RESUMEN
The opioid crisis has disproportionately affected women, but research on approaches to increase initiation of medications for opioid use disorder (MOUD) among women is limited. The Kentucky Justice Community Opioid Innovation Network (JCOIN) will implement a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pretreatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community. The overall goal of the project is to increase initiation and maintenance of MOUD among high-risk justice-involved women during community reentry to reduce opioid relapse and overdose. This project and other studies through the JCOIN network have the potential to significantly impact the OUD treatment field by contributing empirical evidence about the effectiveness and implementation of innovative technologies to increase initiation and maintenance of MOUD during a critical, high-risk time of community reentry among vulnerable, justice-involved individuals in both urban and nonurban communities.
Asunto(s)
Analgésicos Opioides , Trastornos Relacionados con Opioides , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Jurisprudencia , Kentucky , Epidemia de Opioides , Trastornos Relacionados con Opioides/tratamiento farmacológicoRESUMEN
Background: Corrections-involved adults with a history of opioid use disorder are at elevated risk of opioid overdose following release from correctional settings. Increased opioid prescribing restrictions and monitoring during a time when heroin is becoming cheaper and ubiquitous means that adults who misused prescription opioids prior to incarceration may be reentering communities at greater risk for heroin exposure and use. Objectives: Determine risk factors of post-release heroin use among a sample of adults who participated in corrections-based drug treatment in Kentucky released between 2012 and 2017. Methods: Survey data obtained as part of an ongoing evaluation of corrections-based drug treatment were examined. Results: The final sample (N = 1,563) was majority male (80.9%). Nearly 11.0% reported past-year heroin use following their release. Depressive symptoms, polydrug use, and urban proximity were more common among participants reporting post-release heroin use. Heroin use 30 days prior to incarceration was associated with a 432.1% increase in odds of heroin use subsequent to incarceration. Post-release suicidal ideation increased odds of heroin use by 154.2%, whereas reporting satisfaction from social interactions decreased odds of use by nearly 60%. Post-release use of cocaine and diverted buprenorphine were associated with increased likelihood of heroin use during this time period, increasing odds by 469.1% and 265.9%, respectively. Residing in Central Appalachia subsequent to incarceration was associated with decreased likelihood of use. Conclusions: In this sample, post-release heroin use was associated with concerning features, such as polydrug use, lack of social satisfaction, and suicidal ideation. These features can serve as clear targets for clinical intervention.
Asunto(s)
Heroína , Cárceles Locales/estadística & datos numéricos , Trastornos Relacionados con Opioides/epidemiología , Prisioneros/estadística & datos numéricos , Prisiones/estadística & datos numéricos , Adulto , Región de los Apalaches/epidemiología , Femenino , Humanos , Kentucky/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Factores de Riesgo , Ideación SuicidaRESUMEN
BACKGROUND: Illicit, medically unsupervised use of buprenorphine (i.e., "diverted use") among vulnerable and underserved populations, such as corrections-involved adults, remains underexplored. METHODS: Survey data (2016-2017) collected as part of a clinical assessment of incarcerated adults entering corrections-based substance use treatment in Kentucky were analyzed. For years examined, 12,915 completed the survey. Removing cases for participants who did not reside in Kentucky for >6 months during the one-year pre-incarceration period (n = 908) resulted in a final sample size of 12,007. RESULTS: Over a quarter of the sample reported past-year diverted buprenorphine use prior to incarceration and 21.8 % reported use during the 30-days prior to incarceration, using 6.5 months and 14.3 days on average, respectively. A greater proportion of participants who reported diverted buprenorphine use had previously been engaged with some substance use treatment (77.0 %) and reported greater perceived need for treatment (79.4 %) compared to those who did not report use. Use was more likely among participants who were younger, white, male, and who reported rural or Appalachian residence. Diverted buprenorphine users also evidenced extensive polydrug use and presented with greater substance use disorder severity. Non-medical prescription opioid, heroin, and diverted methadone use were associated with increased odds of diverted buprenorphine use while kratom was not. Diverted methadone use was associated with a 252.9 % increased likelihood of diverted buprenorphine use. CONCLUSIONS: Diverted buprenorphine use among participants in this sample was associated with concerning high-risk behaviors and may indicate barriers to accessing opioid agonist therapies for corrections-involved Kentucky residents, particularly those in rural Appalachia.
