A study conducted in two rural Massachusetts jails found that people with opioid use disorder who were incarcerated and received a medication approved to treat opioid use disorder, known as buprenorphine, were less likely to face rearrest and reconviction after release than those who did not receive the medication. After adjusting the data to account for baseline characteristics such as prior history with the criminal justice system, the study revealed a 32% reduction in rates of probation violations, reincarcerations, or court charges when the facility offered buprenorphine to people in jail compared to when it did not. The findings were published in Drug and Alcohol Dependence.

The study was conducted by the Justice Community Opioid Innovation Network (JCOIN), a program to increase high-quality care for people with opioid misuse and opioid use disorder in justice settings and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, through the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative.

“Studies like this provide much-needed evidence and momentum for jails and prisons to better enable the treatment, education, and support systems that individuals with an opioid use disorder need to help them recover and prevent reincarceration,” said Nora D. Volkow, M.D., NIDA Director. “Not offering treatment to people with opioid use disorder in jails and prisons can have devastating consequences, including a return to use and heighted risk of overdose and death after release.”

A growing body of evidence suggests that medications used to treat opioid use disorder, including buprenorphine, methadone, and naltrexone, hold great potential to improve outcomes among individuals after they’re released. However, offering these evidence-based treatments to people with opioid use disorder who pass through the justice system is not currently standard-of-care in U.S. jails and prisons, and most jails that do offer them are in large urban centers.

While previous studies have investigated the impact of buprenorphine provision on overdose rates, risk for infectious disease, and other health effects related to opioid use among people who are incarcerated, this study is one of the first to evaluate the impact specifically on recidivism, defined as additional probation violations, reincarcerations, or court charges. The researchers recognized an opportunity to assess this research gap when the Franklin County Sheriff’s Office and the Hampshire County House of Corrections, jails in two neighboring rural counties in Massachusetts, both began to offer buprenorphine to adults in jail, but at different times. Franklin County was one of the first rural jails in the nation to offer buprenorphine, in addition to naltrexone, beginning in February 2016. Hampshire County began providing buprenorphine in May 2019.

“There was sort of a ‘natural experiment’ where two rural county jails located within 23 miles of each other had very similar populations and different approaches to the same problem,” said study author Elizabeth Evans, Ph.D., of the University of Massachusetts-Amherst. “Most people convicted of crimes carry out short-term sentences in jail, not prisons, so it was important for us to study our research question in jails.”

The researchers observed the outcomes of 469 adults, 197 individuals in Franklin County and 272 in Hampshire County, who were incarcerated and had opioid use disorder, and who exited one of the two participating jails between Jan. 1, 2015 and April 30, 2019. During this time, Franklin County jail began offering buprenorphine while the Hampshire County facility did not. Most observed individuals were male, white, and around 34 to 35 years old.

Using statistical models to analyze data from each jail’s electronic booking system, the researchers found that 48% of individuals from the Franklin County jail recidivated, compared to 63% of individuals in Hampshire County. As well, 36% of the people who were incarcerated in Franklin County faced new criminal charges in court, compared to 47% of people in Hampshire County. The rate of re-incarceration in the Franklin County group was 21%, compared to 39% in the Hampshire County group.

Additional analysis showed that decreases in charges related to property crimes appeared to have fueled the 32% reduction in overall recidivism.

The Massachusetts JCOIN project, led by Dr. Evans and senior author Peter Friedmann, M.D., of Baystate Health, is performing further research on medications for opioid use disorder in both urban and rural jails across more diverse populations, including women and people of color. The investigators are examining the comparative effectiveness of the U.S. Food and Drug Administration-approved medications for opioid use disorder in jail populations, and the challenges jails face in implementing them.

“A lot of data already show that offering medications for opioid use disorder to people in jail can prevent overdoses, withdrawal, and other adverse health outcomes after the individual is released,” said Dr. Friedmann. “Though this study was done with a small sample, the results show convincingly that on top of these positive health effects, providing these medications in jail can break the repressive cycle of arrest, reconviction, and reincarceration that occurs in the absence of adequate help and resources. That’s huge.”

Source: NIDA.NIH.GOV | National Institute on Drug Abuse (NIDA)

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New York City health officials are launching a pilot program for public health vending machines (PHVM) to help drug users who are \”disproportionately burdened\” by overdoses.

