[R01] Evaluating a Novel Approach to Dispensing Methadone in Carceral Facilities
Ente: National Institute on Drug Abuse
Scadenza: 2030-05-31
Importo max: 696.031 EUR
Paese: US
Descrizione
PROJECT SUMMARY
Incarcerated persons have a high prevalence of opioid use disorder (OUD) and an elevated risk of nonfatal
and fatal overdose following release. Methadone is a critical medication for treating OUD but is often
inaccessible in carceral facilities due to the complex federal regulations that typically restrict methadone to
federally licensed opioid treatment programs (OTPs). In 2024, the Substance Abuse and Mental Health
Services Administration issued a final rule clarifying that any carceral facility registered with the Drug
Enforcement Administration as a “hospital/clinic” is permitted to stock and dispense methadone for the
treatment of OUD, as long as the patient is primarily being treated for another medical condition. As most
incarcerated people with OUD have another health condition, the hospital/clinic registration thus provides a
more streamlined approach to stocking methadone that could dramatically expand access to medications for
OUD (MOUD) for incarcerated persons. In partnership with our team, three state prison systems—Colorado,
Delaware, and Washington—are planning widespread methadone expansion using the hospital/clinic
designation. Our mixed-methods study will inform implementation efforts of this new approach to methadone
treatment in the vanguard systems and nationwide. Aim 1 launches a learning collaborative with an embedded
implementation study. The three vanguard state prison systems and several other jail and prison systems that
are planning to implement the hospital/clinic designation will participate in a 24-month program with didactic
education and applied problem-solving modules. Their baseline challenges with implementation, and ongoing
progress addressing challenges, will be tracked via survey and qualitative interview data. Aim 2 will analyze
electronic records on persons who have diagnosed OUD from each system spanning 2022 to 2028. Using a
trial emulation study design that considers the impact of a facility starting to stock methadone under the
hospital/clinic designation, we will evaluate how the rollout of new services in the three state prison systems
affects pre-release initiation and retention on MOUD. Linking carceral records to Medicaid claims, Aim 3 will
extend the same trial emulation framework in Washington State to study the impact on post-release outcomes
such as MOUD and avoidable hospitalizations. Finally, using measures of spending, resources and staffing,
and health impacts collected in Aims 1-3, Aim 4 will examine the associated costs, cost effectiveness, and
budgetary impact of phasing in the hospital/clinic designation. We will calculate the incremental cost
effectiveness per patient and the overall impact on the carceral budget of the hospital/clinic designation
compared to the status quo. Study results will inform decisions about current and future adoption of this
important new option for expanding methadone access to incarcerated populations.
Istituzione: JOHNS HOPKINS UNIVERSITY
PI: Sachini Bandara, BRENDAN K SALONER
Progetto: 5R01DA064510-02
Settori: National Institute on Drug Abuse
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