Assessing County-Level Behavioral Health and Justice Systems with the Sequential Intercept Model Practices, Leadership, and Expertise Scorecard.

The Sequential Intercept Model has helped conceptualize interventions for people with serious mental illness in the criminal/legal system. This paper operationalizes the Sequential Intercept Model into a 35-item scorecard of behavioral health and legal practices. Using interviews, survey, and observational methods, the scorecard assesses an exploratory sample of 19 counties over 27 independent data collections. A series of ordinary least squares regression models assessed the predictor scores on four jail outcomes: prevalence of serious mental illness, length of stay, connections to treatment, and recidivism. Increases in pre-booking scores showed significant decreases in jail prevalence of serious mental illness at the p < 0.05 level, and post-booking scores and overall scores showed significant positive associations with connections to treatment at the p < 0.05 level, though these were non-significant after correcting for multiple comparisons. Preliminary findings suggest a combination of practices across the Sequential Intercept Model could have synergistic impacts on key jail diversion outcomes.

County jails' responses to COVID-19: Practices, procedures, and provisions of behavioral health services.

Michigan was one of the first states to feel the effects of the coronavirus disease 2019 (COVID-19) pandemic. This exploratory, mixed-methods study describes 20 county jails' responses to the pandemic across Michigan and presents a case study of one rural jail to examine changes in booking trends and behavioral health needs and services. Qualitatively, jails decreased their population at the outset of the pandemic via early releases, reconsideration of bond, and reductions in arrests. Quantitatively, the greatest prevalence of serious mental illness was found during the spring (initial shutdown period), which had the lowest weekly booking rates. Significant differences were found when comparing charge severity and charge type between study periods. Bookings occurring during the spring were significantly related to felony charges and drug/alcohol charges while individuals were less frequently booked because of violations. Past year recidivism significantly decreased from the winter to summer phase. Policy should mandate that jails screen for behavioral health problems and provide access to behavioral health services, while also expanding diversion opportunities during and after a pandemic. Innovations in continuity of care are critical for both behavioral and public health needs given the high risk for suicide, overdose, and viral spread after release from jail. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Developing a cascade of care for opioid use disorder among individuals in jail.

INTRODUCTION: The overdose epidemic persists as a public health crisis in the United States. Jails are a critical overdose prevention touchpoint. The risk of overdose postincarceration may be increased if an individual is released without medication for opioid use disorder (MOUD) treatment or transferred to long-term residential treatment. A growing number of studies have examined the difficulties in implementing evidence-based care for opioid use disorder (OUD) in jail settings. METHODS: We use administrative data (July 1, 2020, through September 30, 2020) from four jail facilities that implemented OUD treatment programs. These data included screening data from the Rapid Opioid Dependence Screener (RODS) (n = 2562), along with booking and medication information from jail records, which we used to develop a cascade-of-care. RESULTS: Screening rates varied dramatically by facility, with integration into the jail records management system showing the best outcomes. The prevalence of OUD identified from the RODS was 8.1% and did not vary significantly by facility. Nearly one third (31.3%) of those identified as having an OUD were dispensed medications, with two-thirds receiving methadone and the remaining third buprenorphine. The average length of stay for all screened individuals was two weeks, compared to two months for those who received an MOUD. CONCLUSIONS: Screening for OUD diagnosis is critical to reduce gaps in a cascade-of-care, and our results provide guidance on how to achieve this in jail. Failing to identify OUD and provide MOUD places an individual at an increased risk for fatal overdose. Future studies should consider examining MOUD discharge planning and factors that improve treatment retention following release from incarceration. Our study also illustrates the churn of jail populations and the need for rapid induction of treatment and overdose prevention strategies upon release.

Police discretion in encounters with people who use drugs: operationalizing the theory of planned behavior.

BACKGROUND: Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges. METHODS: On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. FINDINGS: Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others' approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach's alpha of 0.81. CONCLUSION: The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.

Evaluating the effectiveness of problem-solving courts at preventing fatal and non-fatal opioid events: preliminary findings from Indiana.

