Ekaterina Pivovarova1, Elizabeth A Evans2, Thomas J Stopka3, Claudia Santelices4, Warren J Ferguson5, Peter D Friedmann6. 1. Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: ekaterina.pivovarova@umassmed.edu. 2. Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, USA. 3. Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA. 4. Claudia Santelices, Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Boston MA, 02115, USA. 5. Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. 6. University of Massachusetts Chan Medical School (UMCMS) - Baystate and Baystate Health, 3601 Main Street, Springfield, MA 01107, USA.
Abstract
BACKGROUND: Individuals with legal involvement and opioid use disorders (OUD) are at an increased risk of overdose and premature death. Yet, few correctional systems provide all FDA approved medications for OUD (MOUD) to all qualifying incarcerated individuals. We report on the implementation of MOUD in seven Massachusetts' jails following a state legislative mandate to provide access to all FDA-approved MOUD and to connect with treatment upon release. METHODS/PARTICIPANTS: Based on the Exploration, Preparation, Implementation, and Sustainment framework, 61 clinical, corrections, and senior jail administrators participated in semi-structured interviews and focus groups between December 2019 and January 2020. Qualitative analyses focused on external and internal contexts and bridging factors. FINDINGS: Participants detailed how the outer context (i.e., legislative mandate) drove acceptance of MOUD and assisted with continuity of care. Salient inner context factors included decision-making around administration of agonist medications, staff perceptions and training, and changes to infrastructure and daily routines. Leadership was critical in flattening standard hierarchies and advocating for flexibility. System-based characteristics of incarcerated individuals, specifically those who were pre-sentenced, presented challenges with treatment initiation. Inter- and intra-agency bridging factors reduced duplication of effort and led to quick, innovative solutions. CONCLUSIONS: Implementation of MOUD in jails requires collaboration with and reliance on external agencies. Preparation for implementation should involve systematic reviews of available resources and connections. Implementation requires flexibility from institutional systems that are inherently rigid. Accordingly, leaders and policymakers must recognize the cultural shift inherent in such programs and allow for resources and education to assure program success.
BACKGROUND: Individuals with legal involvement and opioid use disorders (OUD) are at an increased risk of overdose and premature death. Yet, few correctional systems provide all FDA approved medications for OUD (MOUD) to all qualifying incarcerated individuals. We report on the implementation of MOUD in seven Massachusetts' jails following a state legislative mandate to provide access to all FDA-approved MOUD and to connect with treatment upon release. METHODS/PARTICIPANTS: Based on the Exploration, Preparation, Implementation, and Sustainment framework, 61 clinical, corrections, and senior jail administrators participated in semi-structured interviews and focus groups between December 2019 and January 2020. Qualitative analyses focused on external and internal contexts and bridging factors. FINDINGS: Participants detailed how the outer context (i.e., legislative mandate) drove acceptance of MOUD and assisted with continuity of care. Salient inner context factors included decision-making around administration of agonist medications, staff perceptions and training, and changes to infrastructure and daily routines. Leadership was critical in flattening standard hierarchies and advocating for flexibility. System-based characteristics of incarcerated individuals, specifically those who were pre-sentenced, presented challenges with treatment initiation. Inter- and intra-agency bridging factors reduced duplication of effort and led to quick, innovative solutions. CONCLUSIONS: Implementation of MOUD in jails requires collaboration with and reliance on external agencies. Preparation for implementation should involve systematic reviews of available resources and connections. Implementation requires flexibility from institutional systems that are inherently rigid. Accordingly, leaders and policymakers must recognize the cultural shift inherent in such programs and allow for resources and education to assure program success.
Authors: Ingrid A Binswanger; Marc F Stern; Richard A Deyo; Patrick J Heagerty; Allen Cheadle; Joann G Elmore; Thomas D Koepsell Journal: N Engl J Med Date: 2007-01-11 Impact factor: 91.245
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Authors: Elizabeth A Evans; Thomas J Stopka; Ekaterina Pivovarova; Sean M Murphy; Faye S Taxman; Warren J Ferguson; Dana Bernson; Claudia Santelices; Kathryn E McCollister; Randall Hoskinson; Thomas Lincoln; Peter D Friedmann Journal: J Subst Abuse Treat Date: 2021-01-08
Authors: Bryan R Garner; Mark Zehner; Mathew R Roosa; Steve Martino; Heather J Gotham; Elizabeth L Ball; Patricia Stilen; Kathryn Speck; Denna Vandersloot; Traci R Rieckmann; Michael Chaple; Erika G Martin; David Kaiser; James H Ford Journal: Addict Sci Clin Pract Date: 2017-11-17