Publications by authors named "Josiah Rich"

246 Publications

What are the greatest health challenges facing people who are incarcerated? We need to ask them.

Lancet Public Health 2021 Jun 8. Epub 2021 Jun 8.

Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2468-2667(21)00074-8DOI Listing
June 2021

Fentanyl-related overdose during incarceration: a comprehensive review.

Health Justice 2021 May 19;9(1):13. Epub 2021 May 19.

The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.

Background: Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration.

Methods: We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021.

Results: Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country.

Conclusions: Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40352-021-00138-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133055PMC
May 2021

Treating pain with open-label placebos: A qualitative study with post-surgical pain patients.

J Pain 2021 May 15. Epub 2021 May 15.

The Alpert Medical School of Brown University, Department of Emergency Medicine; Brown University School of Public Health Departments of Epidemiology & Health Services, Policy, and Practice.

Prior research has shown that Open Label Placebos (OLPs; i.e., placebos described honestly as inactive pills) are effective for a variety of clinical conditions, including pain. However, little is known about patient attitudes towards OLPs. We conducted qualitative interviews with n=11 patients (73% female) who recently had hand or wrist surgery and took ≥ 1 opioid pill. Interview topics included: pain management, the placebo effect, and in particular, attitudes towards OLPs. Interviews were analyzed inductively and content-coded. Five themes were identified: 1) Role of the mind in pain and illness, 2) Shortcomings of opioids are the strengths of OLPs, 3) Perceptions of OLP Effectiveness, 4) Relational aspects of OLP administration, and 5) Practical considerations for OLP implementation. Most patients agreed that, because of their transparency, OLPs are ethical. Participants indicated some degree of reluctance about using OLPs, but the majority said they would take OLPs if prescribed by a doctor. Patients noted that the primary disadvantage of opioids is their potency, which can lead to addiction or side-effects; by contrast, the primary advantage of placebos is their inertness. Results suggest that OLPs appear to be well received as a post-operative pain treatment among the patients in this study. Perspective This qualitative study examines how hand surgery patients view open-label placebos (OLPs), which are placebos described honestly as inactive pills. OLPs were generally well received by patients as a treatment for pain after surgery and could be considered as an adjunctive treatment to potentially reduce reliance on prescription opioids.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpain.2021.05.001DOI Listing
May 2021

Why we vaccinate incarcerated people first.

EClinicalMedicine 2021 May 6;35:100864. Epub 2021 May 6.

University of North Carolina at Chapel Hill School of Medicine, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eclinm.2021.100864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100899PMC
May 2021

Expanding Mail-Based Distribution of Drug-Related Harm Reduction Supplies Amid COVID-19 and Beyond.

Am J Public Health 2021 06;111(6):1013-1017

Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2021.306228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101586PMC
June 2021

Harmonizing healthcare and other resource measures for evaluating economic costs in substance use disorder research.

Subst Abuse Treat Prev Policy 2021 Apr 8;16(1):32. Epub 2021 Apr 8.

Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.

Background: Standardization and harmonization of healthcare resource utilization data can improve evaluations of the economic impact of treating people with substance use disorder (SUD), including reductions in use of expensive hospital and emergency department (ED) services, and can ensure consistency with current cost-effectiveness and cost-benefit analysis guidelines.

Methods: We examined self-reported healthcare and other resource utilization data collected at baseline from three National Institute on Drug Abuse (NIDA)-funded Seek, Test, Treat, and Retain intervention studies of individuals living with/at risk for HIV with SUD. Costs were calculated by multiplying mean healthcare resource utilization measures by monetary conversion factors reflecting cost per unit of care. We normalized baseline recall timeframes to past 30 days and evaluated for missing data.

Results: We identified measures that are feasible and appropriate for estimating healthcare sector costs including ED visits, inpatient hospital and residential facility stays, and outpatient encounters. We also identified two self-reported measures to inform societal costs (days experiencing SUD problems, participant spending on substances). Missingness was 8% or less for all study measures and was lower for single questions measuring utilization in a recall period.

