Overdose deaths have increased dramatically in the United States and are often attributed to prescription opioids. This study presents a framework for “overdose typologies”, including non-medical prescription drug use, to more accurately describe drug use patterns.
This study examined linked prescription drug monitoring program (PDMP) and toxicology data (2016–2018) from accidental overdose deaths from a large metropolitan coroner’s office in the Midwest (Indianapolis, Indiana).
In total, 1,112 accidental overdose deaths occurred and over two-thirds (68.0%; n = 756) were coded as an illicit drug user with no prescription opioid present in the toxicology. The most infrequent categories were prescription opioid users 5.5% (n = 61).
Linked PDMP and toxicology reports are useful in identifying drug use patterns that contribute to mortality.
The overrepresentation of individuals with mental illness in the criminal/legal system is well documented. While professional associations urge diversion towards treatment, little is known about the practices these institutions use to identify this population. One understudied space in the criminal/legal continuum is jails. This exploratory study compares two types of mental health identification at jail booking to assess jail‐ and community‐based service outcomes by identification type (N = 2956): (a) staff observation and (b) a standardized screening instrument. Individuals identified through staff observation were significantly more likely to receive jail‐ and community‐based services, even though current symptomology and substance misuse were both significantly higher for individuals identified only by the screening instrument. These findings point to the importance of jails in providing stabilizing services during incarceration, but further, show the impact that identification practices have on individuals as they transition to the community. Community context showed varied rates of jail staff observations of mental illness, showing greater risks for individuals in rural communities. Implications include a need for system‐level changes by instituting evidence‐based identification practices in jails, and improving professional collaboration practices between mental health and criminal/legal practitioners as individuals enter and exit jails.
We described the change in drug overdoses during the COVID-19 pandemic in one urban emergency medical services (EMS) system. Data was collected from Marion County, Indiana (Indianapolis), including EMS calls for service (CFS) for suspected overdose, CFS in which naloxone was administered, and fatal overdose data from the County Coroner’s Office. With two sample t tests and ARIMA time series forecasting, we showed changes in the daily rates of calls (all EMS CFS, overdose CFS, and CFS in which naloxone was administered) before and after the stay-at-home order in Indianapolis. We further showed differences in the weekly rate of overdose deaths. Overdose CFS and EMS naloxone administration showed an increase with the social isolation of the Indiana stay-at-home order, but a continued increase after the stay-at-home order was terminated. Despite a mild 4% increase in all EMS CFS, overdose CFS increased 43% and CFS with naloxone administration increased 61% after the stay-at-home order. Deaths from drug overdoses increased by 47%. There was no change in distribution of age, race/ethnicity, or zip code of those who overdosed after the stay-at-home order was issued. We hope this data informs policy-makers preparing for future COVID-19 responses and other disaster responses.
Given the increased use of for-profit providers in carceral settings, understanding how these organizations differ from nonprofit providers is imperative to ensure individuals in jails with SMI have the opportunity to engage in high-quality mental health services. The lack of empirical evidence surrounding for-profit providers may force policymakers and practitioners to make decisions about mental health service provision without information about what they are purchasing. In addition, most of the work on the issue of for-profit and nonprofit service providers attributes most differences between the two types of provider modalities,13, 15,16,17, 20, 47 which fails to take into consideration the structural and procedural concerns.24 This is important, as the policy recommendations that focus on a theorized profit motive of for-profit organizations will be significantly different than recommendations focusing on how, structurally, for-profit and nonprofit organizations differ within the jail and community, and how these structural differences affect treatment outcomes for individuals with SMI. This research represents a first step in building a literature on how effective for-profit providers are in providing services in carceral settings, and how well they work and collaborate with jail staff and administrators.
