Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions

BACKGROUND People who inject opioids are at a disproportionate risk for contracting hepatitis C virus (HCV). However, use of HCV prevention and treatment services remains suboptimal among people with substance use disorders due to various health system, societal, and individual barriers. Incorporating HCV-specific resources into addiction treatment services, such as mobile-health applications, may reduce the transmission of HCV and improve screening and treatment rates among people with opioid use disorder. OBJECTIVE The goals of this manuscript are to (1) describe the development of the HCV-specific functionality of a mobile-health innovation called A-CHESS and its implementation and evaluation through a randomized control trial and (2) discuss early implementation issues encountered while monitoring and supporting participants’ movement across the continuum of HCV care. METHODS Opioid users from two addiction treatment centers in Massachusetts were randomly assigned to receive either medication assisted treatment (MAT) alone (control arm) or MAT + A-CHESS (experimental arm), and are followed for 24 months. Data on patient’s HCV risk behaviors and stage of care were collected upon enrollment by telephone interview and used to assign a baseline stage of HCV care. Individual’s stage of care are updated through subsequent weekly surveys delivered electronically through the A-CHESS application. Private messages were sent to individuals’ tailored to their stage of HCV care. Additional HCV prevention and treatment resources were incorporated into A-CHESS including multimedia health education content, access to online resources, and location-specific testing facilities and clinical care. RESULTS Between April 2016 and April 2018, 416 individuals were enrolled and completed the baseline interview; 207 were randomly assigned to the control arm and 209 were assigned to the intervention arm. The sample was 86% non-Hispanic white and 55% male with a mean age of 37 years. The majority of the sample (72%) was receiving methadone at the time of enrollment and heroin was the most commonly used opioid. At baseline, 202 individuals (49%) reported ever testing HCV-antibody positive. Of those, 180 (89%) reported receiving HCV-RNA confirmatory testing, of which 139 (77%) tested HCV-RNA positive. Of those who reported testing HCV-RNA positive, 44 (32%) had ever been prescribed HCV treatment and 32 (23%) had been cured. Of the remaining 214 individuals who had never tested anti-HCV positive, 31% (n=129) reported testing HCV-antibody negative within the past year and 20% (n=85) reported not being tested within the past year. CONCLUSIONS The A-CHESS mobile-health system allows for the implementation of a bundle of services and the collection of longitudinal data related to drug use and HCV care among people with opioid use disorders. This study will provide preliminary evidence to determine whether HCV-specific services embedded into the A-CHESS program can increase the frequency of HCV testing, linkage to care, and treatment for people engaged in addiction treatment. CLINICALTRIAL NCT02712034

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Experiences and opinions of health professional students participating in an opioid use disorder educational event

Mental Health Clinician ◽

10.9740/mhc.2020.03.049 ◽

2020 ◽

Vol 10 (2) ◽

pp. 49-54

Author(s):

Erin L. Winstanley ◽

Gina M. Baugh ◽

Mark Garofoli ◽

Andrew J. Muzyk

Keyword(s):

Health Professional ◽

Opioid Use Disorder ◽

Evidence Based ◽

Opioid Use ◽

Clinical Practices ◽

Professional Students ◽

Treatment Services ◽

Personal Experiences ◽

Prevention And Treatment ◽

Health Professional Students

Abstract Introduction The objectives of this study were to describe health professional students' experiences and opinions about patients with opioid-use disorder (OUD), to summarize evaluation results from an OUD educational event and to compare results by sex, discipline, and clinical experience. Methods The OUD educational event lasted 75 minutes and covered the epidemiology of the opioid epidemic, evidence-based prevention and treatment services, stigma, and recommendations on how to improve care. An anonymous pre-event survey collected information on attendees' experiences and opinions about patients with OUD. The postevent survey collected information on the attendees' evaluation of the event. Results Forty percent of students reported having a friend or family member who has/had an OUD. A minority (29.1%) reported that they would be uncomfortable working with patients with OUD or would prefer not to interact with patients with OUD (27.7%). Overall, the event evaluation results were very positive, and 85.5% reported that the information would change or influence their clinical practices. The open-ended responses found that the content was informative (n = 36); the attendees liked the inclusion of statistics (n = 19) and that the content was locally focused (n = 13). Discussion Health professional students participating in this event had fewer negative opinions of patients with OUD than previous research has found, and this may, in part, be explained by their personal experiences. Overall, health professional students want to learn more about patients with OUD.

