Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders

BACKGROUND:

Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited.

METHODS:

In this five-site, open-label, randomized trial, we compared a 24-week course of extended-release naltrexone (Vivitrol) with usual treatment, consisting of brief counseling and referrals for community treatment programs, for the prevention of opioid relapse among adult criminal justice offenders (i.e., persons involved in the U.S. criminal justice system) who had a history of opioid dependence and a preference for opioid-free rather than opioid maintenance treatments and who were abstinent from opioids at the time of randomization. The primary outcome was the time to an opioid-relapse event, which was defined as 10 or more days of opioid use in a 28-day period as assessed by self-report or by testing of urine samples obtained every 2 weeks; a positive or missing sample was computed as 5 days of opioid use. Post-treatment follow-up occurred at weeks 27, 52, and 78.

RESULTS:

A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extended-release naltrexone had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, P<0.001; hazard ratio, 0.49; 95% confidence interval [CI], 0.36 to 0.68), a lower rate of relapse (43% vs. 64% of participants, P<0.001; odds ratio, 0.43; 95% CI, 0.28 to 0.65), and a higher rate of opioid-negative urine samples (74% vs. 56%, P<0.001; odds ratio, 2.30; 95% CI, 1.48 to 3.54). At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal (46% in each group, P=0.91). The rates of other prespecified secondary outcome measures--self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration--were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group (P=0.02).

CONCLUSIONS:

In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation.

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By:  Lee JD1, Friedmann PD1, Kinlock TW1, Nunes EV1, Boney TY1, Hoskinson RA Jr1, Wilson D1, McDonald R1, Rotrosen J1, Gourevitch MN1, Gordon M1,Fishman M1, Chen DT1, Bonnie RJ1, Cornish JW1, Murphy SM1, O'Brien CP1.

• 1From the Departments of Population Health (J.D.L., R.M., M.N.G.), Medicine, Division of General Internal Medicine and Clinical Innovation (J.D.L.), and Psychiatry (J.R.), New York University, and the New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons (E.V.N.) - both in New York; the Division of General Internal Medicine, the Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence (P.D.F., R.A.H., D.W.); Friends Research Institute (T.W.K., M.G., M.F.), the University of Baltimore, School of Criminal Justice (T.W.K.), and Maryland Treatment Centers (M.F.) - all in Baltimore; the University of Pennsylvania (T.Y.B., J.W.C., C.P.O.) and the Philadelphia Veterans Affairs Medical Center (J.W.C.) - both in Philadelphia; the Center for Biomedical Ethics and Humanities, School of Medicine (D.T.C.) and the School of Law (R.J.B.), University of Virginia, Charlottesville; and Washington State University, Spokane (S.M.M.). 
• N Engl J Med. 2016 Mar 31;374(13):1232-42. doi: 10.1056/NEJMoa1505409.

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Social Support Quality & Availability Affects Risk Behaviors in Offenders

Background

People involved in the justice system are at 2.5 times the risk of HIV infection compared to the general population, which is further complicated by substance abuse. The purpose of this study was to evaluate the role of social network quality and quantity on unprotected sex, criminal risk, and substance use.

Methods

We used data from 330 drug-involved offenders. Structural equation modeling (SEM) was used to model and test path directionality and magnitude between the latent constructs of social support quality and quantity on risky behaviors.

Results

The SEM indicated the latent construct of social support quality was significantly associated with reduced sexual risk behavior (β = −0.27), criminal risk (β = −0.26), and reduced substance use (β = −0.33). Additionally, the proposed model found that social support quantity was significantly positively associated with increased sexual risk behavior (β = 0.40) and substance use (β = 0.20).

Conclusions

Social support quality is an important predictor of risky behaviors; as the quality of an offender’s social support increases, engagement in risky behaviors decreases. Probationers who had broader social support availability also had increased substance use and unprotected sex. Probation systems may be able to reduce substance use and STD/HIV infection risk in offenders by strengthening the quality of social support networks.