Conclusions: We recommend including measures representing units of service with specific recall periods (e.g., 6 months vs. lifetime), and collecting healthcare resource utilization data using single-question measures to reduce missingness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13011-021-00356-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033702PMC
April 2021

COBRE on Opioid and Overdose: A Collaborative Research-Based Center Addressing the Crises in Rhode Island and Beyond.

R I Med J (2013) 2021 Apr 1;104(3):22-26. Epub 2021 Apr 1.

Departments of Medicine and Epidemiology, Brown University; The Center for Health and Justice Transformation, The Miriam Hospital; The COBRE on Opioids and Overdose, Rhode Island Hospital.

Overdose deaths across the country have spiked since the onset of the COVID-19 pandemic. It is crucial now, more than ever, to address the continuing and worsening, complex and dynamic opioid and overdose epidemics. In 2018, The Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, based at Rhode Island Hospital, launched with three major goals: 1) establish a center of scientific excellence on opioids and overdose; 2) train the next generation of scientists to become independent investigators and address the opioid and overdose crises; and 3) contribute to the scientific progress and solutions to combat these epidemics. To date, we have made substantial progress. While the opioid and overdose crises continue to evolve, the COBRE on Opioid and Overdose and its team of investigators are well poised to address the daunting task of understanding and meaningfully addressing these deadly epidemics, with the ultimate goal of saving lives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049088PMC
April 2021

MAb for symptomatic COVID-19 in correctional facilities: an important opportunity.

Lancet 2021 03 19;397(10277):877-878. Epub 2021 Feb 19.

Warren Alpert School of Medicine, Brown University, RI 02903, USA; Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0140-6736(21)00354-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906645PMC
March 2021

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce.

Am J Prev Med 2021 05 9;60(5):729-731. Epub 2021 Jan 9.

Warren Alpert Medical School, Brown University, Providence, Rhode Island.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2020.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794594PMC
May 2021

Effect of Case Management on HIV Outcomes for Community Corrections Population: Results of an 18-Month Randomized Controlled Trial.

J Acquir Immune Defic Syndr 2021 May;87(1):755-762

Friends Research Institute, Baltimore, MD.

Background: Evidence-based interventions that engage community-dwelling, justice-involved, people living with HIV (PLWH) in care are urgently needed. Project Bridge, an intensive case management intervention, has demonstrated efficacy for linking PLWH to care transitioning from prison to the community. We assessed whether a modified Project Bridge model was effective for increasing rates of HIV treatment engagement, antiretroviral therapy receipt, and adherence for community-dwelling individuals supervised on probation and parole.

Setting: Baltimore, Maryland.

Methods: In this study, the 18-month outcomes of a randomized controlled trial in which PLWH were also on probation or parole received either Project Bridge (n = 50) or treatment as usual (n = 50) were assessed. HIV treatment engagement (primary outcome), antiretroviral therapy prescription, and adherence (secondary outcomes) are evaluated using the intent-to-treat approach.

Results: There were no statistically significant differences in rates of HIV treatment engagement, antiretroviral therapy prescription receipt, or adherence between groups over the 18-month study period. Across groups, participants were 5.6 times more likely to receive HIV care, 5.8 times more likely to receive an antiretroviral therapy prescription, and 4 times more likely to report antiretroviral therapy adherence at each follow-up period.

Conclusions: Future research is needed to identify potentially less-intensive interventions that target the unique needs of PLWH under community supervision.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/QAI.0000000000002624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026504PMC
May 2021

Commentary on Richardson et al. : Strategies to mitigate payment-coincident drug-related harms are urgently needed.

Addiction 2021 03 2;116(3):546-547. Epub 2020 Dec 2.

Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/add.15325DOI Listing
March 2021

Revising our attitudes towards agonist medications and their diversion in a time of pandemic.

J Subst Abuse Treat 2020 12 21;119:108139. Epub 2020 Sep 21.

The Miriam Hospital, Warren Alpert Medical School of Brown University, United States of America.

The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2020.108139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505066PMC
December 2020

COVID-19 and mass incarceration: a call for urgent action.

Lancet Public Health 2020 11 10;5(11):e571-e572. Epub 2020 Oct 10.

Department of Social Medicine and Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2468-2667(20)30231-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547322PMC
November 2020

Convalescent plasma for patients with severe COVID-19: a matched cohort study.

