SAFE Solutions - User contributions [en]

Improve Recovery Support for People in the Criminal Justice System

2024-11-07T14:43:27Z

Charliekapinos: /* Available Tools and Resources */

 

= Introductory Paragraph =

Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to integrate evidenced-based practices for treatment and recovery. Implementation of evidenced-based practices allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement. Upon returning to their communities, many individuals require mental and/or physical healthcare services. Community-based behavioral health systems have an essential role in serving individuals who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with an SUD can help lead to a life in recovery, as opposed to a life in long-term incarceration.

= Key Information =

Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and that they live productively with dignity and respect. People who simply need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors related to their untreated mental illness or when a law enforcement officer believes that a person could benefit from healthcare services that are provided in the jail. Arrest and even brief incarceration can destabilize an individual’s life in many ways, including housing, health care, employment, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services that they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration. Programs to improve outcomes of those in recovery within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated, and re-entry resources and services. For more detailed information on re-entry, please see the SAFE wiki titled "Improve Reentry After Incarceration." <ref>https://www.yoursafesolutions.us/wiki/Improve_Reentry_After_Incarceration</ref>

'''SAMHSA's 8 Principles'''

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified eight principles to assist community-based behavioral health providers and criminal justice professionals to collaborate most effectively. <ref>https://store.samhsa.gov/product/Principles-of-Community-based-Behavioral-Health-Services-for-Justice-involved-Individuals-A-Research-based-Guide/SMA19-5097</ref> These principles provide a strong foundation for understanding re-entry programs, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, and medication assisted therapy:

* Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
* Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
* Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
* Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
* Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
* Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
* Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism .
* Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

'''Medication-Assisted Treatment (MAT)'''

MAT can be utilized for drug-dependent individuals within the criminal justice populations. Currently, within the criminal justice system, MAT is used primarily for pregnant women to detoxify and is minimally used for reentry. There are ongoing studies surrounding MAT, as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma, and increasing funding. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation, and funding. More information can be found at the SAFE wiki article titled, "Expand the Use of MAT/MAR in Correctional Facilities." <ref>https://www.yoursafesolutions.us/wiki/Expand_the_Use_of_MAT/MAR_in_Correctional_Facilities</ref>

= Relevant Research =

*'''This article''' documents the benefits of treatment for the incarcerated in terms of both increased recovery rates and decreased recidivism. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

= Impactful Federal, State, and Local Policies =

SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration and will add additional resources.

= Available Tools and Resources =

'''SAFE Project:'''
*'''Pre-Arrest Diversion Guide''' is a SAFE Project downloadable resource intended for law enforcement agencies that provides background information, research, and case studies on the Pre-Arrest Diversion model as an alternative to arresting those with substance use disorders.<ref>https://www.safeproject.us/article/safe-presents-pre-arrest-diversion-guide-law-enforcement/</ref>
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
*'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*See the wiki titled "Expand Access to MAT/MAR for Pregnant People" for more detailed information on the role of Medication Assisted Treatment (MAT) and Medication Assisted Recovery (MAR) for treating substance use disorders during and after pregnancy.<ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_MAT/MAR_for_Pregnant_People/</ref>

'''The Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP)''' website offers peer-to-peer learning opportunities, profiles of COSSUP sites across the nation, information on demonstration projects, and access to technical assistance. <ref>https://www.cossapresources.org/</ref>

'''The Opioid Response Network''' provides "Community Supervision and MOUD Toolkit," a free online learning series to help probation officers and treatment providers enhance client recovery during supervision. <ref>https://resources.opioidresponsenetwork.org/Education/CommunitySupervisionandMOUDToolkit.aspx</ref>

'''The American Academy of Addiction Psychiatry''' Published "Cultivating Law and Medicine Partnerships to Support Justice-Involved Individuals With Substance Use Disorders – Digital Guide." <ref>https://www.aaap.org/law-and-medicine/guide/</ref>

= Promising Practices =

'''Massachusetts -- Plymouth County Outreach (PCO)''' was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered innovative law enforcement collaboration with faith-based coalitions, the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, the Division of Children and Families, recovery coaches, District Court Probation, and the Police Assisted Addiction and Recovery Initiative (PAARI). The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Drop-in centers are held each week in various sites across Plymouth County. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free. <ref>https://otf.plymouthda.com/project-outreach/</ref>

'''Massachusetts -- Arlington Opiate Outreach Initiative.''' This community-based strategy has two major components. First is the proactive outreach to known substance users. This involves a clinician at the police department reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to provide access to services, and to facilitate the long-term process of recovery. The second component is the Arlington Community Training & Support (Arlington ACTS) which involves a series of community-based meetings. These are co-facilitated by the police department’s clinician and a community substance use intervention expert and are aimed at creating a supportive non-judgmental environment for substance users and their families. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

'''North Carolina.''' The HOPE Initiative in Nashville was the first pre-arrest diversion program in North Carolina. Its purpose is to assist those individuals with substance use disorder find treatment options, get into treatment, and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, the Eastpointe Local Management Entity, UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department to start their recovery process by turning over any drugs and/or paraphernalia without fear of charges. The first organization in the HOPE Initiative served 320 clients in 2 years. The program is funded through donations, grants, and fundraisers. <ref> https://www.townofnashville.com/home/showpublisheddocument/129/636527353948700000</ref>

''' Virginia Recovery and Re-Entry Project.''' The VRR Project serves individuals with SUDs during incarceration and through the re-entry process, with a peer-to-peer approach to recovery. The McShin Foundation and SAMHSA’s Building Communities of Recovery Initiative funded two new recovery jail programs in Riverside Regional Jail and the Rappahannock-Shenandoah-Warrenton Regional Jail. Recovery support services are provided five days a week in RSW and three days a week in Riverside. In follow-up to participation in these VRR programs, residential recovery program scholarships were offered to twenty individuals. VRR uses a wide variety of resources to promote long-term recovery support networks and services. <ref>https://mcshin.org/wp-content/uploads/2020/06/1-VRR-Info-Sheet1.pdf</ref>

= Sources =

Improve Recovery Support for People in the Criminal Justice System

2024-11-07T14:43:07Z

Charliekapinos: /* Available Tools and Resources */

 

= Introductory Paragraph =

Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to integrate evidenced-based practices for treatment and recovery. Implementation of evidenced-based practices allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement. Upon returning to their communities, many individuals require mental and/or physical healthcare services. Community-based behavioral health systems have an essential role in serving individuals who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with an SUD can help lead to a life in recovery, as opposed to a life in long-term incarceration.

= Key Information =

Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and that they live productively with dignity and respect. People who simply need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors related to their untreated mental illness or when a law enforcement officer believes that a person could benefit from healthcare services that are provided in the jail. Arrest and even brief incarceration can destabilize an individual’s life in many ways, including housing, health care, employment, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services that they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration. Programs to improve outcomes of those in recovery within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated, and re-entry resources and services. For more detailed information on re-entry, please see the SAFE wiki titled "Improve Reentry After Incarceration." <ref>https://www.yoursafesolutions.us/wiki/Improve_Reentry_After_Incarceration</ref>

'''SAMHSA's 8 Principles'''

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified eight principles to assist community-based behavioral health providers and criminal justice professionals to collaborate most effectively. <ref>https://store.samhsa.gov/product/Principles-of-Community-based-Behavioral-Health-Services-for-Justice-involved-Individuals-A-Research-based-Guide/SMA19-5097</ref> These principles provide a strong foundation for understanding re-entry programs, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, and medication assisted therapy:

* Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
* Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
* Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
* Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
* Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
* Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
* Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism .
* Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

'''Medication-Assisted Treatment (MAT)'''

MAT can be utilized for drug-dependent individuals within the criminal justice populations. Currently, within the criminal justice system, MAT is used primarily for pregnant women to detoxify and is minimally used for reentry. There are ongoing studies surrounding MAT, as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma, and increasing funding. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation, and funding. More information can be found at the SAFE wiki article titled, "Expand the Use of MAT/MAR in Correctional Facilities." <ref>https://www.yoursafesolutions.us/wiki/Expand_the_Use_of_MAT/MAR_in_Correctional_Facilities</ref>

= Relevant Research =

*'''This article''' documents the benefits of treatment for the incarcerated in terms of both increased recovery rates and decreased recidivism. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

= Impactful Federal, State, and Local Policies =

SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration and will add additional resources.

= Available Tools and Resources =

'''SAFE Project:'''
*'''Pre-Arrest Diversion Guide''' is a SAFE Project downloadable resource intended for law enforcement agencies that provides background information, research, and case studies on the Pre-Arrest Diversion model as an alternative to arresting those with substance use disorders.<ref>https://www.safeproject.us/article/safe-presents-pre-arrest-diversion-guide-law-enforcement/<ref>
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
*'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*See the wiki titled "Expand Access to MAT/MAR for Pregnant People" for more detailed information on the role of Medication Assisted Treatment (MAT) and Medication Assisted Recovery (MAR) for treating substance use disorders during and after pregnancy.<ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_MAT/MAR_for_Pregnant_People/</ref>

'''The Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP)''' website offers peer-to-peer learning opportunities, profiles of COSSUP sites across the nation, information on demonstration projects, and access to technical assistance. <ref>https://www.cossapresources.org/</ref>

'''The Opioid Response Network''' provides "Community Supervision and MOUD Toolkit," a free online learning series to help probation officers and treatment providers enhance client recovery during supervision. <ref>https://resources.opioidresponsenetwork.org/Education/CommunitySupervisionandMOUDToolkit.aspx</ref>

'''The American Academy of Addiction Psychiatry''' Published "Cultivating Law and Medicine Partnerships to Support Justice-Involved Individuals With Substance Use Disorders – Digital Guide." <ref>https://www.aaap.org/law-and-medicine/guide/</ref>

= Promising Practices =

'''Massachusetts -- Plymouth County Outreach (PCO)''' was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered innovative law enforcement collaboration with faith-based coalitions, the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, the Division of Children and Families, recovery coaches, District Court Probation, and the Police Assisted Addiction and Recovery Initiative (PAARI). The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Drop-in centers are held each week in various sites across Plymouth County. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free. <ref>https://otf.plymouthda.com/project-outreach/</ref>

'''Massachusetts -- Arlington Opiate Outreach Initiative.''' This community-based strategy has two major components. First is the proactive outreach to known substance users. This involves a clinician at the police department reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to provide access to services, and to facilitate the long-term process of recovery. The second component is the Arlington Community Training & Support (Arlington ACTS) which involves a series of community-based meetings. These are co-facilitated by the police department’s clinician and a community substance use intervention expert and are aimed at creating a supportive non-judgmental environment for substance users and their families. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

'''North Carolina.''' The HOPE Initiative in Nashville was the first pre-arrest diversion program in North Carolina. Its purpose is to assist those individuals with substance use disorder find treatment options, get into treatment, and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, the Eastpointe Local Management Entity, UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department to start their recovery process by turning over any drugs and/or paraphernalia without fear of charges. The first organization in the HOPE Initiative served 320 clients in 2 years. The program is funded through donations, grants, and fundraisers. <ref> https://www.townofnashville.com/home/showpublisheddocument/129/636527353948700000</ref>

''' Virginia Recovery and Re-Entry Project.''' The VRR Project serves individuals with SUDs during incarceration and through the re-entry process, with a peer-to-peer approach to recovery. The McShin Foundation and SAMHSA’s Building Communities of Recovery Initiative funded two new recovery jail programs in Riverside Regional Jail and the Rappahannock-Shenandoah-Warrenton Regional Jail. Recovery support services are provided five days a week in RSW and three days a week in Riverside. In follow-up to participation in these VRR programs, residential recovery program scholarships were offered to twenty individuals. VRR uses a wide variety of resources to promote long-term recovery support networks and services. <ref>https://mcshin.org/wp-content/uploads/2020/06/1-VRR-Info-Sheet1.pdf</ref>

= Sources =

Expand the Use of MAT/MAR in Correctional Facilities

2024-10-24T22:31:39Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

The opioid epidemic has become a national public health crisis, and those in the criminal justice system are significantly impacted by this epidemic. Individuals with opioid use disorder have higher risk of being involved in the criminal legal system. <ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref> Those who are incarcerated have very high risks of opioid overdose upon release. <ref> https://pubmed.ncbi.nlm.nih.gov/30024795/</ref> Individuals struggling with mental health and substance use disorders may revolve in and out of correctional facilities, especially if they have not received treatment and they are released back to the community where their substance use cycle may continue. Several prisons are working towards implementing Medication-Assisted Treatment (MAT) and Medication-Assisted Recovery (MAR). MAT is utilized as an intervention in a controlled, safe environment and has been shown to reduce drug use, overdose, and mortality and recidivism rates. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref> <ref>https://pubmed.ncbi.nlm.nih.gov/29913516/</ref> <ref>https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671411</ref>

=Key Information=

A National Survey on Drug Use and Health indicated the odds of being involved in the criminal justice system increase for those using opioids. <ref>https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf</ref> Those in the criminal justice system who transition back into the community after incarceration have high rates of returning to the criminal justice system or of relapsing. MAT can assist those with substance use disorder and reduce the rate of relapse. Medication, in conjunction with behavioral health therapy, in jails and prisons can lower overdose deaths after release. Best practices surrounding MAT in correctional facilities emphasize the importance of support and buy-in from correctional facilities leadership, support staff and community. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref> The National Council for Wellbeing lists criteria that have been applied by some correctional facilities to determine who should receive MAT: <ref>https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/</ref>

*Individuals previously on MAT in the community prior to arrest
*Individuals diagnosed with a moderate or severe opioid use disorder
*Individuals identified in a validated risk assessment to be at the highest risk of return to use or overdose
*Individuals who are within a few weeks of release to the community
*The capacity of the correctional facility to deliver the resources needed

=Relevant Research=

'''This article''' titled "Release from prison - A high risk of death for former inmates," documents the higher risk of overdose death post-release. <ref>https://pubmed.ncbi.nlm.nih.gov/17215533/</ref>

'''This literature review''' documents the effectiveness of MAT in prison and jail settings, including increased retention in treatment.
<ref>https://pubmed.ncbi.nlm.nih.gov/30797392/</ref>

'''This White Paper''' summarizes research on a variety of benefits of MAT in correctional facilities, such as reduced risk of suicide during incarceration. <ref>https://www.ncchc.org/wp-content/uploads/From_the_General_Public_to_Americas_Jails_-_MAT_Saves_Lives-_Indivior.pdf</ref>

'''Findings from the Justice Community Opioid Innovation Network (JCOIN).''' In a 2023 study, JCOIN researchers (from the Massachusetts Clinical Research Center, the University of Massachusetts at Amherst, the University of Massachusetts Chan Medical School, Baystate Health, and Tufts University) outline key steps MOUD program treatment staff can implement in order to prevent diversion. The study also provides guidance to corrections and lawmakers as they consider establishing and expanding MOUD treatment in correctional settings." <ref>https://mcusercontent.com/a3c8fbb7be6f3cee9df95f0bf/files/8dad90e1-d0f9-2ebd-a7ec-f18826b128ac/Appendix_A.pdf</ref>

=Impactful Federal, State, and Local Policies=

'''Federal Rights.''' In a landmark decision, a federal judge ordered a county jail to provide a woman with access to MAT for her opioid use disorder during her jail sentence. Thus, there is now a legal precedent which is increasing judicial recognition that MAT should be standard care in jails and failing to provide it violates individuals’ rights. <ref>https://www.aclu.org/press-releases/federal-judge-rules-jail-must-allow-access-medication-assisted-treatment</ref>

'''The SUPPORT Act for Patients and Community''' mandated Medicaid coverage for MAT. <ref> https://www.congress.gov/bill/115th-congress/house-bill/6</ref>

'''Medicaid''' provides for Medication Assisted Therapy (MAT) to individuals in the criminal justice system. Several states are working to address the opioid epidemic by utilizing Medicaid 1115 Demonstration Waivers. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/medicaidfinancingmatreport_0.pdf</ref>