The non-profit Fund for Public Health in New York opened a request for proposals in December to install 10 PHVMs that dispense the anti-overdose drug naloxone, sterile syringes, and other harm reduction and wellness supplies to drug users in neighborhoods across the city. 

Since 1999, more than 1 million people have died from fatal overdoses in the US, according to a study from the National Center for Health Statistics and preliminary data from the Centers for Disease Control and Prevention. 

In New York City, 2,062 people died from unintentional overdoses in 2020, the highest rate since reporting began in 2000, according to data from the NYC Department of Health and Mental Hygiene. Black and Latino residents in neighborhoods with the highest rates of poverty, including South Bronx and East Harlem, reported the most overdose deaths in 2020, the report found.

\”Racial equity does not mean simply treating everyone equally, but rather, allocating resources and services in such a way that explicitly addresses barriers imposed by structural racism (i.e. policies and institutional practices that perpetuate racial inequity) and White privilege,\” the Fund for Public Health in New York\’s request for proposals read.

The initiative is expected to cost taxpayers $730,000, which will help opioid overdose prevention programs install the 10 vending machines. The request for proposals names several potential neighborhoods to place the machines, including South Bronx, East Harlem, Union Square, and Brooklyn\’s East New York.

PHVM programs have become an emerging strategy to combat high-barrier access to health and wellness supplies, with successful pilots in Europe, Canada, and Australia. New York is hoping to models its program on those currently operational in US cities like Las Vegas, Nevada, and Cincinnati, Ohio.

In November, New York also became the first city in the US to allow supervised consumption sites for illegal drugs.

\”Unfortunately, the overdose crisis is worsening,\” Dr. Dave Chokshi, commissioner of the New York City Department of Health and Mental Hygiene told NPR in November, adding that these sites were designed to operate long term. \”This is something that we feel deep conviction about and also a sense of urgency to address.\”

These types of programs could be a \”game changer,\” head of Drug Policy Alliance Kassandra Frederique told NPR.

Opioid overdose prevention strategies remain controversial among officials and communities in New York. 

Mayor Eric Adams and former Mayor Bill de Blasio have also voiced support for overdose prevention methods. Four of the city\’s five district attorneys have echoed their support for safe injection sites, according to the New York Times.

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“The time has come for an all-hands-on-deck approach to our overdose death crisis, and safe consumption sites are a proven strategy to save lives,” said Senator Scott Wiener. “Public health interventions to address this crisis exist, and they are working well in other countries. We can’t keep saying no to safe consumption sites and hope that somehow our challenges around addiction, overdoses, and mental health will just go away. They won’t, and they’re getting worse, because we’re not using every tool we have to reduce harm, save lives, and help people get connected to treatment and services. We need these programs, and today’s Assembly Health Committee hearing is a step toward getting this done.”

COVID-19 has increased the urgency to legalize overdose prevention programs, given that overdoses and substance use overall are rising significantly. For example, San Francisco saw a record number of overdose deaths in 2020, with 699 deaths total. Nationally, 100,000 people died of drug overdoses from April 2020 to April 2021, including approximately 10,000 people in California. This is a public health crisis, and it is preventable.

Overdose prevention programs — which have been in existence for years in Europe, Canada, and Australia, with proven success — are supervised facilities where those using drugs intravenously or otherwise can do so more safely, with the goal of transitioning them into recovery programs. In the decades that these approximately 170 facilities have been open in other parts of the world, not one overdose death has occurred in one of them.

Over an 18-month study period of Insite in Vancouver, 336 overdoses were reported – but in every instance, the person overdosing lived. This is because there were trained professionals onsite to administer live saving treatments like Narcan, and get people emergency help. Studies also suggest that overdose prevention programs reduce the burden on emergency services – like ambulances and emergency rooms – that traditionally respond to overdose events. 

Recent studies of an unsanctioned overdose prevention program also suggest that there is no increase in crime, violence, or drug trafficking in areas surrounding these programs. Crime actually decreased in these areas. Studies also show that overdose prevention programs lead to less injection-related litter, like dropped syringes.

SB 57 gives San Francisco, Los Angeles, and Oakland the local discretion to establish and run these programs, where adults may use their own controlled substances under the supervision of staff trained to prevent and treat overdose, prevent HIV and hepatitis infection, and facilitate entry into drug treatment and other services. SB 57 is a pilot program that will run for five years, through January 1, 2028.