Clin Infect Dis 2020 Oct 10. Epub 2020 Oct 10.

Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Background: The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear.

Methods: In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis.

Results: 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (p = 0.52). There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 - 2.20). The overall rate of hospital discharge was not significantly different between the two groups (rate ratio [RR] 1.28, 95% CI 0.91 - 1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03 - 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused).

Conclusions: We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/ciaa1548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665324PMC
October 2020

Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System.

Infect Dis Clin North Am 2020 09;34(3):585-603

Department of Medicine, Brown University, 164 Summit Avenue, Providence, RI 02906, USA; Department of Epidemiology, Brown University, 164 Summit Avenue, Providence, RI 02906, USA.

This article provides an overview of the diagnosis and management of opioid use disorder and its infectious complications among populations with criminal justice involvement. Opioid use disorder and chronic infections such as human immunodeficiency virus and hepatitis C virus are highly prevalent among incarcerated individuals and some of the unique features of correctional facilities present challenges for their appropriate medical management. We outline evidence-based strategies for integrated, patient-centered treatment during incarceration and the potentially hazardous transition back to the community upon release.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.idc.2020.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433020PMC
September 2020

Initial Patterns of Prescription Opioid Supply and Risk of Mortality Among Insured Adults in the United States.

J Addict Med 2021 Apr;15(2):99-108

Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA (HAA, ALB, JB, XW, SJK); Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA (JWH); The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (JDR).

Objective: To examine the association between initial patterns of prescription opioid supply (POS) and risk of all-cause mortality among an insured opioid-naïve patient population in the United States (US).

Methods: This retrospective observational cohort study used de-identified, administrative health care claims data from a large national insurer (Optum Clinformatics Data Mart) from 2010 to 2015. Participants included insured, cancer-free adults prescribed opioid analgesics. Prescription opioids received during the first 6 months of therapy were used to categorize initial patterns of POS as daily or nondaily. Cox regression was used to estimate the association of initial patterns of POS with all-cause mortality within one year of follow-up, adjusting for baseline covariates to control for confounding.

Results: A total of 4,054,417 patients were included, of which 2.75% had incident daily POS; 54.8% were female; median age was 50 years; mean Charlson comorbidity index (CCI) was 0.21 (standard deviation = 0.77); and mean daily morphine milligram equivalent was 34.61 (95% confidence intervals: 34.59, 34.63). There were 2068 more deaths per 100,000 person-years among patients who were prescribed opioids daily than nondaily. After adjusting for baseline covariates, the hazard of all-cause mortality among patients with incident daily POS was nearly twice that among those prescribed nondaily (hazard ratio [HR] = 1.94; 95% confidence intervals: 1.84, 2.04).

Conclusions: Among insured adult patients with noncancer pain, incident chronic POS was associated with a significantly increased risk of all-cause mortality over at most 1 year of follow-up. Because these results may be susceptible to bias, more research is needed to establish causality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ADM.0000000000000701DOI Listing
April 2021

Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: A microsimulation modeling study.

Int J Drug Policy 2021 May 22;91:102841. Epub 2020 Jul 22.

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA. Electronic address:

Background: We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality.

Methods: We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD).

Results: In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively.

Conclusions: Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790977PMC
May 2021

COVID-19 as a Frying Pan: The Promise and Perils of Pandemic-driven Reform.

J Addict Med 2020 Sep/Oct;14(5):e144-e146

The Miriam Hospital, Warren Alpert Medical School of Brown University, RI (BdP); Northeastern University School of Law, MA (LB); The Miriam Hospital, Warren Alpert Medical School of Brown University, RI (JDR).