This study presents an adaptation of the Crisis Intervention Team Model (CIT) to a jail setting. Pre-post surveys and interviews assessed changes in corrections officers’ (CO) knowledge of and attitudes toward mental health. Cell Removal Team (CRT) services assessed the impact of CIT on the use of this specialized unit. Results indicate positive changes in CO attitudes, increased de-escalation skills, and an abrupt decrease in the level of CRT usage, with results sustained in the 8-month follow-up period.
Studies suggest that up to 44% of individuals in the criminal/legal system have a severe mental illness (SMI), and although diversion programs have been established, a significant portion still end up incarcerated. The Sequential Intercept Model is a framework designed to reduce the overrepresentation of individuals with SMI in the criminal/legal system by identifying points of interception to prevent individuals from entering or moving further into the system. Although studies assess programs in each intercept, none has evaluated how individuals process through all intercepts. Using data from eight counties (N = 1,160), this exploratory study assesses criminal/legal involvement across each intercept between individuals identified with (n = 880) or without (n = 280) SMI. Findings indicate longer stays in jail, low rates of treatment engagement and enrollment in specialty courts, and poorer diversion outcomes for individuals with SMI. Recommendations for research, policies, and practices are proposed to advance Smart Decarceration efforts.
Identification of serious mental illness (SMI) among those entering jail is the first step in diversion or appropriate services in jail. Although best practices guidelines for identifying SMI exist, many jails do not employ these standards. Researchers describe identification of SMI in the “practice as usual” and compare/contrast the results with a validated screening instrument for 2,961 individuals across eight jails. Overall, 20% scored positive on the screening instrument, and staff identification yielded an additional 16%. While the instrument was consistent in identifying the proportion of persons with SMI across each county (16% to 22%), the proportion identified by jail staff varied greatly (3% to 33%). Moreover, referral to—and receipt of—subsequent services for the staff-identified individuals varied greatly, leading to recommendations for improved processes.
Given the interrelated nature of opioid use, criminal justice interaction, and mental health issues, the current opioid crisis has created an urgent need for treatment, including medication assisted treatment, among justice-involved populations. Implementation research plays an important role in improving systems of care and integration of evidence-based practices within and outside of criminal justice institutions. The current study is a formative qualitative evaluation of the implementation of a cross-system (corrections and community-based) opioid use treatment initiative supported by Opioid State Targeted Response (STR) funding. The purpose of the study is to assess the fit of the Consolidated Framework for Implementation Research (CFIR) to a cross-system initiative, and to identify key barriers and facilitators to implementation.
The process evaluation showed that adaptability of the clinical model and staff flexibility were critical to implementation. Cultural and procedural differences across correctional facilities and community-based treatment programs required frequent and structured forums for cross-system communication. Challenges related to recruitment and enrollment, staffing, MAT, and data collection were addressed through the collaborative development and continuous review of policies and procedures.
This study found CFIR to be a useful framework for understanding implementation uptake and barriers. The framework was particularly valuable in reinforcing the use of implementation research as a means for continuous process improvement. CFIR is a comprehensive and flexible framework that may be adopted in future cross-system evaluations.
Emergency department (ED)-based peer support programs aimed at linking persons with opioid use disorder (OUD) to medication for addiction treatment and other recovery services are a promising approach to addressing the opioid crisis. This brief report draws on experiences from three states' experience with such programs funded by the SAMHSA Opioid State Targeted Repose (STR) grants. Core functions of such programs include: Integration of peer supports in EDs; Alerting peers of eligible patients and making the patient aware of peer services; and connecting patients with recovery services. Qualitative data were analyzed using a general inductive approach conducted in 3 steps in order to identify forms utilized to fulfill these functions. Peer integration differed in terms of peer's physical location and who hired and supervised peers. Peers often depend on ED staff to alert them to potential patients while people other than the peers often first introduce potential patients to programming. Programs generally schedule initial appointments for recovery services for patients, but some programs provide a range of other services aimed at supporting participation in recovery services. Future effectiveness evaluations of ED-based peer support programs for OUD should consistently report on forms used to fulfill core functions.