'''Massachusetts''' passed Chapter 208, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction. This authorized a four-year pilot administering all three FDA-approved medications to treat opioid use disorder. <ref>https://malegislature.gov/Laws/SessionLaws/Acts/2018/Chapter208</ref>

'''New York''' passed legislation to allow MAT to individuals in diversion programs. <ref>https://www.nysenate.gov/legislation/bills/2019/S2161</ref> The legislation ensures that who those participate would not face charges due to MAT medications/drug screens. <ref>https://www.lac.org/assets/files/Medication-Assisted-Treatment-in-Drug-Courts-Recommended-Strategies.pdf </ref>

'''The American Correctional Association (ACA) and the American Society of Addiction Medicine (ASAM)''' issued a joint policy statement on the treatment of opioid use disorders for justice-involved individuals. It delineates specific recommendations for the following four domains: <ref>https://www.asam.org/docs/default-source/public-policy-statements/2018-joint-public-correctional-policy-on-the-treatment-of-opioid-use-disorders-for-justice-involved-individuals.pdf?sfvrsn=26de41c2_2</ref>
*Screening and Prevention
*Treatment, with several points on MAT
*Reentry and Community Supervision Considerations
*Education

=Available Tools and Resources=

'''SAMHSA''' has published an issue brief titled "Medication Assisted Treatment in Criminal Justice Systems." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matbriefcjs_0.pdf</ref> and a report titled "Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings" <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matusecjs.pdf</ref>

'''BJA''' has published the "Prison/Jail Medication-Assisted Treatment Manual." <ref>https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf</ref>

'''SAFE Project:'''
*'''"Frequently Asked Questions about Medication Assisted Treatment (MAT)"''' is a SAFE Project written article that explores frequently asked questions about MAT, dispelling any myths and/or stigma associated with the treatment.<ref>https://www.safeproject.us/resource/frequently-asked-questions-about-medication-assisted-treatment/</ref>
*'''"Medication Assisted Treatment (MAT) Explained"''' is a SAFE Project written article that explores what Medication Assisted Treatment is and who it's used for.<ref>https://www.safeproject.us/resource/medication-assisted-treatment-explained/</ref>
*See the wiki titled "Expand Access to MAT" for more information on Medication Assisted Treatment (MAT) and it's benefits.<ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

'''The National Council for Wellbeing''' has published a report titled "Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons - A Planning and Implementation Toolkit." <ref>https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/</ref>

'''The National Sheriffs Association''' published "Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field." <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref>

'''The National Conference of State Legislatures''' provides a 50-state index of Medicaid Coverage of MAT. <ref>https://www.ncsl.org/research/health/mat-opiate-50-state-table-medicaid.aspx</ref>

'''The Opioid Response Network''' has a resource page titled "Medications for Opioid Use Disorder (MOUD) in Corrections." <ref>https://opioidresponsenetwork.org/MOUDCorrections.aspx</ref>

'''The Pennsylvania Department of Corrections''' has an extensive resource page on MAT. <ref>https://www.cor.pa.gov/About%20Us/Initiatives/Pages/Medication-Assisted-Treatment.aspx</ref> It has also created a one-page promotional paper on MAT. <ref>https://www.cor.pa.gov/Initiatives/Documents/Medication%20Assisted%20Treatment/Handout%20for%20MAT_For%20Offenders_2.0.png</ref>

=Promising Practices=

'''Pennsylvania''' The Department of Corrections is promoting MAT. The results of a 2019 Pilot program led to the assignment of at least one MAT Specialist for each of the state's 24 prisons. <ref>https://www.pacounties.org/getmedia/1bb2f09d-a970-478e-b1cc-a2f1703c823e/2022CBHTF-FWS-MAT.pdf</ref>

'''Case studies''' from California, Kentucky, Massachusetts, Rhode Island, and Washington are highlighted in this report by the National Sheriffs Association. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref>

'''Pew Charitable Trusts''' published a study titled "Opioid Use Disorder Treatment in Jails and Prisons" that includes positive case studies in Colorado, Massachusetts, Pennsylvania, and Vermont. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/04/opioid-use-disorder-treatment-in-jails-and-prisons</ref>

=Sources=

Expand the Use of MAT/MAR in Correctional Facilities

2024-10-24T22:31:30Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

The opioid epidemic has become a national public health crisis, and those in the criminal justice system are significantly impacted by this epidemic. Individuals with opioid use disorder have higher risk of being involved in the criminal legal system. <ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref> Those who are incarcerated have very high risks of opioid overdose upon release. <ref> https://pubmed.ncbi.nlm.nih.gov/30024795/</ref> Individuals struggling with mental health and substance use disorders may revolve in and out of correctional facilities, especially if they have not received treatment and they are released back to the community where their substance use cycle may continue. Several prisons are working towards implementing Medication-Assisted Treatment (MAT) and Medication-Assisted Recovery (MAR). MAT is utilized as an intervention in a controlled, safe environment and has been shown to reduce drug use, overdose, and mortality and recidivism rates. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref> <ref>https://pubmed.ncbi.nlm.nih.gov/29913516/</ref> <ref>https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671411</ref>

=Key Information=

A National Survey on Drug Use and Health indicated the odds of being involved in the criminal justice system increase for those using opioids. <ref>https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf</ref> Those in the criminal justice system who transition back into the community after incarceration have high rates of returning to the criminal justice system or of relapsing. MAT can assist those with substance use disorder and reduce the rate of relapse. Medication, in conjunction with behavioral health therapy, in jails and prisons can lower overdose deaths after release. Best practices surrounding MAT in correctional facilities emphasize the importance of support and buy-in from correctional facilities leadership, support staff and community. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref> The National Council for Wellbeing lists criteria that have been applied by some correctional facilities to determine who should receive MAT: <ref>https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/</ref>

*Individuals previously on MAT in the community prior to arrest
*Individuals diagnosed with a moderate or severe opioid use disorder
*Individuals identified in a validated risk assessment to be at the highest risk of return to use or overdose
*Individuals who are within a few weeks of release to the community
*The capacity of the correctional facility to deliver the resources needed

=Relevant Research=

'''This article''' titled "Release from prison - A high risk of death for former inmates," documents the higher risk of overdose death post-release. <ref>https://pubmed.ncbi.nlm.nih.gov/17215533/</ref>

'''This literature review''' documents the effectiveness of MAT in prison and jail settings, including increased retention in treatment.
<ref>https://pubmed.ncbi.nlm.nih.gov/30797392/</ref>

'''This White Paper''' summarizes research on a variety of benefits of MAT in correctional facilities, such as reduced risk of suicide during incarceration. <ref>https://www.ncchc.org/wp-content/uploads/From_the_General_Public_to_Americas_Jails_-_MAT_Saves_Lives-_Indivior.pdf</ref>

'''Findings from the Justice Community Opioid Innovation Network (JCOIN).''' In a 2023 study, JCOIN researchers (from the Massachusetts Clinical Research Center, the University of Massachusetts at Amherst, the University of Massachusetts Chan Medical School, Baystate Health, and Tufts University) outline key steps MOUD program treatment staff can implement in order to prevent diversion. The study also provides guidance to corrections and lawmakers as they consider establishing and expanding MOUD treatment in correctional settings." <ref>https://mcusercontent.com/a3c8fbb7be6f3cee9df95f0bf/files/8dad90e1-d0f9-2ebd-a7ec-f18826b128ac/Appendix_A.pdf</ref>

=Impactful Federal, State, and Local Policies=

'''Federal Rights.''' In a landmark decision, a federal judge ordered a county jail to provide a woman with access to MAT for her opioid use disorder during her jail sentence. Thus, there is now a legal precedent which is increasing judicial recognition that MAT should be standard care in jails and failing to provide it violates individuals’ rights. <ref>https://www.aclu.org/press-releases/federal-judge-rules-jail-must-allow-access-medication-assisted-treatment</ref>

'''The SUPPORT Act for Patients and Community''' mandated Medicaid coverage for MAT. <ref> https://www.congress.gov/bill/115th-congress/house-bill/6</ref>

'''Medicaid''' provides for Medication Assisted Therapy (MAT) to individuals in the criminal justice system. Several states are working to address the opioid epidemic by utilizing Medicaid 1115 Demonstration Waivers. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/medicaidfinancingmatreport_0.pdf</ref>

'''Massachusetts''' passed Chapter 208, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction. This authorized a four-year pilot administering all three FDA-approved medications to treat opioid use disorder. <ref>https://malegislature.gov/Laws/SessionLaws/Acts/2018/Chapter208</ref>

'''New York''' passed legislation to allow MAT to individuals in diversion programs. <ref>https://www.nysenate.gov/legislation/bills/2019/S2161</ref> The legislation ensures that who those participate would not face charges due to MAT medications/drug screens. <ref>https://www.lac.org/assets/files/Medication-Assisted-Treatment-in-Drug-Courts-Recommended-Strategies.pdf </ref>

'''The American Correctional Association (ACA) and the American Society of Addiction Medicine (ASAM)''' issued a joint policy statement on the treatment of opioid use disorders for justice-involved individuals. It delineates specific recommendations for the following four domains: <ref>https://www.asam.org/docs/default-source/public-policy-statements/2018-joint-public-correctional-policy-on-the-treatment-of-opioid-use-disorders-for-justice-involved-individuals.pdf?sfvrsn=26de41c2_2</ref>
*Screening and Prevention
*Treatment, with several points on MAT
*Reentry and Community Supervision Considerations
*Education

=Available Tools and Resources=

'''SAMHSA''' has published an issue brief titled "Medication Assisted Treatment in Criminal Justice Systems." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matbriefcjs_0.pdf</ref> and a report titled "Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings" <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matusecjs.pdf</ref>

'''BJA''' has published the "Prison/Jail Medication-Assisted Treatment Manual." <ref>https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf</ref>

'''SAFE Project:'''
*'''"Frequently Asked Questions about Medication Assisted Treatment (MAT)"''' is a SAFE Project written article that explores frequently asked questions about MAT, dispelling any myths and/or stigma associated with the treatment.<ref>https://www.safeproject.us/resource/frequently-asked-questions-about-medication-assisted-treatment/</ref>/
*'''"Medication Assisted Treatment (MAT) Explained"''' is a SAFE Project written article that explores what Medication Assisted Treatment is and who it's used for.<ref>https://www.safeproject.us/resource/medication-assisted-treatment-explained/</ref>
*See the wiki titled "Expand Access to MAT" for more information on Medication Assisted Treatment (MAT) and it's benefits.<ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

'''The National Council for Wellbeing''' has published a report titled "Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons - A Planning and Implementation Toolkit." <ref>https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/</ref>

'''The National Sheriffs Association''' published "Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field." <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref>

'''The National Conference of State Legislatures''' provides a 50-state index of Medicaid Coverage of MAT. <ref>https://www.ncsl.org/research/health/mat-opiate-50-state-table-medicaid.aspx</ref>

'''The Opioid Response Network''' has a resource page titled "Medications for Opioid Use Disorder (MOUD) in Corrections." <ref>https://opioidresponsenetwork.org/MOUDCorrections.aspx</ref>

'''The Pennsylvania Department of Corrections''' has an extensive resource page on MAT. <ref>https://www.cor.pa.gov/About%20Us/Initiatives/Pages/Medication-Assisted-Treatment.aspx</ref> It has also created a one-page promotional paper on MAT. <ref>https://www.cor.pa.gov/Initiatives/Documents/Medication%20Assisted%20Treatment/Handout%20for%20MAT_For%20Offenders_2.0.png</ref>

=Promising Practices=

'''Pennsylvania''' The Department of Corrections is promoting MAT. The results of a 2019 Pilot program led to the assignment of at least one MAT Specialist for each of the state's 24 prisons. <ref>https://www.pacounties.org/getmedia/1bb2f09d-a970-478e-b1cc-a2f1703c823e/2022CBHTF-FWS-MAT.pdf</ref>

'''Case studies''' from California, Kentucky, Massachusetts, Rhode Island, and Washington are highlighted in this report by the National Sheriffs Association. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref>

'''Pew Charitable Trusts''' published a study titled "Opioid Use Disorder Treatment in Jails and Prisons" that includes positive case studies in Colorado, Massachusetts, Pennsylvania, and Vermont. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/04/opioid-use-disorder-treatment-in-jails-and-prisons</ref>

=Sources=

Expand the Use of MAT/MAR in Correctional Facilities

2024-10-24T22:30:52Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

The opioid epidemic has become a national public health crisis, and those in the criminal justice system are significantly impacted by this epidemic. Individuals with opioid use disorder have higher risk of being involved in the criminal legal system. <ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref> Those who are incarcerated have very high risks of opioid overdose upon release. <ref> https://pubmed.ncbi.nlm.nih.gov/30024795/</ref> Individuals struggling with mental health and substance use disorders may revolve in and out of correctional facilities, especially if they have not received treatment and they are released back to the community where their substance use cycle may continue. Several prisons are working towards implementing Medication-Assisted Treatment (MAT) and Medication-Assisted Recovery (MAR). MAT is utilized as an intervention in a controlled, safe environment and has been shown to reduce drug use, overdose, and mortality and recidivism rates. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref> <ref>https://pubmed.ncbi.nlm.nih.gov/29913516/</ref> <ref>https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671411</ref>

=Key Information=

A National Survey on Drug Use and Health indicated the odds of being involved in the criminal justice system increase for those using opioids. <ref>https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf</ref> Those in the criminal justice system who transition back into the community after incarceration have high rates of returning to the criminal justice system or of relapsing. MAT can assist those with substance use disorder and reduce the rate of relapse. Medication, in conjunction with behavioral health therapy, in jails and prisons can lower overdose deaths after release. Best practices surrounding MAT in correctional facilities emphasize the importance of support and buy-in from correctional facilities leadership, support staff and community. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref> The National Council for Wellbeing lists criteria that have been applied by some correctional facilities to determine who should receive MAT: <ref>https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/</ref>

*Individuals previously on MAT in the community prior to arrest
*Individuals diagnosed with a moderate or severe opioid use disorder
*Individuals identified in a validated risk assessment to be at the highest risk of return to use or overdose
*Individuals who are within a few weeks of release to the community
*The capacity of the correctional facility to deliver the resources needed

=Relevant Research=

'''This article''' titled "Release from prison - A high risk of death for former inmates," documents the higher risk of overdose death post-release. <ref>https://pubmed.ncbi.nlm.nih.gov/17215533/</ref>

'''This literature review''' documents the effectiveness of MAT in prison and jail settings, including increased retention in treatment.
<ref>https://pubmed.ncbi.nlm.nih.gov/30797392/</ref>

'''This White Paper''' summarizes research on a variety of benefits of MAT in correctional facilities, such as reduced risk of suicide during incarceration. <ref>https://www.ncchc.org/wp-content/uploads/From_the_General_Public_to_Americas_Jails_-_MAT_Saves_Lives-_Indivior.pdf</ref>

'''Findings from the Justice Community Opioid Innovation Network (JCOIN).''' In a 2023 study, JCOIN researchers (from the Massachusetts Clinical Research Center, the University of Massachusetts at Amherst, the University of Massachusetts Chan Medical School, Baystate Health, and Tufts University) outline key steps MOUD program treatment staff can implement in order to prevent diversion. The study also provides guidance to corrections and lawmakers as they consider establishing and expanding MOUD treatment in correctional settings." <ref>https://mcusercontent.com/a3c8fbb7be6f3cee9df95f0bf/files/8dad90e1-d0f9-2ebd-a7ec-f18826b128ac/Appendix_A.pdf</ref>

=Impactful Federal, State, and Local Policies=

'''Federal Rights.''' In a landmark decision, a federal judge ordered a county jail to provide a woman with access to MAT for her opioid use disorder during her jail sentence. Thus, there is now a legal precedent which is increasing judicial recognition that MAT should be standard care in jails and failing to provide it violates individuals’ rights. <ref>https://www.aclu.org/press-releases/federal-judge-rules-jail-must-allow-access-medication-assisted-treatment</ref>