: The imposition of new regulations can send industries scrambling to comply, fostering innovation in doing so. How we police and treat people with opioid use disorder (OUD), with recent widespread social unrest in reaction to police violence and systemic racism bringing the need for lasting structural changes to our justice system and social services into especially acute relief. Arbitrary laws and counterproductive policies previously subject to only incremental reform have given way to sweeping changes: people convicted of nonviolent drug crimes have been released from jails and prisons, the enforcement of drug laws has been cast aside as a priority, and the regulations surrounding addiction treatment medications and treating patients with OUD have been greatly loosened. These are changes many practitioners and advocates have sought for years if not decades, but they come with the reality that the old systems are culturally entrenched and likely to be resilient. It is critical that researchers evaluate these changes and synthesize the results with existing evidence in ways that empower efforts to make the most effective responses permanent. The COVID-19 pandemic makes for a challenging research environment, but its OUD-related interventions have created new regulatory systems that lend themselves to valuable opportunities for evaluation as natural experiments by the burgeoning field of legal epidemiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ADM.0000000000000703DOI Listing
October 2020

One year of methadone maintenance treatment in a fentanyl endemic area: Safety, repeated exposure, retention, and remission.

J Subst Abuse Treat 2020 08 11;115:108031. Epub 2020 May 11.

The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA.

Introduction: Fentanyl is a potent synthetic opioid that has contributed to increasing overdose deaths in the United States in recent years. Concern over safety and efficacy of agonist treatment for fentanyl use may limit access to treatment. This study sought to address these potential concerns in a naturalistic setting.

Objectives: Measure 12-month treatment outcomes for methadone maintenance treatment (MMT) in a fentanyl endemic area.

Outcomes: Primary: 1) Treatment retention; 2) sustained remission (defined as 3 consecutive negative screens); 3) return to use; 4) methadone dosage required; and 5) number of days to achieve remission. Secondary: Mortality.

Methods: A naturalistic follow-up study and retrospective review of consecutive patients newly admitted to a single methadone maintenance treatment program in Rhode Island.

Results: We observed 154 unique intake events (representing 151 patients). Eighty percent (n = 121) tested positive for fentanyl at intake. Seventy-five percent of patients achieved remission within the 12-month study period. One-year retention was 53% for fentanyl-exposed individuals and 47% for those not exposed. The majority (99%) of patients who remained in treatment at 12 months achieved remission. We saw prolonged, sustained remission in 44% of patients exposed to fentanyl at intake and 47% of those who were not. Dose and time to remission were similar. Unfortunately, 4 patients died after leaving MMT prematurely.

Conclusions: This study suggests MMT is safe despite repeated exposure to fentanyl while taking methadone. Remission is achievable, and MMT is protective against death among fentanyl-exposed patients while in treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2020.108031DOI Listing
August 2020

Emergency department utilization by people living with HIV released from jail in the US South.

Health Justice 2020 Jun 27;8(1):16. Epub 2020 Jun 27.

Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Background: Incarceration is disruptive to HIV care, often resulting in poor retention in care for people living with HIV (PLWH) after jail release. This gap in HIV care might result in potentially preventable emergency department (ED) utilization. We analyzed demographic, incarceration, socioeconomic and clinical data for PLWH released from the Dallas County Jail to the community (1450 incarcerations, 1155 unique individuals) between January 2011 and November 2013.

Results: The study population consisted of predominantly men (77%), with a mean age of 39 years, 67% were black and 14% were Hispanic; half of the releasees visited the ED at least once during the first-year post-jail. In adjusted analyses, female gender, family awareness of HIV status, serious mental illness, and late engagement to HIV care were significantly associated with higher ED utilization. Compared to the general Dallas population, PLWH released from jail had a 5-fold higher proportion of ED visits classified as related to substance use or mental health.

Conclusions: Further efforts are needed to improve the transition from incarceration to community-based HIV care, substance use disorder treatment and mental health services, and to directly address re-engagement in HIV care for out-of-care PLWH who visit the ED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40352-020-00118-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321540PMC
June 2020

An overdose surge will compound the COVID-19 pandemic if urgent action is not taken.

Nat Med 2020 06;26(6):819-820

The Warren Alpert School of Medicine of Brown University, Providence, RI, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41591-020-0898-0DOI Listing
June 2020

Modeling COVID-19 and Its Impacts on U.S. Immigration and Customs Enforcement (ICE) Detention Facilities, 2020.

J Urban Health 2020 08;97(4):439-447

Opioid Policy Research Collaborative, Heller School for Social Policy and Management, Brandeis University, 415 South Main St. MS 035, Waltham, MA, 02454-9110, USA.