Below:  Structural Model of Social Support Quality and Quantity on Risk Taking Behaviors

Full article at:   http://goo.gl/VmUAv0

By:  Stephanie A. Spohr, Sumihiro Suzuki, Brittany Marshall, Faye S. Taxman, and Scott T. Walters

University of North Texas Health Science Center, Fort Worth, USA

George Mason University, Fairfax, VA USA

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Self-Harm Following Release from Prison: A Prospective Data Linkage Study

OBJECTIVE:

Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison.

METHOD:

Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations.

RESULTS:

During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]).

CONCLUSION:

Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.

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By:  Borschmann R1, Thomas E2, Moran P3, Carroll M4, Heffernan E5, Spittal MJ4, Sutherland G4, Alati R6, Kinner SA7.

• 1Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia rohan.borschmann@mcri.edu.au.
• 2Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.
• 3Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
• 4Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
• 5Queensland Forensic Mental Health Service, QLD, Australia.
• 6Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia.
• 7Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia Griffith Criminology Institute and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia. 
• Aust N Z J Psychiatry. 2016 Mar 24. pii: 0004867416640090.

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Access to Recovery and Recidivism among Former Prison Inmates

Access to Recovery (ATR) is a Substance Abuse and Mental Health Services Administration (SAMHSA)–funded initiative that offers a mix of clinical and supportive services for substance abuse. ATR clients choose which services will help to overcome barriers in their road to recovery, and a recovery consultant provides vouchers and helps link the client to these community resources. 

One of ATR’s goals was to provide services to those involved in the criminal justice system in the hopes that addressing substance abuse issues could reduce subsequent criminal behaviors. This study examines this goal by looking at recidivism among a sample of clients in one state’s ATR program who returned to the community after incarceration. 

Results suggest that there were few differential effects of service selections on subsequent recidivism. However, there are significant differences in recidivism rates among the agencies that provided ATR services. Agencies with more resources and a focus on prisoner reentry had better recidivism outcomes than those that focus only on substance abuse services.

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By:  Bradley Ray1, Eric Grommon1, Victoria Buchanan1, Brittany Brown1, Dennis P. Watson1⇑

¹Indiana University–Purdue University Indianapolis, USA

Dennis P. Watson, Center for Health Policy, Indiana University Fairbanks School of Public Health, 714 N Senate Avenue, Indianapolis, IN 46202, USA. Email:dpwatson@iu.edu

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Adult Community Supervised Population

Adult Community Supervised Population | Graphiq

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The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans

The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs’ (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. 

These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.

...The objectives of the current study were to determine the availability of services for justice-involved veterans that address empirically-supported risk factors for recidivism that are targeted by the RNR model, the types of treatment options and resources that are perceived as being most helpful in addressing these risk factors, and whether justice-involved veterans have access to empirically-based treatments for recidivism risk. For most risk factors (substance abuse, lack of positive school or work involvement, family/marital dysfunction, and lack of prosocial activities/interests), responses from the majority of Veterans Justice Program Specialists in our sample included description of some type of treatment option or resource that was available to address these issues among justice-involved veterans. By comparison, only a little more than half of the Specialists’ responses included description of any treatment options or resources to address antisocial tendencies and antisocial associates. This is noteworthy, given that risk factors related to antisociality (i.e., the Big Four) have been identified as the strongest predictors of criminal recidivism (Andrews & Bonta, 2010a, 2010b).

The current findings are largely consistent with research on availability of services for offenders in general. For example, a recent review highlighted the range of offender reentry programs and services that target vocational training, substance abuse prevention, and other psychosocial needs of offenders (e.g., housing; James, 2015). By contrast, others have noted that extant programming for offenders tend not target antisocial tendencies, despite the centrality of these issues in the prediction of recidivism risk (Epperson et al., 2014;Wolff et al., 2013). This potential gap may be greater among justice-involved veterans, given that in the current study the availability of interventions that directly target antisocial cognitions and attitudes (e.g., MRT, T4C) were reported to be less prevalent in VA (vs. non-VA settings)...