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Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

Current HIV/AIDS Reports ◽

10.1007/s11904-018-0402-3 ◽

2018 ◽

Vol 15 (4) ◽

pp. 315-323 ◽

Cited By ~ 10

Author(s):

Jennifer R. Havens ◽

Sharon L. Walsh ◽

P. Todd Korthuis ◽

David A. Fiellin

Keyword(s):

Hepatitis C ◽

Opioid Use Disorder ◽

Opioid Use ◽

Rural Settings ◽

Prevention And Treatment

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Hepatitis C Virus Screening among Medicaid-Insured Individuals with Opioid Use Disorder across Substance Use Disorder Treatment Settings

Substance Use & Misuse ◽

10.1080/10826084.2020.1858106 ◽

2020 ◽

pp. 1-6

Author(s):

Sugy Choi ◽

Shannon Healy ◽

Liudmila Shapoval ◽

Sarah Forthal ◽

Charles J. Neighbors

Keyword(s):

Substance Use ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Substance Use Disorder ◽

Opioid Use Disorder ◽

Opioid Use ◽

Substance Use Disorder Treatment ◽

Disorder Treatment ◽

Virus Screening ◽

Treatment Settings

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Medicaid Expansion Increased Medications For Opioid Use Disorder Among Adults Referred By Criminal Justice Agencies

Health Affairs ◽

10.1377/hlthaff.2020.01251 ◽

2021 ◽

Vol 40 (4) ◽

pp. 562-570

Author(s):

Utsha G. Khatri ◽

Benjamin A. Howell ◽

Tyler N. A. Winkelman

Keyword(s):

Criminal Justice ◽

Opioid Use Disorder ◽

Medicaid Expansion ◽

Opioid Use

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Integrated, Co-located, Telemedicine-based Treatment Approaches for Hepatitis C Virus Management in Opioid Use Disorder Patients on Methadone

Clinical Infectious Diseases ◽

10.1093/cid/ciy899 ◽

2018 ◽

Vol 69 (2) ◽

pp. 323-331 ◽

Cited By ~ 15

Author(s):

Andrew H Talal ◽

Phyllis Andrews ◽

Anthony Mcleod ◽

Yang Chen ◽

Clewert Sylvester ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Multiple Correspondence Analysis ◽

Opioid Use Disorder ◽

Hcv Rna ◽

Directly Observed Therapy ◽

Opioid Use ◽

Hcv Treatment ◽

Opioid Substitution Therapy ◽

Direct Acting

Abstract Background Despite high hepatitis C virus (HCV) prevalence, opioid use disorder (OUD) patients on methadone rarely engage in HCV treatment. We investigated the effectiveness of HCV management via telemedicine in an opioid substitution therapy (OST) program. Methods OUD patients on methadone underwent biweekly telemedicine sessions between a hepatologist and physician assistant during the entire HCV treatment course. All pretreatment labs (HCV RNA, genotype, and noninvasive fibrosis assessments) were obtained onsite and direct-acting antivirals were coadministered with methadone using modified directly observed therapy. We used multiple correspondence analysis, least absolute shrinkage and selection operator, and logistic regression to identify variables associated with pursuit of HCV care. Results Sixty-two HCV RNA–positive patients (24% human immunodeficiency virus [HIV] infected, 61% male, 61% African American, 25.8% Hispanic) were evaluated. All patients were stabilized on methadone and all except 4 were HCV genotype 1 infected. Advanced fibrosis/cirrhosis was present in 34.5% of patients. Of the 45 treated patients, 42 (93.3%) achieved viral eradication. Of 17 evaluated patients who were not treated, 5 were discontinued from the drug treatment program or did not follow up after the evaluation, 2 had HIV adherence issues, and 10 had insurance authorization issues. Marriage and a mental health diagnosis other than depression were the strongest positive predictors of treatment pursuit, whereas being divorced, separated, or widowed was the strongest negative predictor. Conclusions HCV management via telemedicine integrated into an OST program is a feasible model with excellent virologic effectiveness. Psychosocial and demographic variables can assist in identification of subgroups with a propensity or aversion to pursue HCV treatment.