U.S. Immigration and Customs Enforcement (ICE) facilities house thousands of undocumented immigrants in environments discordant with the public health recommendations to reduce the transmission of 2019 novel coronavirus (COVID-19). Using ICE detainee population data obtained from the ICE Enforcement and Removal Operations (ERO) website as of March 2, 2020, we implemented a simple stochastic susceptible-exposed-infected-recovered model to estimate the rate of COVID-19 transmission within 111 ICE detention facilities and then examined impacts on regional hospital intensive care unit (ICU) capacity. Models considered three scenarios of transmission (optimistic, moderate, pessimistic) over 30-, 60-, and 90-day time horizons across a range of facility sizes. We found that 72% of individuals are expected to be infected by day 90 under the optimistic scenario (R0 = 2.5), while nearly 100% of individuals are expected to be infected by day 90 under a more pessimistic (R0 = 7) scenario. Although asynchronous outbreaks are more likely, day 90 estimates provide an approximation of total positive cases after all ICE facility outbreaks. We determined that, in the most optimistic scenario, coronavirus outbreaks among a minimum of 65 ICE facilities (59%) would overwhelm ICU beds within a 10-mile radius and outbreaks among a minimum of 8 ICE facilities (7%) would overwhelm local ICU beds within a 50-mile radius over a 90-day period, provided every ICU bed was made available for sick detainees. As policymakers seek to rapidly implement interventions that ensure the continued availability of life-saving medical resources across the USA, they may be overlooking the pressing need to slow the spread of COVID-19 infection in ICE's detention facilities. Preventing the rapid spread necessitates intervention measures such as granting ICE detainees widespread release from an unsafe environment by returning them to the community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11524-020-00441-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228433PMC
August 2020

Vulnerable Populations: Weathering the Pandemic Storm.

Am J Prev Med 2020 06 22;58(6):892-894. Epub 2020 Apr 22.

Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, Rhode Island.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2020.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174188PMC
June 2020

Development of an integrated digital health intervention to promote engagement in and adherence to medication for opioid use disorder.

Addict Sci Clin Pract 2020 04 29;15(1):16. Epub 2020 Apr 29.

Department of Medicine, Alpert Medical School of Brown University, Providence, USA.

Background: Buprenorphine-naloxone is an evidence-based treatment for Opioid Use Disorder. However, despite its efficacy, nearly half of participants are unsuccessful in achieving stabilization (i.e., period of time following medication induction in which medication dose is adjusted to be effective in reducing cravings/withdrawal, minimize potential side effects, and eliminate illicit substance use). This paper presents the study design and protocol for a digital health intervention designed to promote engagement in and adherence to buprenorphine treatment, offered through an outpatient addiction treatment center, through motivational enhancement and distress tolerance skills training. Personalized feedback interventions represent a promising method to effectively motivate engagement in and adherence to buprenorphine treatment. These interventions are generally brief, individually tailored, and have the potential to be delivered via mobile platforms. Distress tolerance, a transdiagnostic vulnerability factor, has been implicated in the development and maintenance of substance use. Targeting distress tolerance may improve substance use treatment outcomes by promoting the ability to persist in goal-directed activity even when experiencing physical or emotional distress.

Methods: The study aims are to: (1) develop and refine an interactive computer- and text message-delivered personalized feedback intervention that incorporates distress tolerance skills training for persons who have elected to initiate outpatient buprenorphine treatment (iCOPE); (2) examine the feasibility, acceptability, and preliminary efficacy of iCOPE for increasing abstinence, adherence, and retention in treatment compared to a treatment as usual comparison condition; and, (3) examine potential mechanisms that may underlie the efficacy of iCOPE in improving outcomes, including motivation, distress tolerance, self-regulation, and negative affect.

Discussion: Results of this study will be used to determine whether to proceed with further testing through a large-scale trial. This work has the potential to improve treatment outcomes by reducing illicit opioid use, increasing adherence/retention, and preventing future overdose and other complications of illicit opioid use. Trial Registration NCT03842384.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13722-020-00189-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191734PMC
April 2020

Flattening the Curve for Incarcerated Populations - Covid-19 in Jails and Prisons.