'''The SUPPORT Act for Patients and Community''' mandated Medicaid coverage for MAT. <ref> https://www.congress.gov/bill/115th-congress/house-bill/6</ref>

'''Medicaid''' provides for Medication Assisted Therapy (MAT) to individuals in the criminal justice system. Several states are working to address the opioid epidemic by utilizing Medicaid 1115 Demonstration Waivers. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/medicaidfinancingmatreport_0.pdf</ref>

'''Massachusetts''' passed Chapter 208, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction. This authorized a four-year pilot administering all three FDA-approved medications to treat opioid use disorder. <ref>https://malegislature.gov/Laws/SessionLaws/Acts/2018/Chapter208</ref>

'''New York''' passed legislation to allow MAT to individuals in diversion programs. <ref>https://www.nysenate.gov/legislation/bills/2019/S2161</ref> The legislation ensures that who those participate would not face charges due to MAT medications/drug screens. <ref>https://www.lac.org/assets/files/Medication-Assisted-Treatment-in-Drug-Courts-Recommended-Strategies.pdf </ref>

'''The American Correctional Association (ACA) and the American Society of Addiction Medicine (ASAM)''' issued a joint policy statement on the treatment of opioid use disorders for justice-involved individuals. It delineates specific recommendations for the following four domains: <ref>https://www.asam.org/docs/default-source/public-policy-statements/2018-joint-public-correctional-policy-on-the-treatment-of-opioid-use-disorders-for-justice-involved-individuals.pdf?sfvrsn=26de41c2_2</ref>
*Screening and Prevention
*Treatment, with several points on MAT
*Reentry and Community Supervision Considerations
*Education

=Available Tools and Resources=

'''SAMHSA''' has published an issue brief titled "Medication Assisted Treatment in Criminal Justice Systems." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matbriefcjs_0.pdf</ref> and a report titled "Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings" <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matusecjs.pdf</ref>

'''BJA''' has published the "Prison/Jail Medication-Assisted Treatment Manual." <ref>https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf</ref>

'''SAFE Project:'''
*'''"Frequently Asked Questions about Medication Assisted Treatment (MAT)"''' is a SAFE Project written article that explores frequently asked questions about MAT, dispelling any myths and/or stigma associated with the treatment.<ref>https://www.safeproject.us/resource/frequently-asked-questions-about-medication-assisted-treatment/<ref>/
*'''"Medication Assisted Treatment (MAT) Explained"''' is a SAFE Project written article that explores what Medication Assisted Treatment is and who it's used for.<ref>https://www.safeproject.us/resource/medication-assisted-treatment-explained/</ref>
*See the wiki titled "Expand Access to MAT" for more information on Medication Assisted Treatment (MAT) and it's benefits.<ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

'''The National Council for Wellbeing''' has published a report titled "Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons - A Planning and Implementation Toolkit." <ref>https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/</ref>

'''The National Sheriffs Association''' published "Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field." <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref>

'''The National Conference of State Legislatures''' provides a 50-state index of Medicaid Coverage of MAT. <ref>https://www.ncsl.org/research/health/mat-opiate-50-state-table-medicaid.aspx</ref>

'''The Opioid Response Network''' has a resource page titled "Medications for Opioid Use Disorder (MOUD) in Corrections." <ref>https://opioidresponsenetwork.org/MOUDCorrections.aspx</ref>

'''The Pennsylvania Department of Corrections''' has an extensive resource page on MAT. <ref>https://www.cor.pa.gov/About%20Us/Initiatives/Pages/Medication-Assisted-Treatment.aspx</ref> It has also created a one-page promotional paper on MAT. <ref>https://www.cor.pa.gov/Initiatives/Documents/Medication%20Assisted%20Treatment/Handout%20for%20MAT_For%20Offenders_2.0.png</ref>

=Promising Practices=

'''Pennsylvania''' The Department of Corrections is promoting MAT. The results of a 2019 Pilot program led to the assignment of at least one MAT Specialist for each of the state's 24 prisons. <ref>https://www.pacounties.org/getmedia/1bb2f09d-a970-478e-b1cc-a2f1703c823e/2022CBHTF-FWS-MAT.pdf</ref>

'''Case studies''' from California, Kentucky, Massachusetts, Rhode Island, and Washington are highlighted in this report by the National Sheriffs Association. <ref>https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf</ref>

'''Pew Charitable Trusts''' published a study titled "Opioid Use Disorder Treatment in Jails and Prisons" that includes positive case studies in Colorado, Massachusetts, Pennsylvania, and Vermont. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/04/opioid-use-disorder-treatment-in-jails-and-prisons</ref>

=Sources=

Expand Community Service Alternatives to Incarceration

2024-10-24T22:27:28Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

There is a need to address the root causes of incarceration, including substance use and mental health disorders. When people are convicted of a crime, having their punishment be in the form of community service can be an alternative to incarceration. This can be less damaging to their lives moving forward than incarceration. While it may seem that alternative punishments for crimes may be an easy “slap on the wrist,” providing alternatives can have positive impacts on the individual, their family, and the community. It may enhance rehabilitation efforts and treat substance use or mental illness which led to the criminogenic behavior.

= Key Information =

An alternative to incarceration is defined as any punishment given that is served by means outside of confinement in a jail or prison. Alternatives to incarceration have proven to be less expensive than incarceration. Additionally, alternatives can rehabilitate offenders, repair harms suffered by victims, provide benefits to the community, and treat individuals struggling with SUD and/or mental illness. In order to maximize the benefits of alternatives to incarceration, it is necessary to repeal mandatory minimums. <ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref> Families Against Mandatory Minimums (FAMM) has identified the following five benefits for alternatives to incarceration: <ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref>

*'''Increase Effectiveness of Rehabilitation.''' Each offender and crime are unique, and prison or jail time may not always be the most effective response. Giving courts sentencing options other than incarceration can better tailor sentences to fit the offender and the crime.
*'''Save Taxpayer Money.''' It costs over $28,000 to keep one person in federal prison for one year (some states’ prison costs are much higher). Alternatives to incarceration are cheaper, help prevent prison and jail overcrowding, and save taxpayers millions.
*'''Strengthen Families and Communities.''' Prison or jail time separates the offender from his or her spouse and children, sometimes for decades at a time. Alternatives to incarceration keep people with their families, in their neighborhoods and jobs, and allow them to earn money, pay taxes, and contribute to their communities.
*'''Reduce Recidivism.''' Over 40% of all people leaving prison will re-offend and be back in prison within three years of their release. Alternatives to prison such as drug and mental health courts are proven to confront the underlying causes of crime (i.e., substance use and mental illness) and help prevent offenders from committing new crimes.
*'''Respond to Public Support.''' Over 75% of adults believe that alternatives to incarceration (probation, restitution, community service, and/or rehabilitative services) are the most appropriate sentence for nonviolent, non-serious offenders and that prison or jail are appropriate only if these alternatives fail. <ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref>

There are four major types of incarceration alternatives: <ref>https://www.nidirect.gov.uk/articles/non-custodial-sentences</ref>
*'''Monetary Fine.''' A fine is the most common form of punishment given by the courts. The offender must pay a fixed sum of money. If they don't pay, they could get a prison sentence.
*'''Probation.''' A probation order mandates supervision by a probation officer in the community for a certain time. Sometimes the court will apply additional requirements to the probation order, including Mandatory attendance at a alcohol or drug rehabilitation center, a day center, or any other medical treatment or counseling.
*'''Community Service Order.''' When an offender gets a community service order, they must do unpaid work in the community for a duration at the discretion of the judge. They must work the hours as instructed. If they don't do the work, they will be returned to court, where they could receive a fine or any other sentence. This can be utilized in combination with a probation order.
*'''Conditional or Absolute Discharge.''' An absolute discharge eliminates a criminal record. A conditional discharge eliminates a criminal record if conditions the judge sets are met.

=Relevant Research=

*'''Columbia University Study.''' The Mailman School of Public Health made an analysis of U.S. county-level data and found a strong association between jail incarceration and death rates from infectious diseases, chronic lower respiratory disease, drug use, and suicide. <ref>https://medicalxpress.com/news/2021-02-incarceration-strongly-linked-premature-death.html</ref> Sandhya Kajeepeta, who led the research at the Department of Epidemiology said that “Our findings underscore public health benefits of reducing jail incarceration and the importance of interventions to mitigate the harmful effects of mass imprisonment on community health including community-based treatment for substance use disorder and greater investment in social services." <ref>https://www.publichealth.columbia.edu/public-health-now/news/incarceration-strongly-linked-premature-death-us</ref>

*'''The Alliance for Safety and Justice''' performed a survey that counters conventional wisdom regarding the views of crime victims on incarceration. Despite popular assumptions that victims support long sentences and prison expansion, the survey found that victims, by a 2 to 1 margin, would prefer the criminal justice system focus more on rehabilitation than punishment. The vast majority of victims also prefer investments in education, mental health treatment, drug treatment, and job training to more spending on prisons and jails. <ref>https://allianceforsafetyandjustice.org/wp-content/uploads/documents/Crime%20Survivors%20Speak%20Press%20Release.pdf</ref>

=Impactful Federal, State, and Local Policies=

The First Step Act of 2018 is a criminal justice law designed to remedy some of the systemic issues in the American federal prison system. It prioritizes increasing and improving volunteer programs nationwide. This bipartisan bill was passed after nearly a decade without any criminal justice reform at the federal level. Although the law has had positive impact, there are many other issues legislators still need to address. <ref>https://www.firststepalliance.org/post/the-first-step-act-what-is-it-and-how-does-it-affect-the-justice-system?gclid=Cj0KCQiAosmPBhCPARIsAHOen-ODZbBDWza8P_n8eBENywrUaysRx8HVmd0U69yJP9IC4URArEyxAMUaAnQPEALw_wcB</ref>

=Available Tools & Resources =

'''SAFE Project:'''
*See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>

=Promising Practices=

'''Virginia.''' Clinch Valley Community Action runs a Community Corrections Program that provides probation supervision for non-violent offenders in both the General District Court and the Juvenile and Domestic Relations Court. The program performs drug screens on offenders. Referrals are made for counseling for substance use, mental health, drug education programs, anger management and batterer's intervention groups, sex offender treatment, and GED classes. In lieu of paying fines, the program provides an option for offenders to perform community service. Community service programs consist of a variety of services at over 100 work sites throughout the county including parks and recreation, libraries, town and road crews, and transfer stations. Restitution for victims and community service are monitored. The goal of the Community Corrections Program is to provide an alternative to incarceration by providing counseling to the offender and organizing integration back into the community through community service activities, including volunteer services. <ref>https://www.dchealthmatters.org/promisepractice/index/view?pid=3238</ref>

= Sources =

 
</div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand and Enhance Speciality Courts

2024-10-24T22:25:52Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Drug courts reduce time in the criminal just system and provide treatment to individuals instead of punishment. As of 2023, there were more than 3,800 drug courts across the United States. The innovation of drug courts emerged in the late 1980s, when professionals recognized the importance of treating substance use and mental health in prevention of relapse and recidivism. Drug courts aim to reduce drug use relapse and criminal recidivism through a variety of services. These services include risk and needs assessment, judicial interaction, monitoring and supervision, graduated sanctions and incentives, treatment, and various rehabilitation services. <ref>https://www.ojp.gov/pdffiles1/nij/238527.pdf</ref>

= Key Information =

Drug courts are specialized courts targeting those who are charged with or convicted of a crime. Although drug courts vary in resources, programs are generally managed by a multidisciplinary team including judges, prosecutors, defense attorneys, community corrections officers, social workers, and treatment service professionals. Support from those representing law enforcement, the family, and the community is encouraged through participation in hearings, programming, and events such as graduation. <ref> https://www.ojp.gov/pdffiles1/nij/238527.pdf</ref>

There are several types of specialty courts including:

'''DWI/DUI.''' Specialized and comprehensive court programs provide individual treatment, supervision, and accountability for repeat DWI offenders. These specialty courts follow the well-established drug court model and are based on the premise that impaired driving can be prevented if the underlying causes, such as substance use and mental health disorders, are identified and addressed. <ref name="National Center for DWI Courts">https://www.dwicourts.org/whatsatstake/</ref>

'''Mental Health Treatment Courts''' for adults and juveniles work with people with mental illnesses who are involved in the justice system. These courts connect people to effective treatment and support after they undergo screening and assessments. <ref>https://www.samhsa.gov/gains-center/treatment-court-locators</ref>

'''Juvenile''' drug treatment courts are designed for youth with substance use disorders who come into contact with the juvenile justice system. Juvenile mental health courts focus on treatment and rehabilitation, and help divert youth from detention facilities to common-based services. Juvenile mental health courts also engage families and schools in treatment. <ref>https://ojjdp.ojp.gov/programs/juvenile-drug-treatment-court-guidelines</ref>

'''Family Drug Treatment Courts''' also known as dependency drug courts or family drug courts, use a multidisciplinary, collaborative approach to serve families who require substance use disorder treatment and who are involved with the child welfare system. <ref>https://ncsacw.acf.hhs.gov/topics/family-treatment-courts/</ref>

'''Tribal Healing to Wellness Courts,''' like a state drug courts, integrate substance use treatment with the criminal justice system to provide offenders judicially supervised treatment and transitional services using sanctions and incentives, and drug testing in a non-punitive setting. <ref>https://nicic.gov/tribal-healing-wellness-courts-policies-and-procedures-guide</ref>

'''Opioid Intervention Courts''' are an in-depth intervention for people at risk of overdose. They are designed to address the treatment needs for people with an opiate abuse history and to prevent them from using while their case proceeds through the criminal courts. <ref>https://www.courtinnovation.org/sites/default/files/media/documents/2019-07/report_the10essentialelements_07092019.pdf</ref>

'''Re-entry''' drug courts begin when a person enters a jail-based treatment program. The program involves regular judicial monitoring and support through recovery. Ultimately, it prepares individuals for reentry into the community. <ref>http://www.reentrycourtsolutions.com/wp-content/uploads/2009/10/Reentrypdf1.pdf</ref>

Participants who successfully complete drug court programs can have their underlying criminal offenses dismissed or expunged. If a participant fails to complete the program, their case will be processed as it normally would in the traditional criminal justice system. <ref name="National Drug Court Resource Center- What Are Drug Courts?">https://ndcrc.org/what-are-drug-courts/</ref> Drug court programs often include:

*Participation over a series of months or years to establish and maintain long-term recovery strategies
*Frequent and random drug tests
*Clinical treatment for substance use disorders
*Individualized case management services, connecting participants to employment opportunities, community service, pro-social activities, and education
*Mandatory appearances in court
*Rewards for maintaining treatment plans and sanctions for failure to meet obligations
*Support and encouragement from the drug court team

Additional information can be found at the SAFE Project wiki titled "Improving Recovery Support for People in the Criminal Justice System." <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

= Relevant Research =

'''SAMHSA''' published a research brief titled "Adult Drug Courts and Medication-Assisted Treatment for Opioid Dependence." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4852.pdf</ref>

'''BJA''' published a research report titled "Tribal Healing to Wellness Courts - The Key Components." <ref>https://www.ojp.gov/pdffiles1/bja/188154.pdf</ref>

'''The National Institute of Justice (NIJ)''' in the US Department of Justice summarized early research on drug courts. In a 10-year longitudinal study on recidivism and cost analysis of drug court cohorts, NIJ researchers found that drug courts may lower recidivism rates and significantly lower costs. <ref>https://nij.ojp.gov/topics/articles/do-drug-courts-work-findings-drug-court-research</ref>

'''The Urban Institute Justice Policy Center''' conducted a five-year longitudinal study for NIJ. It examined twenty-three drug courts and six comparison groups in eight states: Florida, Georgia, Illinois, New York, Pennsylvania, North Carolina, South Carolina and Washington. The study titled, "Multisite Adult Drug Court Evaluation (MADCE)" went beyond simply measuring recidivism and examined multiple outcomes (crime, drug use, socioeconomic outcomes, family functioning, and mental health). It found that drug courts produce significant reductions in drug relapse and criminal behavior and that drug court participants experience select psychosocial benefits in other areas of their lives. <ref>https://www.ojp.gov/pdffiles1/nij/grants/237108.pdf</ref>

