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Assessing the impact of jail-initiated medication for opioid use disorder: A multisite analysis of the SOMATICS collaborative

Lee, Joshua D; Goldfeld, Keith; Schwartz, Robert P; McDonald, Ryan; Xu, Yifan; Chandler, Redonna; Hallgren, Kevin; Kelly, Sharon M; Mitchell, Shannon Gwinn; Sharma, Anjalee; Farabee, David
The objective of this study was to estimate the associations of jail-initiated medication for opioid use disorder (MOUD) and patient navigation (PN) with opioid use disorder (OUD) at 6 months post-release. Three randomized trials (combined N = 330) were combined to assess whether MOUD (extended-release naltrexone or interim methadone) initiated prior to release from jail with or without PN would reduce the likelihood of a DSM-5 diagnosis of OUD 6 months post-release relative to enhanced treatment-as-usual (ETAU). Across the three studies, assignment to MOUD compared to ETAU was not associated with an OUD diagnosis at 6 months post-release (69% vs. 75%, respectively, OR = 0.67, 95% CI: 0.42 to 1.20). Similarly, PN compared to MOUD without PN was not associated with an OUD diagnosis (63% vs 77%, respectively, OR = 0.61, 95% CI: 0.27 to 1.53). Results underscore the need to further optimize the effectiveness of MOUD for patients initiating treatment in jail, beginning with an emphasis on post-release treatment adherence.
PMID: 38885220
ISSN: 1932-6203
CID: 5671922

Perceptions of COVID-19 vaccine side effects by political affiliation

Farabee, David; Hawken, Angela
BACKGROUND:We sought to assess the extent to which subjective experiences of COVID-19 vaccine side effects among US adults are associated with political party identification. METHODS:An, online survey was conducted of a national sample of US adults (N = 1259) identifying as either Republican or Democrat. RESULTS:There was no significant difference by party identification in the perceived severity of vaccination side effects; however, Republicans were significantly less likely to recommend the vaccine to others in light of their experience (OR = 0.40; 95% CI, 0.31-0.51; P < 0.001). Republicans also reported having a larger share of COVID-19-vaccinated friends and family who experienced notable side effects (OR = 1.31; 95% CI, 1.02-1.68; P < 0.05). There was a positive association between respondents' perceived side-effect severity and the proportion of peers who also reported notable side effects (r = 0.43; P < 0.001). CONCLUSION/CONCLUSIONS:Subjective appraisals of the vaccinated may affect broader vaccine acceptability.
PMID: 37414730
ISSN: 1741-3850
CID: 5539362

Characteristics of Substance Use Screening at Intake in a Sample of U.S. Jails

Bunting, Amanda M; Nowotny, Kathryn; Farabee, David; McNeely, Jennifer; Beckwith, Curt G
BACKGROUND:Despite high rates of substance use among justice-involved populations, the use of substance screening tools in justice settings varies. METHODS:Data are from the National Jail Health Care Study, which surveyed jails across the U.S. about their health care practices (n=371). Jails were asked to voluntarily submit their medical intake forms. A content analysis of intake forms (n=63) specific to questions about substance use was completed. RESULTS:Seventy-three percent (73%) of intake forms used non-standardized questions to assess current substance use, and 27% did not ask any questions about substance use. Alcohol use was most assessed (52%), followed by tobacco (30%), and marijuana (22%). Less than 11% of jails asked about use of opioids and 40% of forms asked about withdrawal history. CONCLUSIONS:The lack of adequate substance use screening in jails hinders identification of substance use disorders, potential for withdrawal symptoms, and appropriate connection to treatment resources.
PMID: 37464488
ISSN: 1548-6869
CID: 5599432

Validation of Two Diagnostic Assessments for Opioid and Stimulant Use Disorder for Use by Non-Clinicians

