Healing a Broken System: Veterans and the War on Drugs

This report examines the plight of returning veterans who struggle with incarceration and psychological wounds of war such as addiction and post-traumatic stress disorder -- and suggests reforms that could improve the health and preserve the freedom of American soldiers returning from war zones and transitioning back to civilian life. Roughly 30 percent of veterans from Iraq and Afghanistan report symptoms of post-traumatic stress disorder (PTSD), traumatic brain injury, depression, mental illness or other cognitive disability. Left untreated, these medical conditions often contribute to substance misuse and addiction, fatal overdose, homelessness and suicide, as well as violations of the law, particularly nonviolent drug offenses. This report recommends alternatives to incarceration for nonviolent drug offenses, increased access to overdose prevention programs and medication-assisted therapy, and research evaluating innovative treatment modalities such as medical marijuana and MDMA-assisted psychotherapy

The trifecta effect: the incarcerated woman’s triple comorbidity and associations with recidivism

Jails are the front door to the criminal justice system, serving as the initial point of contact with inmates (Raggio, Hoffmann, & Kopak, 2017). Females in jail are the fastest growing correctional population (Swavola, Riley, & Subramanian, 2016). Females experience comorbid psychopathologies and substance use disorders at a higher rate than men, and incarcerated populations experience these disorders at far greater rates than the general population (Al Rousan, Rubenstein, Sieleni, Deol, & Wallace, 2017; Fazel, Yoon, & Hayes, 2017; Logan & Blackburn, 2009; Lynch S. M., et al., 2017; Swavola, Riley, & Subramanian, 2016). This study investigates the relationship between comorbid psychopathologies and methamphetamine and opioid substance use disorders with criminal justice outcomes in a sample of females recently incarcerated in three rural jails. Diagnostic indicators were compared with official records to elucidate these relationships. It was hypothesized that multiple comorbidities and severe substance use disorder would have the strongest relationship with recidivism, but results indicate that only severe Amphetamine Use Disorder has any significant associations with recidivism. Results from this study have implications for treatment and security of females incarcerated in local jails

Reducing Recidivism in Alaska Throough Access to Extended-Release Injectable Naltrexone

A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF NURSING PRACTICE in NursingThe goal of this evidence-based project was to provide access to extended-release injectable naltrexone (XR-NTX) upon release from incarceration for individuals who had a self-identified substance or alcohol abuse history, and evaluate whether or not XR-NTX reduced recidivism in comparison with those who declined to use XR-NTX. This project was completed in collaboration with Partners Reentry Center, located in Anchorage, Alaska, who collected and offered retrospective de-identified data for this project. A total of 98 individuals with a self-identified history of substance or alcohol abuse were offered XR-NTX through Partners Reentry Center from September 15, 2015 to September 15, 2016. Of these, 52 were offered XR-NTX in the first six months of this evidenced-based quality improvement project. Of those who accepted XR-NTX (n = 32), 62% remained in the community at the end of 12 months from project initiation. Of those who declined XR-NTX (n = 20), 95% recidivated. The results of this project demonstrate the benefit of using XR-NTX in released prisoners to reduce recidivism. Implications for use the of XR-NTX in Alaska Department of Corrections inmates and the general population who meet criteria for use should be evaluated.Title Page / List of Figures / List of Tables / List of Appendices / Overview of the Problem of Interest / Review of the Literature / Organizational Framework / Project Design / Implementation Process and Procedures / Evaluation and Project Outcomes / Implications for Nursing Practice / Summary and Conclusion / References / Appendice

Lifting the Burden of Addiction: Philanthropic Opportunities to Address Substance Use Disorders in the United States

Substance use disorders (SUDs), also known as substance abuse or addiction, affect an estimated 20 million or more adolescents and adults in the U.S. This guidance provides philanthropic funders with the tools & information to reduce immediate harm from substance use disorders and reduce the burden of the disorder over the long term. This includes reducing the damage the disorder causes to people with SUDs and their loved ones, reducing the overall incidence of SUDs, and reducing SUD-related costs to society. We present four strategies for philanthropic funders who want to help:- Save lives and reduce SUD-related illness and homelessness- Improve access to evidence-based treatment- Improve SUD care by changing systems and policies- Fund innovation to improve prevention and treatmen