'''Re-Entry Drug Court Research.''' This was a collaborative study performed by NPC Research, The Center for Court Innovation, and RTI International. It was based upon an analysis of eight reentry courts. Results were mixed and primarily associated with level of supervision, the consistency and intensity of substance use treatment, the presence of wraparound services for multiple needs, and the degree of use of praise from the judge. It also suggested that eligibility factors associated with risk levels of substance use disorder (moderate versus high) may have also been a factor in the results. <ref>https://ndcrc.org/wp-content/uploads/2020/06/Reentry_Court_Multisite_Evaluation_2017.pdf</ref>

'''Minnesota''' conducted detailed process and outcome evaluations in all nine of its DWI court programs. It also performed a cost-benefit evaluation in seven of these programs. The results for Beltrami County are detailed in this report. <ref>https://npcresearch.com/wp-content/uploads/Beltrami-Co-DWI-Court-Process-Outcome-and-Cost-Evaluation-FINAL-FOR-OTS.pdf</ref>

'''Impact of Mature Drug Court over 10 Years of Operation: Recidivism and Costs.''' This study examined the impact and costs of a primarily pre-plea drug court on the total population of drug court-eligible offenders over a 10-year period in Portland, Oregon. Results included reduced recidivism for drug court participants up to 14 years after drug court entry compared to eligible offenders that did not participate. Drug court judges that worked longer with the drug court had better participant outcomes. Judges that rotated through the drug court twice had better participant outcomes the second time than the first. Compared to traditional criminal justice system costs, there was an average of $1,392 lower cost per drug court participant. Reduced recidivism and other long-term program outcomes resulted in public savings of $79 million over 10 years. <ref>https://nij.ojp.gov/library/publications/impact-mature-drug-court-over-10-years-operation-recidivism-and-costs</ref>

'''Evaluating Treatment Drug Courts in Kansas City, Missouri and Pensacola, Florida: Final Reports for Phase I and Phase II.''' Using retrospective data, researchers found that drug courts reduced recidivism among program participants in contrast to comparable probationers. This study found that within a two-year follow-up period, the felony re-arrest rate decreased from 40 percent before the drug court to 12 percent after the drug court started in one county, and the felony re-arrest rate decreased from 50 percent to 35 percent in another county. <ref>https://nij.ojp.gov/library/publications/evaluating-treatment-drug-courts-kansas-city-missouri-and-pensacola-florida</ref>

= Impactful Federal, State, and Local Policies =

*'''Adult Drug Treatment Court Grants.''' The Violent Crime Control and Law Enforcement Act of 1994 authorized the US Department of Justice to make grants to establish treatment courts. These courts integrate evidence-based substance use disorder treatment, random drug testing, equitable sanctions and incentives, and recovery support services in judicially supervised court settings. They are designed to prevent overdoses, reduce recidivism, and incorporate cultural elements and approaches. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/overview</ref>

*'''The Veterans Treatment Court Coordination Act of 2019''' mandated continued funding for the types of projects that had been implemented by the Bureau of Justice Assistance in the preceding seven years. It directed the Attorney General to establish and carry out the Veterans Treatment Court Grant Program, which supports efforts to plan, implement, and enhance the operations of veterans treatment courts (VTCs). These courts operate in judicially supervised court settings that have jurisdiction over veterans involved in the justice system who have substance use disorders, including a history of violence and post-traumatic stress disorder as a result of their military service. Funding can also support efforts at the state level to assess, collect data, evaluate, training and build or enhance local or tribal VTCs, or to increase the identification and access to services for those underserved. <ref>https://bja.ojp.gov/program/veterans-treatment-court-grant-program/overview</ref>

= Available Tools and Resources =

'''SAMHSA''' maintains a locator for Mental Health Treatment Courts. <ref>https://www.samhsa.gov/gains-center/treatment-court-locators</ref> It also published a YouTube titled, "Drug Treatment Court - Opioid Overdose Prevention Framework." <ref>https://www.youtube.com/watch?v=__zaI4LULJU</ref>

'''SAFE Project:'''
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled “Improve Recovery Support for People in the Criminal Justice System" for more detailed information on supportive treatment for those in the Criminal Justice System with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>
*See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>

'''The National Treatment Court Resources Center''' provides a wealth of useful information including:
*A set of webpages with extensive information on each of nine specific court types. <ref>https://ndcrc.org/resources-by-court-type/</ref>
*A set of webpages on best and evidence-based practice standards for all treatment court types, as set forth by subject matter experts, researchers, and policy makers. <ref>https://ndcrc.org/best-practice-resources/</ref>
*A peer-reviewed journal titled "Drug Court Review" <ref>https://ndcrc.org/drug-court-review/</ref>
*A website on current grants that are available through federal agencies such as BJA and SAMHSA. <ref>https://ndcrc.org/solicitations/</ref>
*A map of all operational treatment court programs by state and county

'''AllRise''' formerly known as National Association of Drug Court Professionals hosts the Treatment Court Institute which leads training, technical assistance, and research dissemination for more than 4,000 treatment court programs in the United States. <ref>https://www.ndci.org/resource/training/ta/</ref> It also hosts Justice for Vets <ref>https://justiceforvets.org/wp-content/uploads/2017/02/The-Ten-Key-Components-of-Veterans-Treatment-Courts.pdf</ref> AllRise has published "Family Treatment Court Best Practices" which provides shared elements required in quality practice. <ref>https://www.nadcp.org/standards/family-treatment-court-best-practice-standards/</ref>

'''Office of Juvenile Justice and Delinquency Prevention''' published "Juvenile Drug Treatment Court Guidelines." <ref>https://ojjdp.ojp.gov/programs/juvenile-drug-treatment-court-guidelines</ref>

'''The Center for Court Innovation''' has published two documents of particular interest: "Ten Essential Elements of Opioid Intervention Courts" <ref>https://www.courtinnovation.org/sites/default/files/media/documents/2019-07/report_the10essentialelements_07092019.pdf</ref> and "Re-entry Courts Looking Ahead: A Conversation about Strategies for Offender Reintegration." <ref>https://www.courtinnovation.org/sites/default/files/documents/Reentry_Courts.pdf</ref>

'''The National Institute of Justice''' published "Seven Program Design Features: Adult Drug Court Principles, Research, and Practice." <ref>https://www.ojp.gov/pdffiles1/nij/248701.pdf</ref> It also provides a website titled "Adult Drug Court Research to Practice Initiative" which indexes a variety of links to webinars and other materials produced by drug court experts at the National Center for State Courts and American University. These resources were designed to promote timely dissemination of research on addiction, substance use treatment, and drug court programming. <ref>https://nij.ojp.gov/topics/articles/adult-drug-court-research-practice-r2p-initiative</ref>

'''The National Institute of Corrections''' has a report titled "Tribal Healing to Wellness Court - Policies & Procedures." <ref>https://nicic.gov/tribal-healing-wellness-courts-policies-and-procedures-guide</ref>

= Promising Practices =

'''Nebraska''' The Nebraska Supreme Court, in response to legislation broadening the definitions of problem-solving courts, established the ''Nebraska Reentry Courts Best Practice Standards.'' <ref>https://ndcrc.org/wp-content/uploads/2020/06/Nebraska_Re-Entry_Court_Best_Practice_Standards.pdf</ref>

'''New York.''' In 2016, the Unified Court System launched an opioid intervention court in Buffalo, the first of its kind in the country. The opioid court provides immediate intervention, treatment, and supervision for defendants who are at risk of an opioid overdose. <ref>https://www.nycourts.gov/LegacyPDFS/courts/problem_solving/oc-OpioidReport-CCI.pdf</ref>

'''Pennsylvania.''' Cumberland County's Opioid Intervention Court was the second opioid court in the US. It is a voluntary program that consists of 30 court appearances as well as daily attendance at either drug counseling or NA/AA type meetings. Unlike other specialty courts, this program is a pre-trial program and not tied to a particular plea. The program is intended to engage participants with treatment resources and provide accountability for persons in the early stages of recovery. <ref>https://www.ccpa.net/4698/Opioid-Intervention-Court</ref>

= Sources =

Expand First Response and Crisis Intervention Teams

2024-10-24T22:23:29Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

In addition to law enforcement officers, other first responders, such as emergency medical technicians, firefighters, and paramedics, are on the front lines of the illicit substance use epidemic. They frequently respond to drug overdoses and calls for services involving individuals with substance use and co-occurring disorders. As a result, a variety of law enforcement-led diversion and fire/emergency medical services (EMS)-led responses have emerged across the country. In partnership with substance use disorder treatment providers, peers, and recovery personnel, these multidisciplinary programs are helping to reduce overdoses by connecting individuals to community-based treatment. First-responder diversion programs represent a pivotal opportunity to redirect individuals with SUDs, mental health disorders, and co-occurring disorders away from jails or emergency departments and toward community-based treatment for substance use, mental health services, recovery support, housing, and social services.<ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>

= Key Information =

There are two approaches used by first responders -- “deflection” and “pre-arrest diversion.” These are detailed in the SAFE article titled, "Expand Law Enforcement Assisted Diversion and Deflection Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs</ref> It is important to note, as two sides of the same coin, deflection and pre-arrest diversion are complementary practices of a systems approach at the intersection of first responders, behavioral health service providers, recovery support, and community. These collaborative interventions connect public safety with public health systems to create community-based pathways to treatment and services for people who have SUD, mental health disorders, or co-occurring disorders. In partnership with SUD treatment providers, other service providers, peers, deflection specialists, and recovery personnel, these multidisciplinary programs help reduce overdoses.

= Relevant Research =

'''PTACC''' published a research report on the benefits of diversion programs. Key findings indicate that despite the lack of large-scale and multi-site evaluation efforts, there are important trends emerging from early research on pre-arrest diversion initiatives across the US. Here are some key results drawn from empirical research on a variety of programs. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2020/06/PTACC_Key_Research_FINAL.pdf</ref>

*Pre-Arrest Diversion represents the first intercept with the criminal justice system, making it a prime opportunity to redirect adults with mental health conditions and substance use disorders from jails and to connect them with community-based service providers.
*The majority of adults booked into local jails require mental health services and treatment for SUDs, which are typically not provided in local facilities.
*Behavioral health conditions are associated with repeat criminal justice contact, and SUDs are the strongest predictor of jail readmission.
*Pre-arrest diversion programs assess and address behavioral health needs associated with continual involvement in the criminal justice system.
*Preliminary results indicate participants who fully engage in pre-arrest diversion programs tend to have low rates of recidivism for extended periods of time.

= Impactful Federal, State, and Local Policies =

Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies. Often, strategies are locally designed and implemented and do not operate in a legal or political vacuum. Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses. Laws that require criminal responses or otherwise circumscribe when and how non-law enforcement responders are able to intervene can impede them. Current statewide barriers exist in pre-arrest diversion and crisis response strategies.

'''R Street''' has a Statewide Policies report which reviews legal status and legislative actions in all fifty states relating to pre-arrest diversion and crisis response. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/12/R_Street_Statewide_Policies_Relating_to_PAD_Crisis_Repsonse.pdf</ref> Policies relating to pre-arrest diversion and crisis response include:
*Emergency Mental Health Hold laws authorize certain first responders to take an individual experiencing a mental health crisis into a form of civil custody in order for them to be evaluated by appropriate mental health or medical personnel.
*Protective Custody. These procedures operate as the substance use analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance use episode in temporary civil custody.
*Citation Authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of detaining them or placing them under arrest.
*Good Samaritan laws offer immunity from arrest, criminal charges, prosecution or conviction for limited, drug-related offenses as an incentive for individuals to call for assistance for someone experiencing a suspected overdose.
*Ambulance Transport laws and regulations can influence where emergency medical services may take an individual experiencing a crisis, potentially by requiring transport to a hospital emergency department or otherwise discouraging the use of alternative destinations.

'''Illinois Senate Bill 3023''' is one example of legislation on deflection. The 2018 Community-Law Enforcement Partnership for Deflection and Substance Use Disorder Treatment Act authorizes and encourages local law enforcement leaders to partner with treatment and community members on programs that deflect individuals who have overdosed or who have substance use problems away from the justice system and into addiction treatment services. <ref>https://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=84&title=SB-3023-Community-Law-Enforcement-Partnership-for-Deflection-and-Treatment#:~:text=Illinois%20Senate%20Bill%203023%2C%20signed,that%20%E2%80%9Cdeflect%E2%80%9D%20individuals%20who%20have</ref>

= Available Tools and Resources =

'''SAMHSA''' provides a guidebook titled, "Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide. <ref>https://www.opioidlibrary.org/document/crisis-intervention-team-cit-methods-for-using-data-to-inform-practice-a-step-by-step-guide/</ref>

'''SAFE Project:'''
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
*See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>

'''Crisis Intervention Team International''' published "A Best Practice Guide for Transforming Community Responses to Mental Health Crises." <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/10/CIT-guide-desktop-printing-2019_08_16-1.pdf</ref>

'''The National League of Cities''' offers "Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization" highlighting case studies in cities in Kansas, Texas, and West Virginia. <ref>https://www.opioidlibrary.org/wp-content/uploads/2020/01/YEF_MentalHealth_IssueBrief2_Final.pdf</ref>

'''Advanced Recovery Systems University''' provides an online library of webinars specific to mental health and substance use within the first responder community. <ref>https://arsuniversity.thinkific.com/collections?category=ba5e2b</ref>

= Promising Practices =

*'''Maryland.''' Safe Stations is an innovative new program in Anne Arundel County. It shifts barriers to treatment for those community members who are ready to recover from drug addiction. Persons seeking treatment for addiction can visit any police or fire station across the county, day or night, to dispose of any paraphernalia and find assistance gaining access to care. <ref>https://www.annapolis.gov/1325/Safe-Stations</ref>

*'''New Hampshire.''' The Safe Station Program offers help to anyone with substance use disorder at any Manchester Fire Department. The firefighters will arrange for or provide a medical assessment within their scope of training. If there is cause for concern that there is something else medically wrong with the patient, transportation to an appropriate level medical facility will be provided. Each individual seeking assistance will be required to drop any needles and/or paraphernalia into a collection bin located at each fire station prior to speaking with coaches or seeking treatment. <ref>https://manchesterinklink.com/as-safe-station-ends-those-in-need-of-addiction-treatment-and-recovery-services-directed-to-call-2-1-1/</ref>

'''Ohio.''' The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create the Quick Response Team. It follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model. <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/HCTF_Hamilton_County_OH_Program_Policy_508.pdf</ref>

''' Tennessee.''' The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage. <ref>https://www.memphistn.gov/government/police-department/crisis-intervention-team/</ref>

= Sources =

Expand Law Enforcement and First Responder Assisted Diversion

2024-10-24T22:21:57Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Diversion and deflection programs seek to re-direct, or channel people away from the justice system. This practice is based on the theory that processing individuals through the justice system may do more harm than good or may not be an appropriate response for someone with behavioral health needs. While the exact number of diversion and deflection programs in the United States is currently unknown, their growth In communities has become accelerated by research showing that they can impact recidivism and help individuals avoid the consequences of having a criminal record. Over the past few decades, much of the innovation in deflection and diversion has focused on individuals whose interactions with the justice system are driven by behavioral health needs. The outcomes sought by diverting or deflecting individuals are generally three-fold:
*Reduce crime by connecting individuals with resources and services that decrease the likelihood of future offenses.
*Assist individuals according to their self-identified needs and provide support and opportunities to change the behaviors that brought them to the attention of the justice system.
*Reduce utilization of limited justice system resources by reducing re-arrest, recidivism, and future justice system expenditures.