Di Paola, Angela; Farabee, David; Springer, Sandra A
OBJECTIVE/UNASSIGNED:The United States is in the fourth wave of the opioid epidemic marked by the increase in fentanyl and co-occurring stimulant use related overdose deaths. Measures are needed to quickly diagnose opioid and stimulant use disorders, yet current traditional diagnostic assessments pose barriers to providing rapid diagnoses. METHODS/UNASSIGNED:This study aimed to (1) validate an updated version of the Rapid Opioid Dependence Screen (RODS) from DSM-IV criteria for opioid dependence to the now DSM-5 moderate-to-severe opioid use disorder, the Rapid Opioid Use Disorder Assessment (ROUDA); and (2) create and validate the Rapid Stimulant Use Disorder Assessment to DSM-5 stimulant use disorder (RSUDA) when compared to the substance use disorder module from the DSM-5 version of the Mini International Neuropsychiatric Interview. RESULTS/UNASSIGNED: = 0.87. The ROUDA and RSUDA are efficient and valid measures that can be administered in various settings by non-clinical staff to rapidly diagnose opioid and stimulant use disorders and allow for immediate treatment and harm reduction interventions. CONCLUSIONS/UNASSIGNED:The ROUDA and RSUDA are efficient and valid measures that can be administered by non-clinicians to rapidly diagnose opioid and stimulant use disorders.
PMID: 37711754
ISSN: 2575-5609
CID: 5593572

The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study

Saunders, Elizabeth C; Satcher, Milan F; Monico, Laura B; McDonald, Ryan D; Springer, Sandra A; Farabee, David; Gryczynski, Jan; Nyaku, Amesika; Reeves, Donald; Kunkel, Lynn E; Schultheis, Alysse M; Schwartz, Robert P; Lee, Joshua D; Marsch, Lisa A; Waddell, Elizabeth Needham
While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January-March 2020) and post- (April-September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January-March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April-September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April-September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.
PMID: 36529829
ISSN: 2194-7899
CID: 5394902

Providing substance use disorder treatment in correctional settings: knowledge gaps and proposed research priorities-overview and commentary

Zaller, Nickolas D; Gorvine, Margaret M; Ross, Jon; Mitchell, Shannon Gwin; Taxman, Faye S; Farabee, David
This manuscript is the product of the authors' discussions, literature overview, and consultation with experts in the field, and identifies important gaps in the evidence base for substance use disorder (SUD) treatment effectiveness within criminal justice (CJ) settings. Lacking from the extant literature are longitudinal investigations of treatment related outcomes during and after incarceration. Such studies could provide rich contextual data about treatment delivery and effectiveness across the CJ continuum, and would provide important insight into individual characteristics (e.g., motivation, treatment modality preferences, treatment completion rates, etc.) as well as institutional and environmental factors (e.g., appropriate staffing, space limitations for individual treatment sessions, distribution of medications, etc.). We also identified the importance of reproducibility within CJ research, and the unfortunate reality of too many single studies conducted in single (or relatively few) correctional facilities. Some of this has been because the studies designed to produce that evidence are not prioritized for funding, which has continually placed researchers in a position where we cannot make firm conclusions or recommendations based on available evidence. The importance of replicating the foundational studies in this field cannot be overstated. We hope this article spurs other researchers to join in the healthy process of questioning the existing state of the CJ-based SUD treatment research, what should be re-examined, and how we can lay a stronger foundation for the future.
PMID: 36482490
ISSN: 1940-0640
CID: 5378812

Commentary on Midgette and Kilmer: Why aren't more researchers 24/7 curious?