Full article at:   http://goo.gl/ty4VwX

By:  Daniel M. Blonigen,1,2 Allison L. Rodriguez,3 Luisa Manfredi,1 Jessica Britt,2 Andrea Nevedal,1 Andrea K. Finlay,1 Joel Rosenthal,4 David Smelson,5,6 and Christine Timko1,7

¹ HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System

² Palo Alto University, Palo Alto, CA

³ National Center for PTSD, VA Palo Alto Health Care System

⁴ Veterans Justice Programs, Veterans Health Administration

⁵ HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center

⁶ University of Massachusetts Medical School, Worcester, MA

⁷ Stanford University School of Medicine, Palo Alto, CA

Correspondence to: Daniel M. Blonigen, Ph.D., HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152), Menlo Park, CA 94025. Phone: 650-493-5000, ext. 27828, Fax: 650-617-2736. Email: vog.av@neginolB.leinaD

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Women in Community Corrections in New York City: HIV Infection and Risks

Although the incidence of HIV among women on probation, parole and alternatives to incarceration programs is significant to public health, drivers of this concentrated epidemic among women under community corrections remain understudied. 

This study examined prevalence of HIV and sexually transmitted infections and the associations between substance use, socio-demographic factors and the prevalence of biologically-confirmed HIV and other sexually transmitted infections among a sample of 337 substance-using women recruited from community correction sites in New York City. 

Prevalence of HIV was 13% and sexually transmitted infections was 26% (Chlamydia, trachomatis and Neisseria gonorrhea). After adjusting for covariates, 

• HIV-positive women were 1.42 times more likely to use crack/cocaine than HIV-negative women. 
• HIV-positive women were 25% less likely than HIV-negative women to report any unprotected vaginal and anal sex with their main partner
• They were 70% less likely than HIV-negative women to report unprotected vaginal sex with a non-paying casual partner and 
• 22% less likely to report unprotected vaginal sex across all partners. 

Community corrections settings may be optimal venues to launch HIV/sexually transmitted infections prevention that have potential to reach and engage an ever-growing number of substance-using women.

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By:  El-Bassel N1, Marotta PL2, Shaw SA2, Chang M2, Ma X2, Goddard-Eckrich D2, Hunt T2, Johnson K2, Goodwin S3, Almonte M4, Gilbert L2

• 1Social Intervention Group, Columbia University, New York, New York, USA ne5@columbia.edu.
• 2Social Intervention Group, Columbia University, New York, New York, USA.
• 3The New York City Department of Probation, New York, New York, USA.
• 4Bronx Community Solutions, Center for Court Innovation, Bronx, New York, USA. 
• Int J STD AIDS. 2016 Feb 16. pii: 0956462416633624.

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Boldness and Its Relation to Psychopathic Personality: Prototypicality Analyses among Forensic Mental Health, Criminal Justice, and Layperson Raters

Research on psychopathic personality has been dominated by a focus on criminality and social deviance, but some theoretical models argue that certain putatively adaptive features are important components of this construct. In 3 samples (forensic mental health practitioners, probation officers and a layperson community sample), we investigated adaptive traits as conceptualized in the Triarchic model of psychopathy (Patrick et al., 2009), specifically the relevance of boldness to construals of psychopathic personality. 

Participants completed prototypicality ratings of psychopathic traits, including 3 items created to tap components of boldness (Socially bold, Adventurous, Emotionally stable), and they also rated a series of attitudinal statements (e.g., perceived correlates of being psychopathic, moral judgments about psychopaths). 

The composite Boldness scale was rated as moderately to highly prototypical among forensic mental health practitioners and probation officers and positively associated with other theoretically relevant domains of psychopathy. Across samples, higher composite Boldness ratings predicted greater endorsement of adaptive traits (e.g., social skills) as characteristic of psychopathy. For the individual items, Socially bold was rated as highly prototypical and was associated with theoretically relevant correlates. Adventurous also was seen as prototypical, though to a lesser degree. Only forensic mental health practitioners endorsed Emotionally stable as characteristic of psychopathy. 

Our results provide partial support for the contention that the boldness concept is viewed as an important component of psychopathy, particularly among professionals who work directly with offender populations. 

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By:  Sörman K, Edens JF, Smith ST, Clark JW, Kristiansson M, Svensson O.