San Francisco’s Mayor and Board of Supervisors have repeatedly requested this authorization. Oakland’s Mayor and City Council requested last year to be included. The Los Angeles County Board of Supervisors voted unanimously to support SB 57 and to ask that Los Angeles County be included in the pilot, and the Los Angeles City Council also voted to support the legislation and be included.

Trained professionals provide those who visit overdose prevention programs with clean needles, have supplies such as Narcan on hand to help in the case of an overdose, and may have testing strips for fentanyl and other potentially lethal drug additives. Studies show that these programs prevent overdose deaths and help those struggling with substance use disorder get connected to treatment and other services. Additionally, overdose prevention programs are an important harm reduction measure that help limit the spread of communicable diseases, like HIV and Hepatitis C, through intravenous drug use. They also reduce crime and syringe litter in the surrounding area and give those who use drugs the ability to avoid using in public spaces. Overdose prevention programs also relieve pressure on hospital emergency rooms.

This legislation has been introduced multiple times, and it passed the legislature in 2018 in a previous form. It was vetoed in 2018 by then-Governor Jerry Brown. The legalization of overdose prevention programs has broad support from the leadership of San Francisco, Oakland, and Los Angeles County, as well as public health and addiction treatment leaders.

The following organizations are co-sponsoring SB 57: Drug Policy Alliance, San Francisco AIDS Foundation, California Society of Addiction Medicine, National Harm Reduction Coalition, Healthright 360, Tarzana Treatment Center, and the California Association of Alcohol & Drug Program Executives.

“We are in the midst of an opioid epidemic that is taking too many lives in our country,” said Mayor London N. Breed. “We know that overdose prevention programs save lives, prevent public drug use, and get people the help and care they so desperately need. We must have programs in place across our state that can better address the needs of individuals suffering from addiction and save lives. I want to thank Senator Wiener for his leadership on this issue and continued work to fight for the life and well-being of every Californian.”

“San Francisco AIDS Foundation continues to support the establishment of safe consumption services, also called overdose prevention programs, in San Francisco and California. We are pleased that SB 57 passed out of the Assembly Health Committee, and look forward to seeing this bill passed in California. We are in the midst of a devastating overdose crisis, and are losing Californians every day to overdose. We cannot afford to slow or stall the establishment of these evidence-based and life-saving services,” said Kevin Rogers, Interim CEO of San Francisco AIDS Foundation.

Source: sd11.senate.ca.gov

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The CDC recently reported that over 100,000 people died to drug overdoses last year, the highest number ever recorded. There was a 35% increase in California , and overdose deaths among young people (between the ages of 15-24) rose 48%.

MAKING SURE NALOXONE IS WIDELY AVAILABLE IN COMMUNITY & STATE COLLEGES, IN ADDITION TO CALIFORNIA UNIVERSITIES IS ALMOST A REALITY. THE BILL (SB367) WILL MOST LIKELY BE ON THE GOVERNOR\’s DESK SOON SO LET\’S BE SURE TO

TAKE THIS SIMPLE ACTION TO LET GOV. NEWSOM KNOW YOU SUPPORT NARCAN ON CAMPUSES BY SIGNING SB367 INTO LAW

Click the Button above to submit your petition!

Thank you for having your voice heard. Please take the time to share these actions across college campuses, in recovery circles, and with impacted family members and allies.

California – Recovery Advocacy Project

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Tom Hardy once said that he would have sold his mother to buy drugs. The actor has had a dark past with drugs and alcohol addiction and has opened up about the same several times before. As per one report, Hardy even went to rehab after he woke up in his own blood and vomit. Even though the actor has been clean for years now, he has revealed that the journey wasn’t easy.

Recently, the first look of Hardy’s famous period crime drama, Peaky Blinders Season 6, was unveiled. The actor is back with his iconic role of Alfie Solomons. On top of that, the actor’s name has also been making the rounds as the frontrunner in the list of who can be the next James Bond.

Tom Hardy knows how to keep himself busy and while his past is his past, there is something that he said, which may come to his fans as a shock. Back in 2015, the Venom actor opened up about his addictions and said that he is “f—king lucky to be here” after his battle with drugs nearly claimed his life. He also stated that it got so bad at one point that he would have done anything to procure drugs.