= Key Information =

'''Pre-Arrest Diversion & Deflection Programs'''

These two types of program are related, but distinct. Deflection is the practice by which law enforcement ''or other first responders,'' such as fire and EMS, connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted. This is done in lieu of inaction when issues of addiction, mental health, and/or other needs are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested. Pre-arrest diversion is the practice by which ''law enforcement officers'' connect individuals who otherwise would have been eligible for criminal charges to community-based treatment and/or services, ''in lieu of arrest.'' This diverts them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs), clients are diverted to community-based services. Pre-arrest diversion programs should not be confused with ''prosecutorial diversion'', which occurs after individuals have already been arrested and become involved in the justice system. In contrast, pre-arrest diversion occurs before the filing of charges.

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.<ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders. They allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. The movement for early diversion is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder and/or mental illness. Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line. It provides appropriate treatment for eligible individuals. It opens up community opportunities for systemic change by leadership looking for creative solutions to complicated problems. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> Thus, these programs serve the best interest of the individuals involved, the community, and taxpayers. A variety of case studies provide documentation of the following beneficial outcomes of pre-arrest diversion and deflection programs: <ref name="SAFE Pre-Arrest Diversion Guide">https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*Break the costly cycle of justice system involvement for eligible individuals.
*Increase cross-sector collaboration to create new pathways to community-based behavioral health services.
*Enhance relations between community members and law enforcement.
*Decrease crime, incarceration, and recidivism rates.
*Lessen the burden on justice systems.
*Improve public health and safety.
*Reduce the burden on individuals who commit non-violent, low-level offenses.
*Ensure equal access to pre-arrest diversion regardless of race, income, or geography; and
*Save taxpayer dollars

'''The Five Pathways to Treatment Model.'''

In 2014, Treatment Alternatives for Safe Communities (TASC) and Center for Health and Justice (CHJ) developed the first iteration of the Five Pathways to Treatment. This offered different methods for deflection that first responders could use, at the point of contact, to move someone from the justice system to community-based treatment. Each pathway has unique characteristics that make it appropriate to address particular problems such as SUD, mental health disorder, homelessness, and other issues. Identifying and naming these pathways created a common language for practitioners to use in the new, emerging field of deflection. For each pathway listed below, the targeted population or circumstance appropriate for the pathway is elaborated. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref> <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>

*''Self-Referral:'' Drug–involved individuals are encouraged to initiate the engagement with law enforcement without fear of arrest, and an immediate treatment referral is made.
*''Active Outreach:'' Participants are identified by law enforcement, but are engaged primarily by an outreach team, often with a clinician and/or a peer with lived experience, who actively contacts them and motivates them to engage in treatment. Individuals with SUDs are the targeted population.
*''Naloxone Plus:'' A first responder and program partner (often a clinician or peer with lived experience) conducts outreach specifically to individuals who have experienced an overdose recently to engage them in and provide linkages to treatment. Individuals with opioid use disorder are the targeted population.
*''First-Responder/Officer Prevention:'' During routine activities such as patrol or response to a service call, a first responder conducts engagement and provides treatment referrals. If a law enforcement officer is the first responder, no charges are filed or arrests made. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.
*''Officer Intervention:'' (applicable only for law enforcement) During routine activities such as patrol or response to a service call, a law enforcement officer engages an individual and provides treatment referrals or issues noncriminal citations for that individual to report to a program. Charges are held until treatment and/or a social service plan is successfully completed. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.

'''The Sequential Intercept Model (SIM) <ref>https://www.samhsa.gov/criminal-juvenile-justice/sim-overview</ref>'''

SIM helps communities identify resources and gaps in services at each of six "interception points." The SIM mapping process brings together leaders and different agencies and systems to work together to identify local strategies and action plans to divert people with mental and substance use disorders away from the justice system into treatment. The six SIM intercepts are described below:

*'''Community Services.''' This involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. The emphasis is on connecting people with treatment or services instead of arresting or charging them with a crime.
*'''Law Enforcement.''' At this point, diversion is performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. It allows people to be diverted to treatment instead of being arrested or booked into jail.
*'''Initial Court Hearings/Initial Detention.''' This involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or an initial hearing.
*'''Jails/Courts.''' This interception involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. It includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
*'''Reentry''' supports reentry back into the community after jail or prison to reduce further justice involvement. It includes reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
*'''Community Corrections.''' This involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.

= Relevant Research =

'''Collaborative Research Report.''' This survey was performed by the Treatment Alternatives for Safe Communities, The University of Chicago, and the US Justice Department. It is titled "Report of the National Survey to Assess Law Enforcement-Led Diversion and First Responder Deflection Programs in Response to the Opioid Crisis. It provides a comprehensive overview of the field and its role in responding to the opioid crisis, as well as how deflection/first responder deflection offers alternatives to law enforcement and first responders in their work. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref>

= Impactful Federal, State, and Local Policies =

*'''The Office of National Drug Control Policy''' funded a study that provides a model for states to use to generate legislation authorizing diversion. When the template is followed and enacted by a state, it allows law enforcement officers to divert some individuals with substance use disorders or mental health conditions away from arrest and prosecution to treatment and other supportive services. This helps states legislate collaborative programs between law enforcement, treatment providers, and community organizations to support individuals to access treatment and services and avoid justice involvement. <ref> https://www.opioidlibrary.org/wp-content/uploads/2019/08/Model-Deflection-Act-FINAL-7.1.2019.pdf</ref>

*'''The R Street Report''' This policies report reviews all fifty states relating to pre-arrest diversion and crisis response including legal status and legislative actions. <ref>https://www.rstreet.org/wp-content/uploads/2019/10/Final-187.pdf</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''"Law Enforcement Pre-Arrest Diversion Resource Guide"''' in collaboration with PTACC. It is designed to help law enforcement agencies create pre-arrest diversion programs for individuals with substance use disorder. The guide describes pre-arrest diversion, defines two types of pre-arrest diversion programs, and provides case studies of PTACC's five pathways. <ref>https://www.safeproject.us/law-enforcement-pre-arrest-diversion/</ref> The guide can be downloaded. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf </ref>
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>
*See the wiki titled “Improve Recovery Support for People in the Criminal Justice System" for more detailed information on supportative treatment for those in the Criminal Justice System with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

'''The U.S. Department of Justice''' Bureau of Justice Assistance (BJA) manages the Comprehensive Opioid, Stimulant & Substance Abuse Program (COSSAP). Its Law Enforcement/First Responder Diversion and Referral Mentoring Initiative provides communities interested in starting diversion and/or referral programs with the opportunity to learn from established or innovative programs that have shown success in meeting the treatment needs of individuals with a substance use disorder, and in some cases may have experienced an overdose. <ref>https://www.cossapresources.org/Learning/PeerToPeer/Diversion</ref>

'''The Police Assisted Addiction and Recovery Initiative (PAARI)''' helps police departments create non-arrest pathways to substance use disorder treatment and recovery like the ANGEL program in Gloucester, Massachusetts. PAARI works with over 400 police departments in 32 states and helps communities customize their programs to their circumstances. Offered services include technical assistance, policy templates and tools, seed grants, and connections to experts with established programs. <ref>https://paariusa.org/</ref>

'''Law Enforcement Assisted Diversion (LEAD)''' is a community-based diversion approach with the goals of improving public safety and reducing unnecessary justice system involvement of people who participate in the program. The site includes a video, tools and resources. <ref>https://www.leadbureau.org/</ref>

'''The Police Treatment And Community Collaborative (PTACC)''' is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref> It provides a webinar titled "Starting Your Pre-Arrest Diversion (PAD) Effort: Law Enforcement, Behavioral Health, and Community Together" which gives information on pre-arrest diversion models. <ref>https://ptaccollaborative.org/webinars/</ref> The PTACC mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. The purpose of the Collaborative is to provide vision, leadership, advocacy, and education to facilitate the practice of pre-arrest diversion across the United States. Their focus is to educate law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services which can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. "PTACC is the national voice of the deflection and pre-arrest diversion field." <ref>https://ptaccollaborative.org/about/</ref> PTACC recognizes that there are multiple models of pre-arrest diversion. It has adopted the TASC model, described above, as its "Pathways to Community" because using one or more of them creates pathways to treatment or social services. <ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> PTACC endorses each of the five pathways and encourages communities to explore the approaches which best meet their needs. PTACC encourages availability of as many pathways as possible to maximize diversion opportunities and connection to treatment, recovery support, and community services.
<ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> PTACC is organized into eight strategic areas, each having their own working groups and associated websites: <ref>https://ptaccollaborative.org/strategy-areas/</ref>
*Children and Families
*Community, Diversity, and Equity
*International Deflection and Diversion
*Policy and Legislation
*Public Safety
*Research
*Stigma Reduction
*Treatment, Housing, and Recovery

'''The Center for Prison Reform''' published "Jail Diversion Programs in America." <ref>https://centerforprisonreform.org/wp-content/uploads/2015/09/Jail-Diversion-Programs-in-America.pdf</ref>

= Promising Practices =

'''Alabama -- The Mercy Project.''' Walker County had the fifth-highest per capita rate of overdoses in the United States and the highest overdose rate of any county in the state. As a result, Sheriff Nick Smith wanted to create a program to help people struggling with SUD and to reduce the recidivism rate resulting from substance misuse. Interested participants fill out an application and then receive consultation. People are ineligible for program entry if they are facing drug charges or have outstanding warrants. However, the consultation allows a potential participant to turn in any drugs or drug paraphernalia without the threat of arrest. Although the individual must still enter the justice system, drug court is an option. If the person is accepted into the program, consultation determines individual treatment needs. <ref>https://walkercountysheriff.com/mercy-project.html</ref>

'''Arizona.''' The Arizona Angel Initiative is a community-based, police-assisted program. Police departments work in partnership with community-based treatment providers and the Governor's Office of Youth, Faith and Family. This program is modeled after a similar program in Gloucester, Massachusetts. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/AZ_AngelInitiativeReport_2018.pdf</ref>

'''Florida.''' The Pre-Arrest Diversion/Adult Civil Citation (PAD/ACC) is a model pre-arrest diversion program. The Leon County/Tallahassee program holds offenders accountable for their crime, but instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, such as community service. Following referral by law enforcement, one essential element of the program is the use of evidence-based behavioral health intervention services to reduce the likelihood of future criminal activity. PAD/ACC also works to avoid an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since its inception, the program has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation of the model. <ref>https://university.pretrial.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=514d95d4-413d-7a4f-f2e2-7fa588a297c2&forceDialog=0</ref>

'''Illinois -- A Way Out.''' In Lake County, an Illinois Law Enforcement Assisted Diversion (LEAD) pilot program was designed to fast-track users to substance use programs and services. This program is available 24 hours a day, 7 days a week, at participating police departments across Lake County. It ensures that no criminal charges will be sought for those who may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change regarding substance use and mental health. <ref>https://awayoutlc.org/</ref>

'''Illinois -- Safe Passage.''' People who realize they need help can go to one of the participating law enforcement agencies in Lee and Whiteside Counties without fear of being arrested. If they ask for help with their drug addiction and turn in their drugs, they will be placed in a treatment facility, usually within 24 hours. Once initial paperwork is completed, persons will be paired with a volunteer who will guide them through the process. Safe Passage partners with treatment centers throughout Illinois and the Midwest. <ref>https://www.dixongov.com/departments/police-department/inside-the-dixon-police-dept/safe-passage.html</ref>

'''Maryland.'''' Stop, Triage, Engage, Educate and Rehabilitate (STEER) in Montgomery County is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a police officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it. As a result of moving people towards the human services system, STEER exemplifies the following outcomes: <ref>https://opioid-resource-connector.org/index.php/program-model/stop-triage-engage-educate-and-rehabilitate-steer</ref>
* reducing crime
* rebuilding community relations
* reducing drug use
* restoring the lives of citizens

'''Minnesota.''' The Yellow Line Project in Blue Earth County provides a collaboration between law enforcement, human services, and care providers to improve coordination and access to treatment for individuals with substance use or mental health conditions, instead of in incarceration. <ref>https://www.yellowlineproject.com/operational-toolkit</ref>

'''New Jersey.''' In Ocean County, the Blue Heroin Addiction Recovery and Treatment (HART) is New Jersey's first program allowing substance users to seek help from authorities without risk of prosecution. <ref>https://www.staffordnj.gov/DocumentCenter/View/943/BLUE-HART-program-brochure?bidId=</ref>

'''New York.''' Hope Not Handcuffs is an initiative started by Families Against Narcotics (FAN). It aims to bring law enforcement and community organizations together in an effort to find viable treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs, and alcohol. A person struggling with any drug addiction can come to a participating police agency and ask for help. They will be greeted with support, compassion, and respect. If accepted into the program, the individual will be guided through a brief intake process to ensure proper treatment placement. <ref>https://www.familiesagainstnarcotics.org/hopenothandcuffs-ny</ref>

'''Ohio.''' In Toledo, the Lucas County Sheriff’s Office developed the Drug Abuse Response Team (DART) model. Lucas County credits it with diverting more than a thousand people from the criminal-justice system and into treatment during its first 4 years. 70% of participants successfully entered detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing the DART program. 39 programs received grant funding for 21-month-long pilots. The Lucas County DART program has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. Each officer works with parents with substance use disorder whose children have been put in foster care, in order for parents to get access to treatment, so that the family can be reunited.

'''Washington.''' Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and to reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs. <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx</ref>

= Sources =

Expand Law Enforcement and First Responder Assisted Diversion

2024-10-24T22:21:23Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Diversion and deflection programs seek to re-direct, or channel people away from the justice system. This practice is based on the theory that processing individuals through the justice system may do more harm than good or may not be an appropriate response for someone with behavioral health needs. While the exact number of diversion and deflection programs in the United States is currently unknown, their growth In communities has become accelerated by research showing that they can impact recidivism and help individuals avoid the consequences of having a criminal record. Over the past few decades, much of the innovation in deflection and diversion has focused on individuals whose interactions with the justice system are driven by behavioral health needs. The outcomes sought by diverting or deflecting individuals are generally three-fold:
*Reduce crime by connecting individuals with resources and services that decrease the likelihood of future offenses.
*Assist individuals according to their self-identified needs and provide support and opportunities to change the behaviors that brought them to the attention of the justice system.
*Reduce utilization of limited justice system resources by reducing re-arrest, recidivism, and future justice system expenditures.

= Key Information =

'''Pre-Arrest Diversion & Deflection Programs'''

These two types of program are related, but distinct. Deflection is the practice by which law enforcement ''or other first responders,'' such as fire and EMS, connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted. This is done in lieu of inaction when issues of addiction, mental health, and/or other needs are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested. Pre-arrest diversion is the practice by which ''law enforcement officers'' connect individuals who otherwise would have been eligible for criminal charges to community-based treatment and/or services, ''in lieu of arrest.'' This diverts them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs), clients are diverted to community-based services. Pre-arrest diversion programs should not be confused with ''prosecutorial diversion'', which occurs after individuals have already been arrested and become involved in the justice system. In contrast, pre-arrest diversion occurs before the filing of charges.

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.<ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders. They allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. The movement for early diversion is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder and/or mental illness. Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line. It provides appropriate treatment for eligible individuals. It opens up community opportunities for systemic change by leadership looking for creative solutions to complicated problems. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> Thus, these programs serve the best interest of the individuals involved, the community, and taxpayers. A variety of case studies provide documentation of the following beneficial outcomes of pre-arrest diversion and deflection programs: <ref name="SAFE Pre-Arrest Diversion Guide">https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*Break the costly cycle of justice system involvement for eligible individuals.
*Increase cross-sector collaboration to create new pathways to community-based behavioral health services.
*Enhance relations between community members and law enforcement.
*Decrease crime, incarceration, and recidivism rates.
*Lessen the burden on justice systems.
*Improve public health and safety.
*Reduce the burden on individuals who commit non-violent, low-level offenses.
*Ensure equal access to pre-arrest diversion regardless of race, income, or geography; and
*Save taxpayer dollars

'''The Five Pathways to Treatment Model.'''

