Advancing Health Equity Through Research
For many people who end up in jail settings, says Siddiqi, “This is the first medical appointment they may have had in years – or even in their life.”
He explains that these individuals are often highly incentivized to accept help because the experience of withdrawal from opioids is so horrific. Medications like buprenorphine and methadone treat not only withdrawal symptoms, but also lessen the cravings that make it hard for people to quit drugs.
One challenge is time: the window of opportunity for offering treatment is short.
The average jail stay in the United States in 25 days, so treatment for opioid use disorder during incarceration can have a great impact on these individuals’ lives after release, as well as on their families and communities.
And it’s also the right thing to do, explains Evans.
“Offering evidence-based treatment like medications for opioid use disorder is an example of how we can level the playing field,” Evans explains, “JCOIN is trying to set a standard of care within the justice system that’s on par with, or maybe even better than, what these folks might receive in the community when they’re not incarcerated.”
Bringing Research to Life
How easy is it to implement an opioid treatment program in a correctional facility – to get buy-in from officers and other staff? A few factors are key for state policymakers. In addition to health and safety benefits, cost is always important.
Jails and prisons often have limited resources to spend on the most effective programs. The JCOIN research team has developed a tool that estimates the start-up and running costs of medication treatment programs. Among other things, it looks at the price tag for necessary facility modifications and staff costs for stocking medications and administering treatment, and other items.
Fears about diversion – in which prescribed medications are rerouted for use by others – have blocked many past efforts to offer addiction treatment in justice settings and elsewhere. However, a JCOIN analysis found that while some diversion occurs, with appropriate preventive protocols in place, the extent to which it happens is small. This shows that research is a powerful tool: Providing proof is more likely to convince skeptics.
The HEAL-funded JCOIN program has accomplished a lot in the 3 years since it began, and the team has set ambitious goals toward informing policy – not just at the system or state level, but also nationally.
For example, JCOIN researchers are analyzing details about development and implementation of medication treatment programs in various settings, such as in rural, suburban, and urban jails. JCOIN projects are also evaluating the outcomes of incarcerated individuals once they leave jail, related to both opioid use and engagement in further treatment.
A key aim of a lot of HEAL research is to find ways to improve access to treatment for those who could benefit, and JCOIN early results are promising. One study found that individuals who had received medication therapy in one Massachusetts jail were about 30% less likely to be arrested, arraigned, or incarcerated again compared with those who had been incarcerated during the same time period in a neighboring Massachusetts jail that did not offer treatment.
Based upon entrenched stigma, especially surrounding people in the justice system, changing minds is a bigger problem. But here, too, comes hope.
Built into the JCOIN research program are periodic surveys to measure public views about opioid addiction. One such survey showed the value of empathy: people with lived justice system experience may be more likely to understand the difficulties of living life in recovery from opioid use disorder. The survey also showed that most U.S. adults see opioid use disorder as a treatable medical condition rather than as a criminal matter.
No doubt, further data from the large and unique JCOIN research endeavor will guide future policy decisions that can help the millions of Americans who are involved with the U.S. justice system.
Justice Community Opioid Innovation Network (JCOIN) Program Page
The Justice Community Opioid Innovation Network (JCOIN) will test strategies to expand effective treatment and care in partnership with local and state justice systems and community-based treatment providers.