Does Bail Reform Decarcerate Mental Illness? Public Health Challenges for a Large County Jail System.

Although bail reform reduces jail census, whether or not its effects extend to incarcerated individuals with mental illness is unknown. Using a novel high-sensitivity measure of serious mental illness (SMI) from jail-based electronic health records, we conducted an interrupted time series analysis assessing the impact of Illinois bail reform on total jail registrations and the nested subset with SMI ± co-occurring substance use disorder (SUD). Compared with a decline in total jail registrations, admission of individuals with SMI ± SUD showed no decline. Consequently, the proportion of admissions involving SMI increased between 2015 and 2019 from 26% to 35%. Intentional efforts involving cooperation by the health, social services, and justice sectors are needed to translate the impact of bail reform onto the population experiencing SMI.

Prevalence and risk factors for opioid related mortality among probation clients in an American city.

INTRODUCTION: Substance use disorder researchers and treatment professionals have long recognized that risk of opioid-related mortality (ORM) is elevated after release from jail and prison. However, there are gaps in knowledge around ORM among people on probation and the relationship of ORM to drug testing and treatment referral while under supervision. Understanding this relationship is critical for probation officers who are often tasked with referring clients to treatment and monitoring compliance with treatment, without having a clinical background. In this cross-sectional study we estimate the prevalence and risk factors for ORM in a large, urban probation department. METHODS: We joined mortality records and probation records for 2018 and 2019 to determine the rate of ORM for the probation population. We stratified ORM rates by risk factors, including demographics, drug testing results, and treatment placements. RESULTS: Individuals on probation were fifteen times more likely to die from ORM (361 per 100,000) than the general county population (23 per 100,000), largely driven by fentanyl (detected in 86.8% of deaths). Risk was elevated for clients over age 45 (838 per 100,000; 95% CI [655-1057]), clients with at least one positive drug test for opioids (1995 per 100,000; 95% CI [1419-2727]) or cocaine (1200 per 100,000; 95% CI [841-1661]), and clients with previous placements in drug treatment (692 per 100,000; 95% CI [503-929]). Positive urine tests for opioids were associated with 80 times greater risk of ORM than the general population. Although Black clients experienced ORM in greater numbers, white clients had relatively greater ORM risk. CONCLUSIONS: Elevated risk for ORM among the probation population justifies urgent and data-driven partnerships between public health and community corrections to train probation staff; to identify high-risk clients for evidence-based treatment and overdose prevention strategies; and to institute policies to support and sustain these activities.

Effect of positive urine fentanyl screen on attitudes toward heroin use.

BACKGROUND: It is unknown if targeted risk reduction counseling in the health care setting, after documented exposure to fentanyl, can affect behavior change to reduce risks and increase utilization of evidence-based overdose prevention strategies. METHODS: We conducted a retrospective analysis of results (7/2018-6/2019) from questionnaire-facilitated counseling by recovery coaches in the emergency department (ED) and primary care settings following disclosure of a urine toxicology positive for fentanyl. RESULTS: Seventy-five percent of N = 101 respondents were neither aware of nor expecting fentanyl in their substances of use. Fifty-three (70 %) of those initially unaware answered that learning about exposure to and the risks from fentanyl changed their thoughts about reducing or abstaining from use. A greater proportion of patients seen in the ED expressed desire to stop or reduce opioid use as compared to ambulatory clinic patients (91 % vs. 46 %, p < 0.001). Of those not already engaged in treatment, 18 % and 15 % were interested in medication and behavioural health treatment, respectively, and each of them indicated a change in thought based on the counseling. Forty-five percent of individuals not yet receiving naloxone endorsed interest in receiving it, and 22 % of all respondents were somewhat or very interested in access to safe consumption sites. CONCLUSION: This study suggests a novel clinical utility in toxicology screens to inform behavior in the setting of illicit fentanyl exposure. In addition to linkages to evidence-based treatment, linkages to harm-mitigating strategies associated with ongoing substance use may be critical to a comprehensive overdose prevention strategy in the clinical setting.