In 2014, Treatment Alternatives for Safe Communities (TASC) and Center for Health and Justice (CHJ) developed the first iteration of the Five Pathways to Treatment. This offered different methods for deflection that first responders could use, at the point of contact, to move someone from the justice system to community-based treatment. Each pathway has unique characteristics that make it appropriate to address particular problems such as SUD, mental health disorder, homelessness, and other issues. Identifying and naming these pathways created a common language for practitioners to use in the new, emerging field of deflection. For each pathway listed below, the targeted population or circumstance appropriate for the pathway is elaborated. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref> <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>

*''Self-Referral:'' Drug–involved individuals are encouraged to initiate the engagement with law enforcement without fear of arrest, and an immediate treatment referral is made.
*''Active Outreach:'' Participants are identified by law enforcement, but are engaged primarily by an outreach team, often with a clinician and/or a peer with lived experience, who actively contacts them and motivates them to engage in treatment. Individuals with SUDs are the targeted population.
*''Naloxone Plus:'' A first responder and program partner (often a clinician or peer with lived experience) conducts outreach specifically to individuals who have experienced an overdose recently to engage them in and provide linkages to treatment. Individuals with opioid use disorder are the targeted population.
*''First-Responder/Officer Prevention:'' During routine activities such as patrol or response to a service call, a first responder conducts engagement and provides treatment referrals. If a law enforcement officer is the first responder, no charges are filed or arrests made. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.
*''Officer Intervention:'' (applicable only for law enforcement) During routine activities such as patrol or response to a service call, a law enforcement officer engages an individual and provides treatment referrals or issues noncriminal citations for that individual to report to a program. Charges are held until treatment and/or a social service plan is successfully completed. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.

'''The Sequential Intercept Model (SIM) <ref>https://www.samhsa.gov/criminal-juvenile-justice/sim-overview</ref>'''

SIM helps communities identify resources and gaps in services at each of six "interception points." The SIM mapping process brings together leaders and different agencies and systems to work together to identify local strategies and action plans to divert people with mental and substance use disorders away from the justice system into treatment. The six SIM intercepts are described below:

*'''Community Services.''' This involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. The emphasis is on connecting people with treatment or services instead of arresting or charging them with a crime.
*'''Law Enforcement.''' At this point, diversion is performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. It allows people to be diverted to treatment instead of being arrested or booked into jail.
*'''Initial Court Hearings/Initial Detention.''' This involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or an initial hearing.
*'''Jails/Courts.''' This interception involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. It includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
*'''Reentry''' supports reentry back into the community after jail or prison to reduce further justice involvement. It includes reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
*'''Community Corrections.''' This involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.

= Relevant Research =

'''Collaborative Research Report.''' This survey was performed by the Treatment Alternatives for Safe Communities, The University of Chicago, and the US Justice Department. It is titled "Report of the National Survey to Assess Law Enforcement-Led Diversion and First Responder Deflection Programs in Response to the Opioid Crisis. It provides a comprehensive overview of the field and its role in responding to the opioid crisis, as well as how deflection/first responder deflection offers alternatives to law enforcement and first responders in their work. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref>

= Impactful Federal, State, and Local Policies =

*'''The Office of National Drug Control Policy''' funded a study that provides a model for states to use to generate legislation authorizing diversion. When the template is followed and enacted by a state, it allows law enforcement officers to divert some individuals with substance use disorders or mental health conditions away from arrest and prosecution to treatment and other supportive services. This helps states legislate collaborative programs between law enforcement, treatment providers, and community organizations to support individuals to access treatment and services and avoid justice involvement. <ref> https://www.opioidlibrary.org/wp-content/uploads/2019/08/Model-Deflection-Act-FINAL-7.1.2019.pdf</ref>

*'''The R Street Report''' This policies report reviews all fifty states relating to pre-arrest diversion and crisis response including legal status and legislative actions. <ref>https://www.rstreet.org/wp-content/uploads/2019/10/Final-187.pdf</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''"Law Enforcement Pre-Arrest Diversion Resource Guide"''' in collaboration with PTACC. It is designed to help law enforcement agencies create pre-arrest diversion programs for individuals with substance use disorder. The guide describes pre-arrest diversion, defines two types of pre-arrest diversion programs, and provides case studies of PTACC's five pathways. <ref>https://www.safeproject.us/law-enforcement-pre-arrest-diversion/</ref> The guide can be downloaded. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf </ref>
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>
*See the wiki titled “Improve Recovery Support for People in the Criminal Justice System" for more detailed information on supportative treatment for those in the Criminal Justice System with substance use issues.
<ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

'''The U.S. Department of Justice''' Bureau of Justice Assistance (BJA) manages the Comprehensive Opioid, Stimulant & Substance Abuse Program (COSSAP). Its Law Enforcement/First Responder Diversion and Referral Mentoring Initiative provides communities interested in starting diversion and/or referral programs with the opportunity to learn from established or innovative programs that have shown success in meeting the treatment needs of individuals with a substance use disorder, and in some cases may have experienced an overdose. <ref>https://www.cossapresources.org/Learning/PeerToPeer/Diversion</ref>

'''The Police Assisted Addiction and Recovery Initiative (PAARI)''' helps police departments create non-arrest pathways to substance use disorder treatment and recovery like the ANGEL program in Gloucester, Massachusetts. PAARI works with over 400 police departments in 32 states and helps communities customize their programs to their circumstances. Offered services include technical assistance, policy templates and tools, seed grants, and connections to experts with established programs. <ref>https://paariusa.org/</ref>

'''Law Enforcement Assisted Diversion (LEAD)''' is a community-based diversion approach with the goals of improving public safety and reducing unnecessary justice system involvement of people who participate in the program. The site includes a video, tools and resources. <ref>https://www.leadbureau.org/</ref>

'''The Police Treatment And Community Collaborative (PTACC)''' is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref> It provides a webinar titled "Starting Your Pre-Arrest Diversion (PAD) Effort: Law Enforcement, Behavioral Health, and Community Together" which gives information on pre-arrest diversion models. <ref>https://ptaccollaborative.org/webinars/</ref> The PTACC mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. The purpose of the Collaborative is to provide vision, leadership, advocacy, and education to facilitate the practice of pre-arrest diversion across the United States. Their focus is to educate law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services which can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. "PTACC is the national voice of the deflection and pre-arrest diversion field." <ref>https://ptaccollaborative.org/about/</ref> PTACC recognizes that there are multiple models of pre-arrest diversion. It has adopted the TASC model, described above, as its "Pathways to Community" because using one or more of them creates pathways to treatment or social services. <ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> PTACC endorses each of the five pathways and encourages communities to explore the approaches which best meet their needs. PTACC encourages availability of as many pathways as possible to maximize diversion opportunities and connection to treatment, recovery support, and community services.
<ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> PTACC is organized into eight strategic areas, each having their own working groups and associated websites: <ref>https://ptaccollaborative.org/strategy-areas/</ref>
*Children and Families
*Community, Diversity, and Equity
*International Deflection and Diversion
*Policy and Legislation
*Public Safety
*Research
*Stigma Reduction
*Treatment, Housing, and Recovery

'''The Center for Prison Reform''' published "Jail Diversion Programs in America." <ref>https://centerforprisonreform.org/wp-content/uploads/2015/09/Jail-Diversion-Programs-in-America.pdf</ref>

= Promising Practices =

'''Alabama -- The Mercy Project.''' Walker County had the fifth-highest per capita rate of overdoses in the United States and the highest overdose rate of any county in the state. As a result, Sheriff Nick Smith wanted to create a program to help people struggling with SUD and to reduce the recidivism rate resulting from substance misuse. Interested participants fill out an application and then receive consultation. People are ineligible for program entry if they are facing drug charges or have outstanding warrants. However, the consultation allows a potential participant to turn in any drugs or drug paraphernalia without the threat of arrest. Although the individual must still enter the justice system, drug court is an option. If the person is accepted into the program, consultation determines individual treatment needs. <ref>https://walkercountysheriff.com/mercy-project.html</ref>

'''Arizona.''' The Arizona Angel Initiative is a community-based, police-assisted program. Police departments work in partnership with community-based treatment providers and the Governor's Office of Youth, Faith and Family. This program is modeled after a similar program in Gloucester, Massachusetts. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/AZ_AngelInitiativeReport_2018.pdf</ref>

'''Florida.''' The Pre-Arrest Diversion/Adult Civil Citation (PAD/ACC) is a model pre-arrest diversion program. The Leon County/Tallahassee program holds offenders accountable for their crime, but instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, such as community service. Following referral by law enforcement, one essential element of the program is the use of evidence-based behavioral health intervention services to reduce the likelihood of future criminal activity. PAD/ACC also works to avoid an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since its inception, the program has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation of the model. <ref>https://university.pretrial.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=514d95d4-413d-7a4f-f2e2-7fa588a297c2&forceDialog=0</ref>

'''Illinois -- A Way Out.''' In Lake County, an Illinois Law Enforcement Assisted Diversion (LEAD) pilot program was designed to fast-track users to substance use programs and services. This program is available 24 hours a day, 7 days a week, at participating police departments across Lake County. It ensures that no criminal charges will be sought for those who may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change regarding substance use and mental health. <ref>https://awayoutlc.org/</ref>

'''Illinois -- Safe Passage.''' People who realize they need help can go to one of the participating law enforcement agencies in Lee and Whiteside Counties without fear of being arrested. If they ask for help with their drug addiction and turn in their drugs, they will be placed in a treatment facility, usually within 24 hours. Once initial paperwork is completed, persons will be paired with a volunteer who will guide them through the process. Safe Passage partners with treatment centers throughout Illinois and the Midwest. <ref>https://www.dixongov.com/departments/police-department/inside-the-dixon-police-dept/safe-passage.html</ref>

'''Maryland.'''' Stop, Triage, Engage, Educate and Rehabilitate (STEER) in Montgomery County is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a police officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it. As a result of moving people towards the human services system, STEER exemplifies the following outcomes: <ref>https://opioid-resource-connector.org/index.php/program-model/stop-triage-engage-educate-and-rehabilitate-steer</ref>
* reducing crime
* rebuilding community relations
* reducing drug use
* restoring the lives of citizens

'''Minnesota.''' The Yellow Line Project in Blue Earth County provides a collaboration between law enforcement, human services, and care providers to improve coordination and access to treatment for individuals with substance use or mental health conditions, instead of in incarceration. <ref>https://www.yellowlineproject.com/operational-toolkit</ref>

'''New Jersey.''' In Ocean County, the Blue Heroin Addiction Recovery and Treatment (HART) is New Jersey's first program allowing substance users to seek help from authorities without risk of prosecution. <ref>https://www.staffordnj.gov/DocumentCenter/View/943/BLUE-HART-program-brochure?bidId=</ref>

'''New York.''' Hope Not Handcuffs is an initiative started by Families Against Narcotics (FAN). It aims to bring law enforcement and community organizations together in an effort to find viable treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs, and alcohol. A person struggling with any drug addiction can come to a participating police agency and ask for help. They will be greeted with support, compassion, and respect. If accepted into the program, the individual will be guided through a brief intake process to ensure proper treatment placement. <ref>https://www.familiesagainstnarcotics.org/hopenothandcuffs-ny</ref>

'''Ohio.''' In Toledo, the Lucas County Sheriff’s Office developed the Drug Abuse Response Team (DART) model. Lucas County credits it with diverting more than a thousand people from the criminal-justice system and into treatment during its first 4 years. 70% of participants successfully entered detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing the DART program. 39 programs received grant funding for 21-month-long pilots. The Lucas County DART program has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. Each officer works with parents with substance use disorder whose children have been put in foster care, in order for parents to get access to treatment, so that the family can be reunited.

'''Washington.''' Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and to reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs. <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx</ref>

= Sources =

Expand Law Enforcement and First Responder Assisted Diversion

2024-10-24T22:20:12Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Diversion and deflection programs seek to re-direct, or channel people away from the justice system. This practice is based on the theory that processing individuals through the justice system may do more harm than good or may not be an appropriate response for someone with behavioral health needs. While the exact number of diversion and deflection programs in the United States is currently unknown, their growth In communities has become accelerated by research showing that they can impact recidivism and help individuals avoid the consequences of having a criminal record. Over the past few decades, much of the innovation in deflection and diversion has focused on individuals whose interactions with the justice system are driven by behavioral health needs. The outcomes sought by diverting or deflecting individuals are generally three-fold:
*Reduce crime by connecting individuals with resources and services that decrease the likelihood of future offenses.
*Assist individuals according to their self-identified needs and provide support and opportunities to change the behaviors that brought them to the attention of the justice system.
*Reduce utilization of limited justice system resources by reducing re-arrest, recidivism, and future justice system expenditures.

= Key Information =

'''Pre-Arrest Diversion & Deflection Programs'''

These two types of program are related, but distinct. Deflection is the practice by which law enforcement ''or other first responders,'' such as fire and EMS, connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted. This is done in lieu of inaction when issues of addiction, mental health, and/or other needs are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested. Pre-arrest diversion is the practice by which ''law enforcement officers'' connect individuals who otherwise would have been eligible for criminal charges to community-based treatment and/or services, ''in lieu of arrest.'' This diverts them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs), clients are diverted to community-based services. Pre-arrest diversion programs should not be confused with ''prosecutorial diversion'', which occurs after individuals have already been arrested and become involved in the justice system. In contrast, pre-arrest diversion occurs before the filing of charges.

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.<ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders. They allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. The movement for early diversion is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder and/or mental illness. Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line. It provides appropriate treatment for eligible individuals. It opens up community opportunities for systemic change by leadership looking for creative solutions to complicated problems. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> Thus, these programs serve the best interest of the individuals involved, the community, and taxpayers. A variety of case studies provide documentation of the following beneficial outcomes of pre-arrest diversion and deflection programs: <ref name="SAFE Pre-Arrest Diversion Guide">https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*Break the costly cycle of justice system involvement for eligible individuals.
*Increase cross-sector collaboration to create new pathways to community-based behavioral health services.
*Enhance relations between community members and law enforcement.
*Decrease crime, incarceration, and recidivism rates.
*Lessen the burden on justice systems.
*Improve public health and safety.
*Reduce the burden on individuals who commit non-violent, low-level offenses.
*Ensure equal access to pre-arrest diversion regardless of race, income, or geography; and
*Save taxpayer dollars

'''The Five Pathways to Treatment Model.'''

In 2014, Treatment Alternatives for Safe Communities (TASC) and Center for Health and Justice (CHJ) developed the first iteration of the Five Pathways to Treatment. This offered different methods for deflection that first responders could use, at the point of contact, to move someone from the justice system to community-based treatment. Each pathway has unique characteristics that make it appropriate to address particular problems such as SUD, mental health disorder, homelessness, and other issues. Identifying and naming these pathways created a common language for practitioners to use in the new, emerging field of deflection. For each pathway listed below, the targeted population or circumstance appropriate for the pathway is elaborated. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref> <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>

*''Self-Referral:'' Drug–involved individuals are encouraged to initiate the engagement with law enforcement without fear of arrest, and an immediate treatment referral is made.
*''Active Outreach:'' Participants are identified by law enforcement, but are engaged primarily by an outreach team, often with a clinician and/or a peer with lived experience, who actively contacts them and motivates them to engage in treatment. Individuals with SUDs are the targeted population.
*''Naloxone Plus:'' A first responder and program partner (often a clinician or peer with lived experience) conducts outreach specifically to individuals who have experienced an overdose recently to engage them in and provide linkages to treatment. Individuals with opioid use disorder are the targeted population.
*''First-Responder/Officer Prevention:'' During routine activities such as patrol or response to a service call, a first responder conducts engagement and provides treatment referrals. If a law enforcement officer is the first responder, no charges are filed or arrests made. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.
*''Officer Intervention:'' (applicable only for law enforcement) During routine activities such as patrol or response to a service call, a law enforcement officer engages an individual and provides treatment referrals or issues noncriminal citations for that individual to report to a program. Charges are held until treatment and/or a social service plan is successfully completed. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.