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Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa141 ◽

2020 ◽

Vol 222 (Supplement_5) ◽

pp. S354-S364 ◽

Cited By ~ 1

Author(s):

Jacqueline E Sherbuk ◽

Terry Kemp Knick ◽

Chelsea Canan ◽

Patrice Ross ◽

Bailey Helbert ◽

...

Keyword(s):

Hepatitis C ◽

Sustained Virologic Response ◽

Virologic Response ◽

Opioid Use Disorder ◽

Support Staff ◽

World Population ◽

Opioid Use ◽

Provider Training ◽

Financial Barriers ◽

Efficient Treatment

Abstract Background Hepatitis C virus (HCV) and the opioid epidemic disproportionately affect the Appalachian region. Geographic and financial barriers prevent access to specialty care. Interventions are needed to address the HCV-opioid syndemic in this region. Methods We developed an innovative, collaborative telehealth model in Southwest Virginia featuring bidirectional referrals from and to comprehensive harm reduction (CHR) programs and office-based opioid therapy (OBOT), as well as workforce development through local provider training in HCV management. We aimed to (1) describe the implementation process of provider training and (2) assess the effectiveness of the telehealth model by monitoring patient outcomes in the first year. Results The provider training model moved from a graduated autonomy model with direct specialist supervision to a 1-day workshop with parallel tracks for providers and support staff followed by monthly case conferences. Forty-four providers and support staff attended training. Eight providers have begun treating independently. For the telehealth component, 123 people were referred, with 62% referred from partner OBOT or CHR sites; 103 (84%) attended a visit, 93 (76%) completed the treatment course, and 61 (50%) have achieved sustained virologic response. Rates of sustained virologic response did not differ by receipt of treatment for opioid use disorder. Conclusions Providers demonstrated a preference for an in-person training workshop, though further investigation is needed to determine why only a minority of those trained have begun treating HCV independently. The interdisciplinary nature of this program led to efficient treatment of hepatitis C in a real-world population with a majority of patients referred from OBOTs and CHR programs.

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Practical steps to improve chronic hepatitis C treatment in people with opioid use disorder

Hepatic Medicine Evidence and Research ◽

10.2147/hmer.s187133 ◽

2018 ◽

Vol Volume 11 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Carlos Roncero ◽

Pablo Ryan ◽

Richard Littlewood ◽

Juan Macías ◽

Juan Ruiz ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Opioid Use Disorder ◽

Opioid Use ◽

Hepatitis C Treatment

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Opioids and the Criminal Justice System: New Challenges Posed by the Modern Opioid Epidemic

Annual Review of Criminology ◽

10.1146/annurev-criminol-061020-125715 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Jonathan P. Caulkins ◽

Anne Gould ◽

Bryce Pardo ◽

Peter Reuter ◽

Bradley D. Stein

Keyword(s):

Criminal Justice ◽

Criminal Justice System ◽

Justice System ◽

Crime Control ◽

Medical Condition ◽

Opioid Use Disorder ◽

Annual Review ◽

Publication Date ◽

Opioid Use ◽

New Challenges

The traditional US heroin market has transformed into a broader illegal opioid market, dominated first by prescription opioids (PO) and now also by fentanyl and other synthetic opioids (FOSO). Understanding of opioid-use disorder (OUD) has also transformed from being seen as a driver of crime to a medical condition whose sufferers deserve treatment. This creates new challenges and opportunities for the criminal justice system (CJS). Addressing inmates’ OUD is a core responsibility, including preventing overdose after release. Treatment can be supported by diversion programs (e.g., drug courts, among others) and by providing medication-assisted treatment in prison, not only as a crime-control strategy but also because of ethical and legal responsibilities to provide appropriate healthcare. The CJS also has opportunities to alter supply that were not relevant in the past, including deterring pill-mill doctors and disrupting web sites used to distribute FOSO. Expected final online publication date for the Annual Review of Criminology, Volume 4 is January 13, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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