N Engl J Med 2020 May 2;382(22):2075-2077. Epub 2020 Apr 2.

From the Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (M.J.A.); the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta (A.C.S.); and the Departments of Medicine and Epidemiology, Division of Infectious Diseases, Brown University and the Miriam Hospital, Providence, RI (J.D.R.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMp2005687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398586PMC
May 2020

Correlates of death during outpatient treatment for opioid use disorder: A national study.

J Subst Abuse Treat 2020 05 15;112:76-85. Epub 2020 Jan 15.

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA. Electronic address:

Background: As the burden of opioid use disorder (OUD) increases in the United States, manifold federal and state initiatives have sought to increase access to treatment for OUD, which includes behavioral and pharmaceutical treatment modalities. Although the evidence base for outpatient treatment for OUD-including medications for opioid use disorder-is substantial, few studies have examined the risk factors for fatality during treatment for OUD.

Methods: Treatment Episode Data Set-Discharges (TEDS-D) data were used to evaluate correlates of death during outpatient treatment for OUD in 2016. To determine the correlates of mortality during an outpatient treatment for OUD, we constructed a pooled logistic regression model, stratified by use of medication for opioid use disorder (MOUD), to control for the duration of time in treatment and to identify the independent characteristics that may lead to differences in the odds of mortality during treatment.

Findings: 1861 (0.8%) of 235,745 outpatient treatment episodes for OUD included in our analysis resulted in fatality. Many factors correlated with death during treatment were similar for individuals who did and did not receive MOUD. However, non-White race was only significantly associated with decreases in fatality in non-MOUD treatment episodes. Male sex and reported intravenous drug use at admission were associated with fatality only for treatment episodes that did not involve MOUD.

Conclusions: In this national study of outpatient treatment episodes for OUD, we found differences in age, sex, region, drug use history, treatment setting, and treatment history significantly affected the risk of death during treatment. As more people become engaged with treatment, facilities should work toward delivering optimal treatment for all patients regardless of personal characteristics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2020.01.003DOI Listing
May 2020

Prescribers and Naloxone Pharmacy Claims.

J Gen Intern Med 2020 08 19;35(8):2474. Epub 2020 Mar 19.

Brown University School of Public Health, Providence, RI, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11606-020-05760-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403247PMC
August 2020

The protective effect of trusted dealers against opioid overdose in the U.S.

Int J Drug Policy 2020 04 4;78:102695. Epub 2020 Mar 4.

The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Emergency Medicine, Boston University School of Medicine, 771 Albany St, Room 1208, Boston, MA 02118, USA.

Background: Opioid overdose has become the leading cause of death among adults between 25 and 54 years old in the U.S. The purpose of this study is to explore the social and relational factors that shape the current opioid overdose epidemic.

Methods: Between January 2016 and February 2017, adults in Providence, Rhode Island, who use opioids were recruited to complete structured survey and semi-structured interview about the social context of their substance use.

Results: A total of 92 individuals completed a survey and an interview. Of those, 51 individuals (68.6% male, 49.0% white) discussed their relationships with drug suppliers in their interview and were included in this sub-study. Many of these participants indicated that long-term relationships with trusted dealers represent a key strategy for reducing the risk of substance use-related harm due to suppliers' alleged adoption of consumer protection strategies (e.g. refusing to sell fentanyl) and quality assurance measures (e.g. testing batches of drugs for fentanyl prior to sale).

Conclusion: Interpersonal relationships between individuals who use drugs and their suppliers strongly influence the risk and protective factors experienced by people who use drugs in today's opioid overdose epidemic. Evidence-based prevention strategies that are based on an awareness of-or even designed to harness-those positive and/or protective relationships that people who use drugs have already constructed for themselves are likely merited.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302982PMC
April 2020

Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails.

Drug Alcohol Depend 2020 03 18;208:107858. Epub 2020 Jan 18.

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA. Electronic address:

Background: Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality.

Methods: We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016.

Results: Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 - 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 - 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 - 1812) and 1609 (95% SI: 972 - 2037) lives saved per 10,000 persons incarcerated, respectively.

Conclusions: Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2020.107858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075016PMC
March 2020