Drug use and HIV infection status of detainees in re-education through labour camps in Guangxi Province, China

This study describes HIV disease burden and patterns of drug use before and during incarceration among detainees in Re-education-Through-Labour-Camps (RTLCs) in China. A cross-sectional survey of 576 men and 179 women from three RTLCs was conducted in Guangxi Province, China. Over three-quarters of study participants were detained due to drug-related offences. Over half of the women (n = 313, 54.3%) and twothirds of men (n = 119, 66.5%) had been previously been incarcerated in a compulsory detoxification treatment centre (CDTC), and around one-third (men n = 159, 27.6%; women n = 50, 27.9%) in a RTLC. Of those surveyed, 49 men (8.5%) and one (0.6%) woman reported ever using drugs while in a CDTC and/or RTLC. Previous incarceration in CDTCs and RTLCs were associated with HIV infection among both male (OR = 2.15 [1.11–4.15]) and female (OR = 3.87 [1.86–9.04]) detainees. Being married/cohabiting with a partner (OR = 0.53, [0.30–0.93]) and being employed (OR = 0.46, [0.22–0.95]) were associated with a reduced odds of HIV infection among male detainees. A significant proportion of RTLC detainees had a history of drug use and a limited number of inmates had used illegal substances whilst in custody. Repeat incarcerations in CDTCs/RTLCs were associated with higher risks of HIV infection

POLYSUBSTANCE OPIOID USE IN A JUSTICE-INVOLVED POPULATION: AN ANALYSIS OF PATTERNS AND REENTRY OUTCOMES

The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by the Gelberg Behavioral Model of Vulnerable Populations. This project utilizes secondary data from the Criminal Justice Kentucky Treatment Outcome Study, a Kentucky Department of Corrections funded two-wave longitudinal study of individuals who participated in substance abuse treatment programming while incarcerated. Latent profile analysis is used to determine the patterns of pre-incarceration opioid PSU in aim 1. Analyses for aims 2 and 3 examine PSU profiles, along with variables drawn from the Behavioral Model for Vulnerable Populations, in order to predict important reentry outcomes of relapse and health service utilization 12-months post-release in a series of logistic regressions. Six unique profiles of opioid PSU were found among the current justice-involved population, which faced disproportionate risk of adverse outcomes at follow-up. Findings indicate heterogeneity of opioid use among a justice-involved population. The role of mental and physical health in PSU severity is also highlighted. Further, results from post-release analyses indicate that a continuum of risk exists among PSU such that PSU patterns are unique and important predictors of post-release outcomes which can be used to inform interventions during incarceration. The importance of accounting for vulnerability as conceptualized in the Behavioral Model for Vulnerable Populations is also discussed

Homelessness and Incarceration Associated With Relapse into Stimulant and Opioid Use among Youth Who Are Street-Involved in Vancouver, Canada

The full text of this paper will be available in May 2020 due to the embargo policies of Drug and Alcohol Review. Contact [email protected] to enquire if the full text of the accepted manuscript can be made available to you

The fast and furious

Cocaine and amphetamines (‘stimulants’) are distinct central nervous system stimulants with similar effects (Pleuvry, 2009; Holman, 1994). Cocaine is a crystalline tropane alkaloid extracted from coca leaves. Amphetamines are a subclass of phenylethylamines with primarily stimulant effects, including amphetamine, methamphetamine, methcathinone and cathinone and referred to as ‘amphetamines’ in this review (Holman, 1994). MDMA (3,4-methylenedioxy-N-methamphetamine or ecstasy) is a substituted amphetamine known for its entactogenic, psychedelic, and stimulant effects (Morgan, 2000). Stimulants can produce increased wakefulness, focus and confidence, elevated mood, feelings of power, and decreased fatigue and appetite; stimulants also produce nervousness or anxiety and, in some cases, psychosis and suicidal thoughts (Holman, 1994; EMCDDA, 2007f; Hildrey et al., 2009; Pates and Riley, 2009). Although there is little evidence that stimulants cause physical dependence, tolerance may develop upon repetitive use and withdrawal may cause discomfort and depression (EMCDDA, 2007f; Pates and Riley, 2009). Users may engage in ‘coke or speed binges’ alternated with periods of withdrawal and abstinence (Beek et al., 2001)