'''The Sequential Intercept Model (SIM) <ref>https://www.samhsa.gov/criminal-juvenile-justice/sim-overview</ref>'''

SIM helps communities identify resources and gaps in services at each of six "interception points." The SIM mapping process brings together leaders and different agencies and systems to work together to identify local strategies and action plans to divert people with mental and substance use disorders away from the justice system into treatment. The six SIM intercepts are described below:

*'''Community Services.''' This involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. The emphasis is on connecting people with treatment or services instead of arresting or charging them with a crime.
*'''Law Enforcement.''' At this point, diversion is performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. It allows people to be diverted to treatment instead of being arrested or booked into jail.
*'''Initial Court Hearings/Initial Detention.''' This involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or an initial hearing.
*'''Jails/Courts.''' This interception involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. It includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
*'''Reentry''' supports reentry back into the community after jail or prison to reduce further justice involvement. It includes reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
*'''Community Corrections.''' This involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.

= Relevant Research =

'''Collaborative Research Report.''' This survey was performed by the Treatment Alternatives for Safe Communities, The University of Chicago, and the US Justice Department. It is titled "Report of the National Survey to Assess Law Enforcement-Led Diversion and First Responder Deflection Programs in Response to the Opioid Crisis. It provides a comprehensive overview of the field and its role in responding to the opioid crisis, as well as how deflection/first responder deflection offers alternatives to law enforcement and first responders in their work. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref>

= Impactful Federal, State, and Local Policies =

*'''The Office of National Drug Control Policy''' funded a study that provides a model for states to use to generate legislation authorizing diversion. When the template is followed and enacted by a state, it allows law enforcement officers to divert some individuals with substance use disorders or mental health conditions away from arrest and prosecution to treatment and other supportive services. This helps states legislate collaborative programs between law enforcement, treatment providers, and community organizations to support individuals to access treatment and services and avoid justice involvement. <ref> https://www.opioidlibrary.org/wp-content/uploads/2019/08/Model-Deflection-Act-FINAL-7.1.2019.pdf</ref>

*'''The R Street Report''' This policies report reviews all fifty states relating to pre-arrest diversion and crisis response including legal status and legislative actions. <ref>https://www.rstreet.org/wp-content/uploads/2019/10/Final-187.pdf</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''"Law Enforcement Pre-Arrest Diversion Resource Guide"''' in collaboration with PTACC. It is designed to help law enforcement agencies create pre-arrest diversion programs for individuals with substance use disorder. The guide describes pre-arrest diversion, defines two types of pre-arrest diversion programs, and provides case studies of PTACC's five pathways. <ref>https://www.safeproject.us/law-enforcement-pre-arrest-diversion/</ref> The guide can be downloaded. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf </ref> Also, see the SAFE Project wiki titled “Improve Recovery Support for People in the Criminal Justice System."
<ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>

'''The U.S. Department of Justice''' Bureau of Justice Assistance (BJA) manages the Comprehensive Opioid, Stimulant & Substance Abuse Program (COSSAP). Its Law Enforcement/First Responder Diversion and Referral Mentoring Initiative provides communities interested in starting diversion and/or referral programs with the opportunity to learn from established or innovative programs that have shown success in meeting the treatment needs of individuals with a substance use disorder, and in some cases may have experienced an overdose. <ref>https://www.cossapresources.org/Learning/PeerToPeer/Diversion</ref>

'''The Police Assisted Addiction and Recovery Initiative (PAARI)''' helps police departments create non-arrest pathways to substance use disorder treatment and recovery like the ANGEL program in Gloucester, Massachusetts. PAARI works with over 400 police departments in 32 states and helps communities customize their programs to their circumstances. Offered services include technical assistance, policy templates and tools, seed grants, and connections to experts with established programs. <ref>https://paariusa.org/</ref>

'''Law Enforcement Assisted Diversion (LEAD)''' is a community-based diversion approach with the goals of improving public safety and reducing unnecessary justice system involvement of people who participate in the program. The site includes a video, tools and resources. <ref>https://www.leadbureau.org/</ref>

'''The Police Treatment And Community Collaborative (PTACC)''' is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref> It provides a webinar titled "Starting Your Pre-Arrest Diversion (PAD) Effort: Law Enforcement, Behavioral Health, and Community Together" which gives information on pre-arrest diversion models. <ref>https://ptaccollaborative.org/webinars/</ref> The PTACC mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. The purpose of the Collaborative is to provide vision, leadership, advocacy, and education to facilitate the practice of pre-arrest diversion across the United States. Their focus is to educate law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services which can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. "PTACC is the national voice of the deflection and pre-arrest diversion field." <ref>https://ptaccollaborative.org/about/</ref> PTACC recognizes that there are multiple models of pre-arrest diversion. It has adopted the TASC model, described above, as its "Pathways to Community" because using one or more of them creates pathways to treatment or social services. <ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> PTACC endorses each of the five pathways and encourages communities to explore the approaches which best meet their needs. PTACC encourages availability of as many pathways as possible to maximize diversion opportunities and connection to treatment, recovery support, and community services.
<ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> PTACC is organized into eight strategic areas, each having their own working groups and associated websites: <ref>https://ptaccollaborative.org/strategy-areas/</ref>
*Children and Families
*Community, Diversity, and Equity
*International Deflection and Diversion
*Policy and Legislation
*Public Safety
*Research
*Stigma Reduction
*Treatment, Housing, and Recovery

'''The Center for Prison Reform''' published "Jail Diversion Programs in America." <ref>https://centerforprisonreform.org/wp-content/uploads/2015/09/Jail-Diversion-Programs-in-America.pdf</ref>

= Promising Practices =

'''Alabama -- The Mercy Project.''' Walker County had the fifth-highest per capita rate of overdoses in the United States and the highest overdose rate of any county in the state. As a result, Sheriff Nick Smith wanted to create a program to help people struggling with SUD and to reduce the recidivism rate resulting from substance misuse. Interested participants fill out an application and then receive consultation. People are ineligible for program entry if they are facing drug charges or have outstanding warrants. However, the consultation allows a potential participant to turn in any drugs or drug paraphernalia without the threat of arrest. Although the individual must still enter the justice system, drug court is an option. If the person is accepted into the program, consultation determines individual treatment needs. <ref>https://walkercountysheriff.com/mercy-project.html</ref>

'''Arizona.''' The Arizona Angel Initiative is a community-based, police-assisted program. Police departments work in partnership with community-based treatment providers and the Governor's Office of Youth, Faith and Family. This program is modeled after a similar program in Gloucester, Massachusetts. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/AZ_AngelInitiativeReport_2018.pdf</ref>

'''Florida.''' The Pre-Arrest Diversion/Adult Civil Citation (PAD/ACC) is a model pre-arrest diversion program. The Leon County/Tallahassee program holds offenders accountable for their crime, but instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, such as community service. Following referral by law enforcement, one essential element of the program is the use of evidence-based behavioral health intervention services to reduce the likelihood of future criminal activity. PAD/ACC also works to avoid an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since its inception, the program has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation of the model. <ref>https://university.pretrial.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=514d95d4-413d-7a4f-f2e2-7fa588a297c2&forceDialog=0</ref>

'''Illinois -- A Way Out.''' In Lake County, an Illinois Law Enforcement Assisted Diversion (LEAD) pilot program was designed to fast-track users to substance use programs and services. This program is available 24 hours a day, 7 days a week, at participating police departments across Lake County. It ensures that no criminal charges will be sought for those who may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change regarding substance use and mental health. <ref>https://awayoutlc.org/</ref>

'''Illinois -- Safe Passage.''' People who realize they need help can go to one of the participating law enforcement agencies in Lee and Whiteside Counties without fear of being arrested. If they ask for help with their drug addiction and turn in their drugs, they will be placed in a treatment facility, usually within 24 hours. Once initial paperwork is completed, persons will be paired with a volunteer who will guide them through the process. Safe Passage partners with treatment centers throughout Illinois and the Midwest. <ref>https://www.dixongov.com/departments/police-department/inside-the-dixon-police-dept/safe-passage.html</ref>

'''Maryland.'''' Stop, Triage, Engage, Educate and Rehabilitate (STEER) in Montgomery County is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a police officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it. As a result of moving people towards the human services system, STEER exemplifies the following outcomes: <ref>https://opioid-resource-connector.org/index.php/program-model/stop-triage-engage-educate-and-rehabilitate-steer</ref>
* reducing crime
* rebuilding community relations
* reducing drug use
* restoring the lives of citizens

'''Minnesota.''' The Yellow Line Project in Blue Earth County provides a collaboration between law enforcement, human services, and care providers to improve coordination and access to treatment for individuals with substance use or mental health conditions, instead of in incarceration. <ref>https://www.yellowlineproject.com/operational-toolkit</ref>

'''New Jersey.''' In Ocean County, the Blue Heroin Addiction Recovery and Treatment (HART) is New Jersey's first program allowing substance users to seek help from authorities without risk of prosecution. <ref>https://www.staffordnj.gov/DocumentCenter/View/943/BLUE-HART-program-brochure?bidId=</ref>

'''New York.''' Hope Not Handcuffs is an initiative started by Families Against Narcotics (FAN). It aims to bring law enforcement and community organizations together in an effort to find viable treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs, and alcohol. A person struggling with any drug addiction can come to a participating police agency and ask for help. They will be greeted with support, compassion, and respect. If accepted into the program, the individual will be guided through a brief intake process to ensure proper treatment placement. <ref>https://www.familiesagainstnarcotics.org/hopenothandcuffs-ny</ref>

'''Ohio.''' In Toledo, the Lucas County Sheriff’s Office developed the Drug Abuse Response Team (DART) model. Lucas County credits it with diverting more than a thousand people from the criminal-justice system and into treatment during its first 4 years. 70% of participants successfully entered detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing the DART program. 39 programs received grant funding for 21-month-long pilots. The Lucas County DART program has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. Each officer works with parents with substance use disorder whose children have been put in foster care, in order for parents to get access to treatment, so that the family can be reunited.

'''Washington.''' Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and to reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs. <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx</ref>

= Sources =

Shift from Punishment to Treatment in the Criminal Justice System

2024-10-23T20:23:15Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

A significant number of inmates suffer from substance use disorder, a mental health disorder, or a combination of the two. When proper treatment is made during incarceration there is a decrease in inmate misconduct. When treatment is followed through to post-release, there is documented lower risk for relapse and recidivism.

The United States has the highest incarceration rate in the world. <ref>https://medicalxpress.com/news/2021-02-incarceration-strongly-linked-premature-death.html</ref> There is substantial evidence that shows how detrimental it is to overcrowd jails and prisons and to turn a blind eye to the revolving door effect that happens when individuals are incarcerated without adequate support to change behaviors. Although evidence shows that addiction is a treatable disease of the brain, many people never receive treatment. As a result too many end up involved in the criminal justice system from illegal drug-seeking behavior. Recent data shows a significant correlation between criminal justice involvement and substance use. This highlights the importance of identifying a different approach to the problem and the need to shift from a punishment to a treatment approach.

More than half of the prison population in the United States, about 65%, is estimated to have an active substance use disorder. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> About 20% who did not fully meet the criteria for a substance use disorder were under the influence of substances at the time of their arrest. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> Many of the individuals in prison who need treatment are not receiving it. Thus, they have a high risk of reoffending once released. Treatment has impacts that can last for decades -- on an individual’s quality of life, reduced likelihood of recidivism, and future relapse. Failure to provide adequate and high-quality substance use treatment is not only detrimental to the individuals who are incarcerated but also has negative implications for their families, society, and the economy.

It should be a priority to offer treatment to individuals within the criminal justice system who have a substance use disorder. The National Institute on Drug Abuse has increased its efforts to find solutions. It supports social workers, counselors, and others who work within the court system to provide services to individuals involved in the criminal justice system due to drug use. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This helps both to decrease substance abuse and to reduce crime. There are evidence-based strategies that play a role in transforming traditional punishment-based approaches which may be used within the criminal justice system. Moving from a punishment to treatment approach improves both public health and public safety while decreasing rates of future incarceration. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/#R16</ref>

= Key Information =

Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated, including those under supervision in the community. A study by Pew Trusts study shows that more imprisonment does not reduce drug related issues. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew</ref> This study reinforces a large body of research that casts doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies which the research shows work better. There have been two major avenues that have proven successful in shifting a from a punishment to treatment approach. The first is through by-passing incarceration with therapeutic alternatives. The second is through increasing treatment options inside jails and prisons.

'''Therapeutic alternatives''' to incarceration, such as judicial oversight in drug courts, has proven to be helpful in transitioning offenders back into the community where they can address their illness and live productive lives. Further research has shown the positive impact community-based drug treatment has on criminal behavior and may result in 1.8 times better outcomes in reducing drug use and the chances of reoffending. Drug courts that combined judicial supervision and treatment in place of incarceration had half the rearrests rates than those who did not participate in said programs. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>.

'''Treatment services''' for people within the criminal justice system, gives society an opportunity to better the lives of the individuals and to improve public health and safety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Without treatment, individuals are more likely to commit crimes at a higher rate once released from prison when compared to those who are not using substances. <ref>https://drugfree.org/drug-and-alcohol-news/choosing-substance-abuse-treatment-over-prison-could-save-billions-study/</ref> The provision of drug treatment inside the prisons and jails while the offenders are incarcerated has shown promise. Since the 1990’s researchers have discovered highly effective interventions that can be implemented while offenders are incarcerated and after they are released. <ref>https://www.apa.org/research/action/aftercare</ref> A critical component of this approach is adequate pre-release and post-release counseling and support. This reduces detrimental impacts of individuals returning to a stressful home-life or environments with negative peer influences. Lack of access to treatment upon release increases the likelihood of relapse. The risk of overdose is amplified due to the changes in an individual’s tolerance after being incarcerated, leading to a higher probability of death. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Common treatments include the following proven evidence-based approaches: <ref>https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction</ref>

*behavioral counseling
*medication assisted treatment (MAT)
*evaluation and treatment for co-occurring mental health issues such as depression and anxiety
*long-term follow-up to prevent relapse

Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. Cost-benefit analysis indicates that residential prison treatment is cost-effective if prisoners continue treatment after their release. There are immediate and long-term fiscal benefits. In a direct and immediate cost comparison, the cost of treatment pales in comparison to the cost of incarceration. In a longer-term vantage point, when prisoners overcome drug use, it reduces the economic burden of recidivism. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref>

In general, the criminal justice system supports treatment during incarceration by offering inmates with substance use problems a mix of psychotherapy sessions, religious ministry meetings, and 12-step programs, such as Alcoholics Anonymous. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref> The ''federal prison system'' utilizes four primary types of programs to assist inmates in overcoming a substance use disorder:

*'''The Residential Drug Abuse Program (RDAP)''' is the most intensive program that the Federal Bureau of Prisons will provide and is normally nine months in length. Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and a half-day of work, school, or vocational activities. Research has shown that inmates that take part in RDAP are significantly less likely to recidivate and relapse to drug use compared to those inmates who do not take part in RDAP. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Nonresidential Drug Abuse Treatment.''' This involves a 12-week cognitive behavioral therapy (CBT) program that is organized in group sessions that address criminal lifestyles while increasing skills in the areas of rational thinking, communication, and institution-to-community adjustment. Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community or have a positive urinalysis test <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Drug Abuse Education''' entails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Community Treatment Services (CTS)''' provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement. Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity. So, continued treatment after release is vital to the success of the offender completing their treatment. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

= Relevant Research =

*'''SAMHSA''' has published Treatment Improvement Protocol (TIP) titled, "Substance Abuse Treatment: For Adults in the Criminal Justice System." In addressing the need for trauma-informed care, the report distinguishes between historic trauma as root cause of criminality and trauma associated with incarceration. The panel that made the report, reached consensus on the recommendation that in-prison treatment address both the trauma of the incarceration itself and the prison culture that conflicts with treatment goals. Since prisons can be violent, harsh, and psychologically damaging, incarcerated people live in an environment that is both depersonalizing and dehumanizing. When added to the social stigma associated with incarceration, this may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt -- highlighting the need to concurrently treat for both substance use and mental health. <ref>https://www.ncbi.nlm.nih.gov/books/NBK572935/</ref>

*'''NIDA''' has published a research-based guide titled "Principles of Drug Abuse Treatment for Criminal Justice Populations." <ref>https://www.txwp.uscourts.gov/wp-content/uploads/2017/05/Recommended-Reading-Drug-Abuse-Treatment-for-Criminal-Justice-Populations.pdf</ref> NIDA reports that over 80% of prisoners who would benefit from treatment while incarcerated do not receive it -- despite the overwhelming evidence that drug treatment is more effective than incarceration. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref>

*'''GAO Report on Overcrowding of Jails and Prisons.''' One of the major barriers to treatment and recovery support during incarceration is the availability of effective treatment. Overcrowding is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. This report indicates that over 50,000 inmates were on waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the enrollment issues in drug treatment programs. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''The National Drug Intelligence Center (NDIC)''' estimated the cost of illicit drug use to society was $193 billion. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This is in addition to the $249 billion, estimated by the Office of the Surgeon General, in costs associated with alcohol misuse. <ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref> The NDIC estimated the cost to treat drug use at $14 billion -- including healthcare costs, hospitalizations, and government specialty treatment.

