Implementation of Medications for Opioid Use Disorder in Massachusetts Jails

Project Summary: Opioid overdose deaths and other substance-related mortality remain at an all-time high in the United States, and evidence suggests that mortality will continue to worsen without significant changes to the landscape of opioid use disorder (OUD) treatment. Overdose mortality is the leading cause of death in the first two weeks post-release due to a variety of factors including changes in drug tolerance during incarceration and volatility of the illicit drug supply, leading to a more than 100-fold increased risk of overdose death compared to the nonincarcerated population during this period. Despite advances in addiction health services and clinical addiction medicine, many people with OUD do not have access to healthcare or medications for opioid use disorder (MOUD) treatment, which remain the most effective treatment strategies to reduce OUD- related mortality. Correctional facilities such as jails are a critical healthcare access point for people with OUD who may not receive healthcare in other settings. However, MOUD treatment availability in jails is highly variable across the United States, leaving many people with OUD without access to evidence-based treatment while incarcerated. Implementation of MOUD treatment in jails is critical to improve accessibility of MOUD treatment and reduce OUD-related mortality in this vulnerable population. There is need for further research elucidating strategies that lead to successful and sustained implementation of MOUD in jails and other correctional settings. This proposal uses a mixed-methods approach to analyze implementation of MOUD from multiple perspectives. The proposal utilizes data from the Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) study, a type 1 hybrid effectiveness-implementation study of MA Chapter 208, which established a pilot program to expand all FDA-approved forms of MOUD in MA county jails. Aim 1 will qualitatively assess organizational factors related to MOUD implementation in jails and post-release overdose risk through thematic analysis of interviews with jail staff and people who received MOUD while incarcerated in MA jails. Aim 2 will investigate the association between staff perspectives of MOUD and organizational factors such as staff training and readiness for change. Aim 3 will compare MOUD retention outcomes for people who screened positive for OUD while incarcerated between different types of MOUD treatment using the Public Health Data (PHD) Warehouse database created by the Massachusetts Department of Public Health. The proposed research and training plan will provide rigorous education in addiction health services research, which will be integrated with the robust clinical training of UMass Chan Medical School and supported through a multidisciplinary team of mentors with significant expertise in implementation science and OUD research in criminal-legal settings. This proposal will provide valuable insights into strategies that lead to effective and sustained MOUD treatment in jail settings with the goal of increasing accessibility to evidence-based MOUD treatment and reducing opioid-related mortality for people who experience incarceration.