While talking to Yahoo! New Zealand, the ‘Mad Max: Fury Road’ star said, “I would have sold my mother for a rock of crack.” “I was a shameful suburban statistic. I was told very clearly, ‘You go down that road, Tom, you won’t come back. That’s it. All you need to know.’ That message stayed with me clearly for the rest of my days. I am f–king lucky to be here,” Tom Hardy added.

The actor further spoke about his reputation as Hollywood’s hard man. “People didn’t sit up and take any notice of me until I started putting on weight, kicking people, and being aggressive. The trouble with Hollywood is that they want you to be something, then they think you’re who they wanted you to be. I’m not a fighter. I’m a petite little bourgeois boy from London,” he said,

Tom Hardy recently appeared in Venom: Let There Be Carnage, the second instalment of the film series based on the Marvel character. He is also set to appear as Eddie Brock in the upcoming film, Spider-Man: No Way Home, alongside Tom Holland.

By: Koimoi.com Team

 -December 3, 2021

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The Department of Health Care Services (DHCS) is providing this update of significant developments regarding DHCS programs, as well as published COVID-19 information.

California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Advisory Group Meeting

On November 23 at 9 a.m., DHCS will convene its second CalAIM Justice-Involved Advisory Group meeting. Through 2022, the group will discuss topics such as Medi-Cal application processes, the 90-days pre-release services delivery model, and reentry planning. Presentation materials will be published on the DHCS website prior to the meeting, and the presentation from the October 28 meeting is available on the website. While advisory group participation is limited to a select group of key stakeholders, members of the public are welcome to listen to the discussion via the webinar link once the meeting starts.

Questions about the CalAIM Justice-Involved Advisory Group may be directed to CalAIMJusticeAdvisoryGroup@dhcs.ca.gov.

CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup Meeting

On November 18, at 11 a.m., DHCS will host the CalAIM MLTSS and Duals Integration Workgroup meeting. The goal of the workgroup is to collaborate with stakeholders on statewide MLTSS and Dual Eligible Special Needs Plan (D-SNP) exclusively aligned enrollment, including the transition of the Coordinated Care Initiative (CCI) and Cal MediConnect (CMC), the D-SNP look-alike transition, and new enrollment in exclusively aligned enrollment. Under exclusively aligned enrollment, beneficiaries can enroll in a D-SNP for Medicare benefits and in a Medi-Cal managed care plan, both of them operated by the same parent organization for better care coordination and integration.

Agenda items include an update on CMC transition noticing, an overview of the DHCS outreach and communications strategy for the CalAIM D-SNP exclusively aligned enrollment in 2023, and a panel discussion and breakout sessions on promising practices and lessons learned from CMC outreach.

Please register for the November 18 workgroup meeting, which is open to the public. Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage.

CalAIM: Criteria for Beneficiary Access to Specialty Mental Health Services (SMHS)

On November 18, at 3 p.m., DHCS will hold a virtual webinar to provide an opportunity for stakeholders to learn about the criteria for beneficiary access to SMHS policy that goes live in January 2022 as part as CalAIM.

The webinar is for behavioral health providers, county mental health plans, advocates, and others interested in learning more about the updated criteria for beneficiary access to SMHS. Time will be reserved at the end of the webinar for a Q&A session. Please register in advance for the webinar.

Doula Services as a Covered Medicaid State Plan Benefit Meeting

On November 19, at 2 p.m., DHCS will hold a virtual stakeholder workgroup meeting about adding doula services as a covered Medicaid State Plan benefit. The meeting is open to the public. Doula services include personal support to pregnant individuals and families throughout pregnancy, labor, and the postpartum period.

DHCS continues to work with this stakeholder workgroup to define the doula benefit, including federal requirements for supervision, qualifications to provide Medi-Cal services, and a description of covered services. All interested stakeholders have the opportunity to listen to the workgroup discussion and provide their input via email, prior to DHCS’ submission of a State Plan Amendment to the Centers for Medicare & Medicaid Services in March 2022. Doula services are scheduled to be a covered Medi-Cal benefit beginning on July 1, 2022.

Please register for the meeting. More information about the doula services is available on the DHCS website. For questions, please email DoulaBenefit@dhcs.ca.gov.

Source: Significant Updates of Interest to DHCS Stakeholders – (peervoices.org)

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The substantial prison population in the United States is strongly connected to drug-related offenses. While the exact rates of inmates with substance use disorders (SUDs) is difficult to measure, some research shows that an estimated 65% percent of the United States prison population has an active SUD. Another 20% percent did not meet the official criteria for an SUD, but were under the influence of drugs or alcohol at the time of their crime.

