PROVIDENCE, RI [Brown University] -- People who find themselves in the criminal justice system are disproportionately likely to be affected by opioid use disorder (OUD), and that includes people on parole and probation. With a new $10.8 million grant from the National Institutes of Health, Brown University researchers will work with state and community partners to implement and evaluate a treatment program for people in community-based justice supervision.
Rosemarie Martin, an assistant professor in Brown's School of Public Health and the principal investigator on the grant, says the pilot project fills a critical gap in the effort to better treat OUD in vulnerable criminal justice-associated populations.
"For years, the standard of care for OUD in the criminal justice system was insufficient and in need of reform, but that is now starting to change," Martin said. "Rhode Island is the first state in the nation to offer all three forms of FDA-approved medication for OUD in all of its correctional institutions. With this grant, we're extending that same kind of evidence-based intervention to a similarly vulnerable population of people on parole and probation."
Research shows that those in the criminal justice system are particularly prone to overdose, says Martin, who is a researcher in the School of Public Health's Center for Alcohol and Addiction Studies. Twenty-one percent of fatal opioid overdose victims in Rhode Island in 2014 and 2015 had been incarcerated in the two years prior to their deaths.
The program to offer medication for OUD to Rhode Island's entire prison population began in 2016, partially in response to prior research. A 2018 study showed that the program was associated with a 61% decrease in post-incarceration deaths statewide and a 12% decrease in overall opioid deaths during the study period.
Extending a similar program from those in correctional institutions to formerly incarcerated people in community-based supervision has the potential to improve outcomes for a larger set people, the researchers say.
"While our incarcerated population has decreased over time, the population under community-based supervision remains sizable," said Dr. Jennifer Clarke, medical programs director at the Rhode Island Department of Corrections. "Now that we've started to address OUD in the correctional facilities, it's important to start moving into the community. That requires a substantial amount of work to implement and this grant will help us to do that. We're hopeful that we'll see similar success in the community as we see within our institutions."
The program will be implemented through a partnership among Brown, the Department of Corrections, the University of Rhode Island, and CODAC, a non-profit, community-based provider of OUD medications in New England. The effort will begin in five communities across Rhode Island: Cranston, Kent County, Pawtucket, Providence and Woonsocket. Programs will also be implemented in Philadelphia, Pennsylvania and Brunswick, North Carolina, in partnership with Philadelphia-based Temple University and the University of North Carolina-Chapel Hill.
"We wanted to be able to demonstrate how this model is going to hold up in different types of settings, and the places we chose give us demographic diversity," Martin said. "The goal is to understand what works in which settings."
Under the pilot program, the research team will work directly with probation and parole officers, providing them with further specialized training on how to better identify individuals in need of treatment and helping to obtain that treatment. Community treatment partners will receive additional training in working with criminal justice populations. The program will also recruit peer navigators -- people who have experience with OUD and medication-assisted treatment -- to help clients enter and stay in treatment.
"We have learned that engagement in treatment is most successful when an individual receives the care they request when and where it is requested," said Linda Hurley, president and CEO of CODAC. "This can only occur through clear and timely communication between a network of community providers. Although Rhode Island has certainly made great strides in community collaboration, this project allows for comprehensive development of such a safety net."
Once the programs are up and running, the team will evaluate the effects of the program on treatment engagement, re-arrest, continued illicit drug use and fatal and non-fatal overdoses.
"Professor Martin and her team have experience linking justice-involved individuals to evidence-based care here in Rhode Island, and we're excited that the strategies that have been so successful here will be tested in other communities," said Bess Marcus, dean of the School of Public Health. "We hope the evidence they produce will move the national conversation on the benefits of opioid treatment for justice-involved individuals forward."
The Brown grant is one of 12 awarded to select institutions around the country to form the Justice Community Opioid Innovation Network (JCOIN). The network will include 10 research centers, including one at Brown, and two additional support centers all working to improve the quality of addiction treatment for OUD in criminal justice settings nationwide. The 12 awards, totaling an estimated $155 million, were issued by the National Institute on Drug Abuse, part of NIH.
JCOIN is part of the NIH HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. Launched in April 2018, the NIH HEAL Initiative is focused on improving prevention and treatment strategies for opioid misuse and addiction and enhancing pain management.
The team is hopeful the program will prove to be another evidence-based tool in the effort to stem the tide of the opioid use epidemic.
"Rhode Island is on the leading edge of a paradigm shift in opioid policy -- one in which law enforcement and corrections are a key part of the solution," Martin said. "We see this program as another potential step in that direction."