BARRIERS AND FACILITORS OF HEALTHCARE USE AMONG PEOPLE WHO INJECT DRUGS

Hepatitis C Virus (HCV) is an infection that can have grave consequences when left untreated. Hepatitis C can be easily eradicated with direct acting antiviral therapy. People who inject drugs (PWID) and inmates are among those with the highest incidence of HCV. However, cure rates among this population remains low. This is, in part, related to an interruption in the HCV care cascade such that only 30% of PWID are linked to care and only 8% of those receive treatment. Inadequate screening and failure to be linked to HCV care remain the largest impediments to treatment success. There is limited research on barriers and facilitators to primary care, where screening may take place, and linkage to HCV care among PWID. Few studies have evaluated vulnerable populations such as those living in rural communities or inmates. The purpose of this dissertation was to develop a broader understanding of barriers and facilitators to healthcare utilization among PWID at the primary care and specialist levels (linkage to care). Three manuscripts addressed important gaps in knowledge. The first was a review of the literature to describe the state of science on linkage to care among PWID. All but one reviewed study recruited from countries with universal healthcare, urban areas, and opioid substitution facilities. The review of the literature revealed that little is known about the barriers/facilitators to linkage to HCV care faced by rural-dwelling PWID from countries without universal healthcare. The second manuscript is a study to determine whether predictors of linkage to care identified in urban-dwelling PWID from countries with universal healthcare predicted seeking HCV care among PWID living in rural Appalachia. Data were obtained from a subsample of 63 HCV positive PWID who recently used opioids, were between the ages of 18-35 years, and lived in one of five rural counties in Kentucky. Logistic regression revealed that recent injection drug use was the only predictor of seeking HCV care. However, remote use of opioid substitution therapy and no transportation issues approached clinical significance. Although not evaluated in our second manuscript, seeing a primary care provider (PCP) is associated with an increased likelihood of being linked to care and higher rates of screening/diagnosis. Among rural dwelling PWID, there are subpopulations that may face unique barriers to linkage to care. One sub-population that may be particularly vulnerable are female PWID who are incarcerated. Therefore, the purpose of the third study was to determine predictors of primary care use using data from 302 female inmates from rural Appalachia with a history of injecting drugs. Age, insurance issues, and health problems that interfere with responsibilities were predictors of PCP use. In this dissertation, I have addressed important gaps in the literature by determining barriers and facilitators to seeking HCV care and primary care use among PWID from rural Kentucky. Additional studies are needed using a larger sample of rural PWID to confirm our findings. In addition, further studies should evaluate system and provider level barriers to linkage to care and PCP use among rural PWID

Measurement of ASQ Usage in the County Jail Setting

Approved May 2020 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing PracticeSince the year 2000, the leading cause of death in a jail setting has been suicide. The purpose of this retrospective, descriptive quality improvement project was to evaluate the usage of the ASQ screening tool in the county jail setting after implementation of the tool. Data was collected on a convenience sample of 98 adults, age 18-65, located at a county jail in Wisconsin. Data regarding usage of the ASQ in the facility, demographic data and substance use history was collected. Outcome measures included determining the usage of the ASQ as well as analyzing the demographics and substance use in this population. Results showed the ASQ tool was used exclusively by the mental health staff, with no use by nursing or the correctional officers. The ASQ was used 61% of the time as a follow up screen for inmates identified as suicidal on intake assessment and 79% of the time for inmates placed on observation after arrest. The tool was not used during intake screening. Seventy percent of the subjects admitted to some type of substance use with alcohol being the most common substance of choice (52%). The data collected provides the foundation to guide further education and training to improve the implementation of the ASQ in the jail setting. The substance abuse data was congruent with national data and, given that substance use increases suicide risk, supports the need for improved suicide screening in the jail setting