Decades of science shows that providing comprehensive substance use treatment to criminal offenders while incarcerated works, reducing both drug use and crime after an inmate returns to the community. Treatment while in jail or prison is critical to reducing overall crime and other drug-related societal burdens—such as lost job productivity, family disintegration and a continual return to jail or prison, known as recidivism. Inadequate treatment while incarcerated also contributes to overdoses and deaths when inmates leave the prison system.

What are the challenges in addressing substance use disorders in this population?

To be effective for this population, treatment must begin in prison and be sustained after release through participation in community treatment programs. By engaging in a continuing therapeutic process, people can learn how to avoid relapse and withdraw from a life of crime. However, only a small percentage of those who need treatment while behind bars actually receive it, and often the treatment provided is inadequate.

Inmates with opioid use disorders particularly pose a challenge. During their time in prison, many untreated inmates will experience a reduced tolerance to opioids because they have stopped using drugs while incarcerated. Upon release, many will return to levels of use similar to what they used before incarceration, not realizing their bodies can no longer tolerate the same doses, increasing their risk of overdose and death.2 One study found that 14.8 percent of all former prisoner deaths from 1999 to 2009 were related to opioids.3 Insufficient pre-release counseling and/or post release follow-up are partially responsible for this alarming increase in mortality.

Why is treatment so critical in this population?

Scientific research since the mid-1970s shows that treatment of those with SUDs in the criminal justice system can change their attitudes, beliefs, and behaviors toward drug use; avoid relapse; and successfully remove themselves from a life of substance use and crime.5-7 For example, studies suggest that using medications for opioid use disorder treatment in the criminal justice system decreases opioid use, criminal activity post-incarceration, and infectious disease transmission.8-10 Studies have also found that overdose deaths following incarceration were lower when inmates received medications for their addiction.

How are substance use disorders treated in the criminal justice system?

The recent National Academy of Sciences report on Medications for Opioid Use Disorder stated that only 5% of people with opioid use disorder in jail and prison settings receive medication treatment.13 A survey of prison medical directors suggested that most are not aware of the benefits of using medications with treatment, and when treatment is offered, it usually consists of only behavioral counseling, and/or detoxification without follow-up treatment.

Effective treatment of substance use disorders for incarcerated people requires a comprehensive approach including the following:

• Behavioral therapies, including:
  • cognitive-behavioral therapy, which helps modify the patient’s drug-use expectations and behaviors, and helps effective manage triggers and stress
  • contingency management therapy, which provides motivational incentives in the forms of vouchers or cash rewards for positive behaviors
• Medications including methadone, buprenorphine, and naltrexone
• Wrap-around services after release from the criminal justice system, including employment and housing assistance
• Overdose education and distribution of the opioid reversal medication naloxone while in justice diversion treatment programs or upon release.

What about the cost of treatment?

Failure to treat substance use disorder in the criminal justice system not only has negative societal implications, but also proves to be expensive. One study of people involved in the criminal justice system in California showed that engagement in treatment was associated with lower costs of crime in their communities in the 6 months following treatment. In addition, the economic benefits were far greater for individuals receiving time-unlimited treatment.

A report from the National Drug Intelligence Center estimated that the cost to society for drug use was $193 billion in 2007, a substantial portion of which—$113 billion—was associated with drug related crime, including criminal justice system costs and costs borne by victims of crime. The same report showed that the cost of treating drug use (including health costs, hospitalizations, and government specialty treatment) was estimated to be $14.6 billion, a fraction of these overall societal costs.14 It is estimated that the cost to society has increased significantly since the 2007 report, given the growing costs of prescription drug misuse.

Science suggests that even those who are not motivated to change at first can eventually become engaged in a continuing treatment process, suggesting it is a myth that treatment has to be voluntary to work. More information can be found in the Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide.

NIDA funded scientists are actively seeking solutions through the NIH HEAL (Helping to End Addiction Long-Term) initiative. In addition, to support those who work with juveniles and adults within the court system, including judges, counselors, social workers, case workers, and others, NIDA has created materials and has identified other helpful resources that can be used in educating offenders and those who work with them about the science related to drug use, misuse, and addiction.

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