Farabee, David
PMID: 34235797
ISSN: 1360-0443
CID: 4965692

Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS)

Waddell, Elizabeth Needham; Springer, Sandra A; Marsch, Lisa A; Farabee, David; Schwartz, Robert P; Nyaku, Amesika; Reeves, Rusty; Goldfeld, Keith; McDonald, Ryan D; Malone, Mia; Cheng, Anna; Saunders, Elizabeth C; Monico, Laura; Gryczynski, Jan; Bell, Kathleen; Harding, Kasey; Violette, Sandra; Groblewski, Thomas; Martin, Wendy; Talon, Kasey; Beckwith, Nicole; Suchocki, Andrew; Torralva, Randy; Wisdom, Jennifer P; Lee, Joshua D
The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.
PMID: 33865691
ISSN: 1873-6483
CID: 5066472

A randomized comparison of 4 vs. 16 weeks of psychosocial treatment for stimulant users

Rawson, Richard; Glasner, Suzette; Brecht, Mary-Lynn; Farabee, David
Controlled studies provide little empirical evidence to inform clinical recommendations for the optimal duration (i.e., "dosage") of psychosocial treatment for substance use disorders (SUDs). The current study prospectively examined the relationships among treatment dosage, participant adherence to the treatment regimen, and treatment outcomes in a population of adults with stimulant use disorder (cocaine and/or methamphetamine). The study randomly assigned eighty-five participants to receive either 4 weeks or 16 weeks of standardized outpatient treatment. The treatment consisted of cognitive behavioral therapy (CBT) and content covered was identical for each condition; only the planned duration of participation differed. Although both groups reduced stimulant use over time, participants in the 16-week condition were significantly more likely than those in the 4-week condition to provide stimulantnegative urine specimens 26 and 52 weeks following randomization. Participant adherence to treatment correlated significantly with drug-use outcomes: we observed a greater likelihood of stimulant-negative urine tests among those who completed treatment, irrespective of group assignment. Both the number of sessions attended and the percentage of prescribed sessions attended were associated with reductions in stimulant-use frequency 26 and 52 weeks after admission.
PMID: 33771278
ISSN: 1873-6483
CID: 4836762

A randomized comparison of extended-release naltrexone with or without patient navigation vs enhanced treatment-as-usual for incarcerated adults with opioid use disorder

Farabee, David; Condon, Timothy; Hallgren, Kevin A; McCrady, Barbara
The high prevalence of opioid use among justice-involved adults make jails an exceptional setting to initiate opioid use disorder (OUD) treatment, but optimal strategies for delivering these interventions are still not well understood. The objective of this study was to conduct a randomized controlled trial to assess the effectiveness of extended-release naltrexone (XR-NTX, Vivitrol®; Alkermes Inc) alone or in conjunction with patient navigation (XR-NTX + PN) for jail inmates with OUD. We randomized a sample of 135 sentenced jail inmates with moderate to severe OUD to (1) XR-NTX only; (2) XR-NTX + PN; or (3) enhanced treatment-as-usual (ETAU) with drug education, each initiated prior to release from jail. We scheduled follow-up data assessments at 1, 3, 6, and 12 months post-release. Primary outcomes were opioid use (based on Timeline Followback Interview and Addiction Severity Index) and meeting CIDI DSM-5 criteria for OUD 6 months postrelease. We also measured treatment adherence, HIV risk, and recidivism. XR-NTX participants received a mean of 2.26 of 7 possible injections compared to XR-NTX + PN participants, who received a mean of 2.93 injections (Cohen's d = 0.33, 95% CI: -0.09 to 0.74). Thirty-six percent of patients in XR-NTX + PN attended at least one postrelease PN session. We found no significant differences by study condition six months after release from jail for the primary outcomes of any opioid use (ETAU: 17%, XR-NTX: 16%, XR-NTX + PN: 29%) and past 30-day OUD (ETAU: 8%, XR-NTX: 11%, XR-NTX + PN: 10%). Secondary outcomes of rearrest and HIV risk also were similar across groups, with the exception of lower sex-related HIV risk among those in the XR-NTX condition at 12 months. This study did not show superior outcomes of XR-NTX or XR-NTX + PN with regard to opioid use or recidivism outcomes, relative to ETAU. It did, however, highlight the difficulties with adherence to XR-NTX and PN interventions in OUD patients initiating treatment in jail.
PMID: 32811623
ISSN: 1873-6483
CID: 4576322