Asunto(s)
Buprenorfina/uso terapéutico , Instalaciones Correccionales/tendencias , Tratamiento de Sustitución de Opiáceos/tendencias , Trastornos Relacionados con Opioides/tratamiento farmacológico , Desvío de Medicamentos bajo Prescripción/tendencias , Centros de Tratamiento de Abuso de Sustancias/tendencias , Adulto , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Región de los Apalaches/epidemiología , Buprenorfina/efectos adversos , Estudios Transversales , Femenino , Humanos , Kentucky/epidemiología , Masculino , Persona de Mediana Edad , Tratamiento de Sustitución de Opiáceos/psicología , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/psicología , Desvío de Medicamentos bajo Prescripción/psicología , Automedicación/psicología , Automedicación/tendencias , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Criminological research has tended to consider employment in a dichotomy of employed versus unemployed. The current research examines a sample of individuals 1-year post-release to assess the extent to which four distinct employment categories (full-time, part-time, disabled, and unemployed) are associated with reincarceration and days remaining in the community. Findings indicate disabled individuals remain in the community longer and at a higher proportion compared with other employment categories. Furthermore, unique protective and risk factors are found to be associated with each employment category while some risk factors (e.g., homelessness) highlight the importance of addressing reentry barriers regardless as to employment status.
Asunto(s)
Criminales/clasificación , Criminales/estadística & datos numéricos , Empleo/clasificación , Empleo/estadística & datos numéricos , Reincidencia/estadística & datos numéricos , Adulto , Personas con Discapacidad/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Personas con Mala Vivienda , Humanos , Análisis de Series de Tiempo Interrumpido , Kentucky , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Trastornos Relacionados con Sustancias , Encuestas y CuestionariosRESUMEN
Use of novel psychoactive substances (NPS) such as synthetic cannabinoids (e.g., "Spice," "Serenity") and cathinones (e.g., "bath salts") has proliferated in recent years; however, there is a gap in research examining prevalence among offender samples. This study examined demographics, drug use, mental health characteristics, and criminal histories of NPS users compared to non-NPS users within an offender sample entering drug treatment. Using logistic regression analysis, combined 2013-2015 assessment data were examined (N = 8,791). NPS users offended more often (xÌ = 10.3), were more likely to have experienced homelessness (12.2%), and to have lived in a metro area (59.0%). NPS users reported significantly more past-year drug use, including substances not readily detected by standard urine analysis (e.g., hallucinogens, alcohol, and inhalants). Individuals with higher anxiety symptom counts (OR = 1.07; p < .001) and those who reported drinking to intoxication (OR = 1.30; p < .001) had an increased likelihood of NPS use. Older individuals (OR = 0.95; p < .001) and those who began using drugs at an older age (OR = 0.95; p < .001) were less likely to report NPS use. NPS use may be a marker of more severe using patterns in an offender sample. Future investigation should focus on NPS use as a possible method for bypassing drug testing measures.
Asunto(s)
Alcaloides/efectos adversos , Cannabinoides/efectos adversos , Consumidores de Drogas/psicología , Prisioneros/psicología , Psicotrópicos/efectos adversos , Trastornos Relacionados con Sustancias/psicología , Adulto , Factores de Edad , Intoxicación Alcohólica/epidemiología , Intoxicación Alcohólica/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Conducta Adictiva , Cannabinoides/síntesis química , Distribución de Chi-Cuadrado , Femenino , Personas con Mala Vivienda/psicología , Humanos , Kentucky , Modelos Logísticos , Masculino , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Psicotrópicos/síntesis química , Factores de Riesgo , Detección de Abuso de Sustancias , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitación , Factores de Tiempo , Población Urbana , Adulto JovenRESUMEN
The majority of corrections-based treatment outcome studies focus on individuals paroling to urban areas; thus there is a significant gap in the literature on outcomes, including recidivism, among individuals paroling to non-urban and rural communities. This study examines differences in factors associated with recidivism among former corrections-based treatment participants living in urban and rural communities following release. Analyses focused on secondary data collected from treatment participants in one southeastern state over a four year period between July 2006 and June 2010 including both baseline (treatment intake) and follow-up data (12-months post-release). Findings indicated that individuals in urban areas were 2.4 times more likely to recidivate than rural individuals. Other factors identified in separate rural and urban analyses also emerged as significant predictors in the overall model including age, gender, race, employment and drug use. Overall, these findings suggest that corrections-based treatment participants living in urban and rural areas following release may share similar risk factors for recidivism. However, rural areas may be protective for returning to custody despite the presence of some of these risks.