BACKGROUND: Fatal and non-fatal events associated with drug misuse are skyrocketing in most United States jurisdictions, including Indiana. Historically, the role of the judiciary is to arrest, impose sanctions and protect society from harm. Adults arrested for drug abuse in Indiana can be sentenced to 1 of 17 correctional facilities. As an alternative, they may be eligible to participate in a problem-solving court (PSC) programme that refers individuals to treatment as a pretrial diversionary strategy. The aim of the study is to determine which interventions offered by PSCs and correctional facilities impact morbidity and mortality. The study began in 2019 and will end in 2023; therefore, the results in this manuscript are preliminary. METHODS: The study cohort included two populations arrested for drug misuse: (1) adults sentenced to Indianan correctional facilities (1 January 2018 to 30 June 2021) and (2) adults participating in an Indiana PSC programme (1 January 2018 to 30 June 2021). The study used a mixed-methods design that integrated qualitative interviews of deputy wardens, PSC team members and service providers with the following quantitative datasets: sentencing information, emergency department visits, inpatient hospitalization admissions, prescription drug monitoring programme data and death records. The individuals will be followed at 2-week, 4-week, 6-month and 1-year intervals post-release. Difference-in-difference and time-to-event analyses will identify impactful interventions. A model will be created to show the effect of impactful interventions in Indiana counties that do not have PSCs. RESULTS: Findings are preliminary. There is variability amongst correctional facilities regarding programme eligibility, provided services and provision of medication-assisted treatment. All correctional facilities were severely impacted by the COVID-19 pandemic. CONCLUSION: It is anticipated that the adoption of impactful interventions will lower opioid-related morbidity and mortality rates.

Buprenorphine Treatment Intake and Critical Encounters following a Nonfatal Opioid Overdose.

BACKGROUND: Individuals with prior opioid-related overdose events have an increased risk for opioid-related mortality. Buprenorphine is a partial agonist that has shown to be an effective medication for opioid use disorder (MOUD). Yet, few studies have investigated whether buprenorphine reduces the risk of opioid-related mortality following a nonfatal opioid-related overdose. METHODS: A retrospective study was conducted on all overdose cases in Indiana between January 1, 2017 and December 31, 2017. Data were linked from multiple administrative sources. Cases were linked to vital records to assess mortality. Bivariate analyses were conducted to assess group differences between survivors and decedents. A series of multiple logistic regression models were used to determine main and interaction effects of opioid-related mortality. RESULTS: Among the 10,195 nonfatal overdoses, 2.4% (247) resulted in a subsequent fatal overdose. Overdose decedents were on average 36.4 years-old, 66.8% male, 91.1% White, and 83.8% did not receive a buprenorphine dispensation. Incremental increases in the number of buprenorphine dispensations decreased the likelihood of fatal overdose by 94% (95% CI = 0.88-0.98, p = .001). Incremental increases in arrest encounters were found to significantly increase the likelihood of a fatal overdose (AOR = 2.16; 95% CI = 1.13-3.55). Arrest encounters were a significant moderator of the relationship between buprenorphine uptake effectiveness and drug-related mortality. CONCLUSIONS: Analysis of linked data provided details of risk and protective factors of fatal overdose. Buprenorphine reduced the risk of death; however, criminal justice involvement remains an area of attention for diversion and overdose death prevention interventions.

Impact of COVID-19 Pandemic on Drug Overdoses in Indianapolis.

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.

Using prescribing and toxicology data to determine non-medical prescription drug overdose.

BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSION: Linked PDMP and toxicology reports are useful in identifying drug use patterns that contribute to mortality.

Baltimore Ceasefire 365: Estimated Impact of a Recurring Community-Led Ceasefire on Gun Violence.

Objectives. To estimate the impact of recurring community-led, weekend-long ceasefires on gun violence in the City of Baltimore, Maryland.Methods. The City of Baltimore releases detailed data on all crimes occurring in the city. We compiled daily counts of fatal and nonfatal shootings occurring between January 2012 and July 2019 and fit a Bayesian model to estimate the impact of the ceasefires on gun violence during designated weekends after accounting for yearly seasonality, day of the week, calendar days, and overall time trends. We also looked at the 3-day periods following each 3-day ceasefire weekend to test for a possible postponement effect.Results. There was an estimated 52% (95% credible interval [CI] = 33%, 67%) reduction in gun violence during ceasefire days and no evidence of a postponement effect on either the next 3 days or the next 3-day weekend following each ceasefire weekend (incidence rate ratio = 0.88; 95% CI = 0.72, 1.06).Conclusions. The Baltimore Ceasefire weekends may be an effective short-term intervention for reducing gun violence. Future research should aim to understand the key components and transferability of the intervention.