals post-release (Banta-Green et al, 2019 ; Bellamy et al, 2019 ; Howell et al, 2021 ; Myers et al, 2018 ; Ray et al, 2021 ; Shavit et al, 2017 ; Waddell et al, 2020 ; Watson et al, 2017 ). Insights from the implementation of these programs with respect to their feasibility and applicability in Canadian contexts should be considered towards the improvement of post-release care for correctional populations with OUD.…”

Genomic Analysis of Community Transmission Networks for MRSA Among Females Entering a Large Inner-city Jail

“…We similarly observed a 4-fold higher risk of MRSA colonization in females at jail entrance among injection drug users, and 15 out of 16 females epidemiologically linked in a genomic cluster reported illicit drug use in the past year. Illicit drug use is common among females entering correctional facilities [ 34 , 35 ] and likely represents a potential, although difficult, intervention target.…”