Over 75% of women imprisoned in the Oregon state prison system require treatment for a substance use disorder. Furthermore, according to Elizabeth Needham Waddell, Ph.D., assistant professor of the OHSU-PSU School of Public Health, opioid overdose is a major cause of death following the release of the prison.
"We know from experiences in other states, that women run a significantly higher risk of opiate overdose than their male counterparts, "she says." Especially in the first weeks after their release ".
Although sex-related differences specific to the risk of overdose in incarcerated adults are not yet fully understood, there are more individual and social factors to consider, explains Waddell. For example, compared to jailed men, women have higher rates of substance use disorders and simultaneously occurring medical and mental conditions. Limited access to treatment, support social networks and affordable housing are also related to the risk of overdose.
"When these factors are not taken into account and no effective links are provided to support services for treatment and recovery before release from prison, women are not predisposed to success in the community and are more likely to return to consumption of substances, "says Waddell. "We must offer an adequate continuum of treatment and support for recovery that begins before their release."
Presentation of ROAR
Waddell is collaborating with researchers from the OHSU-PSU School of Public Health, OHSU School of Medicine, Oregon State University / OHSU College of Pharmacy and Health Comagine in conducting a three-year pilot study to evaluate a new opiate overdose prevention program called Reducing Overdose after release from incarceration or ROAR.
Launched in June 2019 in collaboration with the Oregon Corrections Department, ROAR is specifically designed to meet the specific needs of women incarcerated with a diagnosis of moderate to severe opioid use disorder. The program, funded by the Centers for Disease Control and Prevention, has already recruited more than 20 participants.
The certified recovery mentor Morgan Nelson works with some of them. Nelson, previously incarcerated, works for the ROAR program partner Bridgeway Recovery Services. He recognizes a five-year period in the state prison system for saving her life.
"Many incarcerated women have the odds accumulated against them from the beginning of their time in prison: mental health, addiction and minimal support," he says. "The experience of being released from prison can be incredibly overwhelming and emotional. It is an awareness that the world has continued without you. That children have grown, that simple things like banks or shopping can be difficult in that way. many ways. "
Nelson believes that ROAR can prepare women for success and help facilitate the stressful transition to their community.
"Now, as a mentor, I can build relationships with women with similar experiences," he says. "The combination of substance use disorder treatment and a mentor's ability to relate to the challenges of detention create a support system that can help normalize the emotions they are experiencing at release."
The ROAR experience
An interdisciplinary approach, ROAR combines the beginning of therapy and peer support with a continuous link to the treatment of the substance use disorder of the community, before release.
In the month before leaving the Coffee Correctional Facility, the only female prison in the Oregon, program participants connect with certified recovery tutors through "handy" visits, which help prepare participants to access community-based treatments. The visits also help educate adults in custody of the importance of carrying a rescue kit for nasal naloxone overdose, commonly known as Narcan, at the time of release. All participants are released with Narcan rescue kits provided by the project.
Women who choose to participate in the ROAR pilot study receive an extended release naltrexone injection from a corrective health care provider in the week before release. Naltrexone prolonged release is an opioid antagonist drug that can block the effects of opioids for up to four weeks, in addition to providing protection from overdose.
After incarceration, a certified recovery tutor will help the study participant to link to the treatment of substance use disorder and provide support for ongoing treatment conservation and recovery efforts. Participants can work with their health care providers at partner treatment facilities, CODA and Bridgeway Recovery Services, to continue extended release naltrexone or explore alternative treatments.
Tracking of ROAR impacts
In collaboration with the Oregon Department of Corrections, the Department of Human Services and the Oregon Health Authority, Waddell and his colleagues will use vital statistics, interviews with hospital data and Medicaid to evaluate the impact of the pilot project on overdose rates among participants in four Oregon counties: Clackamas, Marion, Multnomah and Washington – compared to women released in the rest of the state. The insights obtained by the participants will help the research team assess the feasibility and the acceptability of resizing the project in future years.
"We will follow these women to learn about their experiences in the program, conducting interviews with them, as well as with their mentors and doctors, for six months after their release," says Waddell, who hopes to involve 100 participants in the program over the next 18 months.
She and the research team hope to see a reduction in overdose rates and, together with the Department of Corrections, identify concrete and achievable strategies to increase the program to reach men and women imprisoned in Oregon and other states. The results are expected for 2022.
Post-emerging post-overdose interventions emerge in the United States
Reduction of the risk of post-incident opioid overdose in women (11 September 2019)
recovered 11 September 2019
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