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Recidivism Rates within Three Years Release from Prison

Recidivism
Create bar charts

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Systematic Assessment of Linkage to Care for Persons with HIV Released from Corrections Facilities Using Existing Datasets

Populations in corrections continue to have high prevalence of HIV. Expanded testing and treatment programs allow persons to be identified and stabilized on treatment while incarcerated. However, these gains and frequently lost on reentry. Systemic frameworks are needed to monitor linkage to care to guide programs supporting linkage to care. 

To assess the adequacy of linkage to care on reentry, incarceration data from the National Corrections Reporting Program and data from the Ryan White Services Report from 2010 to 2012 were linked using an encrypted client identification (eUCI). Time from release to the first visit and presence of detectable HIV RNA at linkage were assessed. Multivariate survival analyses were performed to identify associations between patient characteristics and time to linkage. 

Among those linking, only 43% in Rhode Island and 49% in North Carolina linked within 90 days, and 33% in both states had detectable viremia at the first visit. Those not previously in care and with shorter incarceration experiences longer linkage times. Persons identified as black, had median times greater than 1 year. 

Using existing datasets, significant gaps in linkage to care for persons with HIV on release from corrections were demonstrated in Rhode Island and North Carolina. Systemically implementing this monitoring to evaluate changes over time would provide important information to support interventions to improve linkage in high-risk populations. 

Using national datasets for both corrections and clinical data, this framework equally could be used to evaluate experiences of persons with HIV linking to care on release from corrections facilities nationwide.

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By:  Montague BT1, Rosen DL2, Sammartino C3, Costa M4, Gutman R3, Solomon L4, Rich J3,5.

• 1 Department of Infectious Diseases, University of Colorado , Aurora, Colorado.
• 2 University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
• 3 School of Public Health, Brown University , Providence, Rhode Island.
• 4 Abt Associates , Cambridge, Massachusetts.
• 5 Warren Alpert School of Medicine, Brown University , Providence, Rhode Island.

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Low-Intensity Case Management Increases Contact with Primary Care in Recently Released Prisoners

BACKGROUND:

The world prison population is large and growing. Poor health outcomes after release from prison are common, but few programmes to improve health outcomes for ex-prisoners have been rigorously evaluated. The aim of this study was to evaluate the impact of individualised case management on contact with health services during the first 6 months post-release.

METHODS:

Single-blinded, randomised, controlled trial. Baseline assessment with N=1325 adult prisoners in Queensland, Australia, within 6 weeks of expected release; follow-up interviews 1, 3 and 6 months post-release. The intervention consisted of provision of a personalised booklet ('Passport') at the time of release, plus up to four brief telephone contacts in the first 4 weeks post-release.

RESULTS:

Of 1179 eligible participants, 1003 (85%) completed ≥1 follow-up interview. In intention-to-treat analyses, 53% of the intervention group and 41% of the control group reported contacting a general practitioner (GP) at 1 month post-release (difference=12%, 95% CI 5% to 19%). Similar effects were observed for GP contact at 3 months (difference=9%, 95% CI 2% to 16%) and 6 months (difference=8%, 95% CI 1% to 15%), and for mental health (MH) service contact at 6 months post release (difference=8%, 95% CI 3% to 14%).

CONCLUSIONS:

Individualised case management in the month after release from prison increases usage of primary care and MH services in adult ex-prisoners for at least 6 months post-release. Given the poor health profile of ex-prisoners, there remains an urgent need to develop and rigorously evaluate interventions to increase health service contact in this profoundly marginalised population.

Below:  Percentage of intervention group participants contacting a general practitioner (GP) at 1 month post release, according to number of intervention telephone calls completed

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By:  Kinner SA1, Alati R2, Longo M3, Spittal MJ4, Boyle FM2, Williams GM2, Lennox NG5.

• 1Griffith Criminology Institute & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia.
• 2School of Public Health, University of Queensland, Brisbane, Australia.
• 3Drug and Alcohol Services South Australia, Adelaide, Australia.
• 4Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
• 5Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia. 
• J Epidemiol Community Health. 2016 Jan 19. pii: jech-2015-206565. doi: 10.1136/jech-2015-206565. 

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