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Principal Investigator: CARRIE BETH OSER
Organization: UNIVERSITY OF KENTUCKY
Fiscal Year: 2024
Award: $562,683
Funding agency: National Institute on Drug Abuse
ABSTRACT: As outlined in DAT18-08, NIDA has a strong interest in understanding treatment utilization among
persons with opioid use disorders (POUDs) as they transition from prison to the community, because treating
individuals with opioid use disorder (OUD) simultaneously improves public health and public safety. Kentucky
is in the midst of an opioid crisis, with many POUDs cycling through the criminal justice system each year. While
evidenced-based medications for addiction treatment (MAT) exist for treating OUD, MAT is underutilized within
prisons, which elevates the risk of relapse and overdose when POUDs are released and re-enter their
communities. Research is scant regarding the multi-level factors associated with offenders’ willingness to initiate
MAT while in prison and their continued engagement in treatment after release. Furthermore, rural and urban
populations have not been compared. In response to NIDA DAT18-08, we propose to conduct the high-impact
Geographic variation in Addiction Treatment (GATE) study, which will address the knowledge gap on multi-level
factors influencing prison-based extended-release injectable naltrexone (XR-NTX) initiation as well as examine
predictors of post-release MAT use and adverse outcomes (i.e., relapse, overdose, recidivism) among both rural
and urban POUDs. This mixed methods study employs a social ecological framework to understand individual
characteristics that influence MAT initiation and adverse outcomes, as well as contexts more distal to the
individual, including social networks and structural factors. The specific aims of the GATE study are: 1) to
identify the individual, personal network, and structural factors associated with XR-NTX initiation in
prison among rural, as compared to urban, POUDs, and 2) to examine the individual, personal network,
and structural factors predicting MAT use, treatment use, and adverse outcomes in the community
among re-entering rural, as compared to urban, POUDs over time. A prospective observational longitudinal
cohort study will be conducted with 500 POUDs, using survey and social network data collected in prison and
at 6- and 12-months post-release to explore multi-level rural-urban variation in key outcomes. In-depth guided
qualitative interviews will be conducted with POUDs, prison-based treatment staff, and social service clinicians.
To maximize rigor and reproducibility, we will employ a concurrent triangulation strategy, whereby qualitative
and quantitative data contribute equally to the analysis and are used for cross-validation. This study is led by a
qualified interdisciplinary team and is the first mixed methods study examining the processes of social influences
that occur in rural and urban social networks as POUDs transition from prison back to geographically diverse
counties. The GATE study will enhance our ability to address the opioid epidemic within the correctional contexts
of prisons and community supervision by informing process improvement efforts for prison-based MAT initiation
and post-release retention in care, applying network science findings to improve the re-entry planning process,
and establishing the foundation for future R-level intervention applications.
Terms: <Access to Care><Active Follow-up><Address><Back><Caring><Characteristics><Communities><Continuity of Care><Continuity of Patient Care><Continuum of Care><County><Crime><Criminal Justice><Data><Distal><Dorsum><Drug Screening><Drug usage><Drugs><Economically Deprived><Education><Educational aspects><Elements><Eligibility><Eligibility Determination><Enrollment><Equipment and supply inventories><Foundations><Future><Geographic Area><Geographic Locations><Geographic Region><Geographical Location><Geography><Goals><Health><Health Services Accessibility><Healthcare><Imprisonment><Individual><Injectable><Intervention><Intervention Strategies><Interview><Inventory><Kentucky><Knowledge><Literature><Long-term cohort study><Longitudinal cohort study><Longterm cohort study><Measures><Mediating><Medicaid><Medication><Mentors><Methods><NIDA><NIH><Nalorex><Naltrexone><National Institute of Drug Abuse><National Institute on Drug Abuse><National Institutes of Health><Nemexin><Opiate Addiction><Opiate Dependence><Out-patients><Outcome><Outpatients><Overdose><Persons><Pharmaceutical Preparations><Pilot Projects><Predictive Factor><Prison Inmates><Prisoner><Prisons><Process><Protocol Screening><Public Health><Qualifying><ReVia><Recovery><Relapse><Reproducibility><Research><Research Resources><Resources><Rural><Rural Appalachia><Rural Appalachian><Rural Population><Rural group><Rural people><Safety><Sampling><Science><Self-Help Groups><Social Network><Social Service><Social Work><Structure><Substance abuse problem><Supervision><Support Groups><Survey Instrument><Surveys><System><Time><Treatment outcome><United States National Institutes of Health><Urban Population><Validation><Variant><Variation><Vivitrol><Woman><abuse of substances><access to health services><access to services><access to treatment><accessibility to health services><active followup><addiction><addictive disorder><adverse consequence><adverse outcome><availability of services><care access><correctional institution resident><criminal offender><drug use><drug/agent><economic disparity><economically disadvantaged><effective therapy><effective treatment><enroll><evidence base><experience><follow up><follow-up><followed up><followup><geographic difference><geographic site><geographic variation><health care><health service access><health services availability><improved><incarcerated><incarceration><interest><interventional strategy><jail inmate><medication for opioid use disorder><non-medical opioid use><nonmedical opioid use><offender><opiate crisis><opiate misuse><opiate use disorder><opioid addiction><opioid crisis><opioid dependence><opioid dependent><opioid epidemic><opioid misuse><opioid use disorder><pilot study><primary outcome><process improvement><programs><prospective><recidivism><recruit><relapse risk><response><rural individual><self help organization><service availability><social><social influence><social structural><social structure><socio-structural><sociostructural><structural determinants><structural factors><substance abuse><treatment access><uptake><urban group><urban individual><urban people><validations><willingness>