*'''This article''' is titled "Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety." It summarizes relevant findings in neuroscience and evidence-based principles of addiction treatment that could help improve public heath and reduce criminal behavior. The authors report that individuals who participated in prison-based drug treatment programs paired with community programs after release were 7 times more likely to continue to abstain from substances and 3 times less likely to re-offend when compared to those who did not receive treatment. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

= Impactful Federal, State, and Local Policies =

*'''The Residential Substance Use Disorder Treatment Act''' of 2021 expanded access to substance use treatment in jails and prisons within the United States. This bill also expanded access to treatment within the communities after offenders were released. This was a step in the right direction for providing treatment in place of incarceration. One major advance was the government’s acknowledgment of how important it is to stop the "revolving door" pattern associated with substance use and incarceration through the use of treatment and medication. <ref>https://www.whitehouse.senate.gov/news/release/-cornyn-whitehouse-introduce-bill-to-fight-substance-use-in-jails-and-prisons-support-inmates-upon-release</ref>

*'''The Adult Drug Court Grant Program''' is managed by the Department of Justice. It provides financial assistance to states, local courts and government, and federally recognized Indian tribal governments to integrate substance abuse treatment, drug testing, incentives, and sanctions in judicially supervised settings with the intent to reduce recidivism and substance use among offenders. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/overview</ref>

*'''Connecticut''' enacted sentencing and drug-free zoning reform based on two models promoted by the American Legislative Exchange Council (ALEC). In its 2021 Report, ALEC has a policy section titled "Criminal Justice Reform" which references ALEC resolutions, supporting drug free zones and a minimum age of 10 for delinquency adjudication. <ref>https://alec.org/wp-content/uploads/2022/05/2021-Annual-Report_V10_WEB.pdf</ref>

*'''Oregon''' passed a groundbreaking drug law in 2020 that decriminalized the possession of small amounts of illegal substances. “Measure 110” expanded funding and access to addiction treatment. It uses tax revenue from expected savings resulting from reduced arrests and incarceration. One downside to this new approach is the impact it may have on the medical community, potentially stressing resources to handle and increase in overdose patients. Nonetheless, the radical change in the way law enforcement handles possession of substances is supportive to finding alternatives to incarceration. Many times, the only way to receive treatment for substance use treatment is by being arrested or coming into contact with the criminal justice system. This has detrimental impacts on an individual’s life and ability to hold employment. Measure 110 has offered another pathway by treating possession like a traffic ticket and opening the door to treatment instead of incarceration. <ref>https://www.npr.org/2021/06/18/1007022652/oregons-pioneering-drug-decriminalization-experiment-is-now-facing-the-hard-test</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''Treatment and Family Support Locator''' is a SAFE Project and University of Maryland created resource designed to allow users seeking substance use/mental health treatment to search the SAMHSA Treatment Locator database using more specific criteria to help find the best options available.<ref>https://safelocator.org/en/search</ref>
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled "Expand Law Enforcement Assisted Diversion and Deflection Programs" for more detailed information on diversion and deflection programs that aim to redirect individuals away from the justice system, particularly those with behavioral health needs, to reduce recidivism, address personal needs, and optimize justice system resources.<ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs#Available_Tools_and_Resources</ref>

'''The US Department of Justice''' has published "Criminal Conduct & Substance Abuse Treatment: Strategies for Self-Improvement and Change Pathways to Responsible Living." <ref>https://www.ojp.gov/ncjrs/virtual-library/abstracts/criminal-conduct-substance-abuse-treatment-strategies-self</ref>

'''BJA''' manages the Residential Substance Abuse Treatment Program (RSAT) which offers training and technical assistance to county and states <ref>https://www.rsat-tta.com/</ref> and "Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals." <ref>https://www.cossup.org/Content/Documents/JailResources/Guidelines_for_Managing_Substance_Withdrawal_in_Jails_6-6-23_508.pdf</ref>

'''The National Institute of Corrections''' provides training for correctional professionals. One of these is Residential Substance Abuse Training (RSAT). <ref> https://nicic.gov/training</ref>

'''Oregon.''' Two hotlines provide support:
* "Lines for Life" is a 24/7 helpline that is dedicated to preventing substance use and suicide. They provide free and confidential drug-prevention education and treatment referral services. <ref>https://www.linesforlife.org</ref>

*Addiction Recovery Center is also open 24/7. It provides assessments, care planning, links to services, and connects callers with crisis care and emergency care if needed. <ref>https://www.oregon.gov/oha/HSD/AMH/Pages/Measure110.aspx</ref>

= Promising Practices =

'''Georgia.''' The Adult Felony Drug Court Program in Clayton County is an 18-to-24-month program that gives nonviolent drug offenders with a substance use disorder the chance to avoid incarceration. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>.

'''Massachusetts.''' This video titled "Reforming Criminal Justice to Help Inmates Live a Life of Dignity, not Dependency" highlights a positive case study associated with fostering musical talent in a Worcester prison. <ref>https://alec.org/article/video-reforming-criminal-justice-to-help-inmates-live-a-life-of-dignity-not-dependency/</ref>

'''New York.''' An innovative triage approach called Buffalo Opioid Court, reduced the risk of overdose deaths and substance use by providing funding for court staff and treatment programs such as addiction counseling and medical interventions. The court staff has the ability to deploy a Rapid Integration Team that connects individuals with immediate treatment, assessment, and access to a licensed professional counselor. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>

= Sources =

Shift from Punishment to Treatment in the Criminal Justice System

2024-10-23T20:20:21Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

A significant number of inmates suffer from substance use disorder, a mental health disorder, or a combination of the two. When proper treatment is made during incarceration there is a decrease in inmate misconduct. When treatment is followed through to post-release, there is documented lower risk for relapse and recidivism.

The United States has the highest incarceration rate in the world. <ref>https://medicalxpress.com/news/2021-02-incarceration-strongly-linked-premature-death.html</ref> There is substantial evidence that shows how detrimental it is to overcrowd jails and prisons and to turn a blind eye to the revolving door effect that happens when individuals are incarcerated without adequate support to change behaviors. Although evidence shows that addiction is a treatable disease of the brain, many people never receive treatment. As a result too many end up involved in the criminal justice system from illegal drug-seeking behavior. Recent data shows a significant correlation between criminal justice involvement and substance use. This highlights the importance of identifying a different approach to the problem and the need to shift from a punishment to a treatment approach.

More than half of the prison population in the United States, about 65%, is estimated to have an active substance use disorder. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> About 20% who did not fully meet the criteria for a substance use disorder were under the influence of substances at the time of their arrest. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> Many of the individuals in prison who need treatment are not receiving it. Thus, they have a high risk of reoffending once released. Treatment has impacts that can last for decades -- on an individual’s quality of life, reduced likelihood of recidivism, and future relapse. Failure to provide adequate and high-quality substance use treatment is not only detrimental to the individuals who are incarcerated but also has negative implications for their families, society, and the economy.

It should be a priority to offer treatment to individuals within the criminal justice system who have a substance use disorder. The National Institute on Drug Abuse has increased its efforts to find solutions. It supports social workers, counselors, and others who work within the court system to provide services to individuals involved in the criminal justice system due to drug use. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This helps both to decrease substance abuse and to reduce crime. There are evidence-based strategies that play a role in transforming traditional punishment-based approaches which may be used within the criminal justice system. Moving from a punishment to treatment approach improves both public health and public safety while decreasing rates of future incarceration. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/#R16</ref>

= Key Information =

Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated, including those under supervision in the community. A study by Pew Trusts study shows that more imprisonment does not reduce drug related issues. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew</ref> This study reinforces a large body of research that casts doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies which the research shows work better. There have been two major avenues that have proven successful in shifting a from a punishment to treatment approach. The first is through by-passing incarceration with therapeutic alternatives. The second is through increasing treatment options inside jails and prisons.

'''Therapeutic alternatives''' to incarceration, such as judicial oversight in drug courts, has proven to be helpful in transitioning offenders back into the community where they can address their illness and live productive lives. Further research has shown the positive impact community-based drug treatment has on criminal behavior and may result in 1.8 times better outcomes in reducing drug use and the chances of reoffending. Drug courts that combined judicial supervision and treatment in place of incarceration had half the rearrests rates than those who did not participate in said programs. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>.

'''Treatment services''' for people within the criminal justice system, gives society an opportunity to better the lives of the individuals and to improve public health and safety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Without treatment, individuals are more likely to commit crimes at a higher rate once released from prison when compared to those who are not using substances. <ref>https://drugfree.org/drug-and-alcohol-news/choosing-substance-abuse-treatment-over-prison-could-save-billions-study/</ref> The provision of drug treatment inside the prisons and jails while the offenders are incarcerated has shown promise. Since the 1990’s researchers have discovered highly effective interventions that can be implemented while offenders are incarcerated and after they are released. <ref>https://www.apa.org/research/action/aftercare</ref> A critical component of this approach is adequate pre-release and post-release counseling and support. This reduces detrimental impacts of individuals returning to a stressful home-life or environments with negative peer influences. Lack of access to treatment upon release increases the likelihood of relapse. The risk of overdose is amplified due to the changes in an individual’s tolerance after being incarcerated, leading to a higher probability of death. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Common treatments include the following proven evidence-based approaches: <ref>https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction</ref>

*behavioral counseling
*medication assisted treatment (MAT)
*evaluation and treatment for co-occurring mental health issues such as depression and anxiety
*long-term follow-up to prevent relapse

Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. Cost-benefit analysis indicates that residential prison treatment is cost-effective if prisoners continue treatment after their release. There are immediate and long-term fiscal benefits. In a direct and immediate cost comparison, the cost of treatment pales in comparison to the cost of incarceration. In a longer-term vantage point, when prisoners overcome drug use, it reduces the economic burden of recidivism. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref>

In general, the criminal justice system supports treatment during incarceration by offering inmates with substance use problems a mix of psychotherapy sessions, religious ministry meetings, and 12-step programs, such as Alcoholics Anonymous. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref> The ''federal prison system'' utilizes four primary types of programs to assist inmates in overcoming a substance use disorder:

*'''The Residential Drug Abuse Program (RDAP)''' is the most intensive program that the Federal Bureau of Prisons will provide and is normally nine months in length. Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and a half-day of work, school, or vocational activities. Research has shown that inmates that take part in RDAP are significantly less likely to recidivate and relapse to drug use compared to those inmates who do not take part in RDAP. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Nonresidential Drug Abuse Treatment.''' This involves a 12-week cognitive behavioral therapy (CBT) program that is organized in group sessions that address criminal lifestyles while increasing skills in the areas of rational thinking, communication, and institution-to-community adjustment. Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community or have a positive urinalysis test <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Drug Abuse Education''' entails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Community Treatment Services (CTS)''' provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement. Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity. So, continued treatment after release is vital to the success of the offender completing their treatment. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

= Relevant Research =

*'''SAMHSA''' has published Treatment Improvement Protocol (TIP) titled, "Substance Abuse Treatment: For Adults in the Criminal Justice System." In addressing the need for trauma-informed care, the report distinguishes between historic trauma as root cause of criminality and trauma associated with incarceration. The panel that made the report, reached consensus on the recommendation that in-prison treatment address both the trauma of the incarceration itself and the prison culture that conflicts with treatment goals. Since prisons can be violent, harsh, and psychologically damaging, incarcerated people live in an environment that is both depersonalizing and dehumanizing. When added to the social stigma associated with incarceration, this may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt -- highlighting the need to concurrently treat for both substance use and mental health. <ref>https://www.ncbi.nlm.nih.gov/books/NBK572935/</ref>

*'''NIDA''' has published a research-based guide titled "Principles of Drug Abuse Treatment for Criminal Justice Populations." <ref>https://www.txwp.uscourts.gov/wp-content/uploads/2017/05/Recommended-Reading-Drug-Abuse-Treatment-for-Criminal-Justice-Populations.pdf</ref> NIDA reports that over 80% of prisoners who would benefit from treatment while incarcerated do not receive it -- despite the overwhelming evidence that drug treatment is more effective than incarceration. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref>

*'''GAO Report on Overcrowding of Jails and Prisons.''' One of the major barriers to treatment and recovery support during incarceration is the availability of effective treatment. Overcrowding is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. This report indicates that over 50,000 inmates were on waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the enrollment issues in drug treatment programs. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''The National Drug Intelligence Center (NDIC)''' estimated the cost of illicit drug use to society was $193 billion. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This is in addition to the $249 billion, estimated by the Office of the Surgeon General, in costs associated with alcohol misuse. <ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref> The NDIC estimated the cost to treat drug use at $14 billion -- including healthcare costs, hospitalizations, and government specialty treatment.

*'''This article''' is titled "Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety." It summarizes relevant findings in neuroscience and evidence-based principles of addiction treatment that could help improve public heath and reduce criminal behavior. The authors report that individuals who participated in prison-based drug treatment programs paired with community programs after release were 7 times more likely to continue to abstain from substances and 3 times less likely to re-offend when compared to those who did not receive treatment. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

= Impactful Federal, State, and Local Policies =

*'''The Residential Substance Use Disorder Treatment Act''' of 2021 expanded access to substance use treatment in jails and prisons within the United States. This bill also expanded access to treatment within the communities after offenders were released. This was a step in the right direction for providing treatment in place of incarceration. One major advance was the government’s acknowledgment of how important it is to stop the "revolving door" pattern associated with substance use and incarceration through the use of treatment and medication. <ref>https://www.whitehouse.senate.gov/news/release/-cornyn-whitehouse-introduce-bill-to-fight-substance-use-in-jails-and-prisons-support-inmates-upon-release</ref>

*'''The Adult Drug Court Grant Program''' is managed by the Department of Justice. It provides financial assistance to states, local courts and government, and federally recognized Indian tribal governments to integrate substance abuse treatment, drug testing, incentives, and sanctions in judicially supervised settings with the intent to reduce recidivism and substance use among offenders. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/overview</ref>

*'''Connecticut''' enacted sentencing and drug-free zoning reform based on two models promoted by the American Legislative Exchange Council (ALEC). In its 2021 Report, ALEC has a policy section titled "Criminal Justice Reform" which references ALEC resolutions, supporting drug free zones and a minimum age of 10 for delinquency adjudication. <ref>https://alec.org/wp-content/uploads/2022/05/2021-Annual-Report_V10_WEB.pdf</ref>

*'''Oregon''' passed a groundbreaking drug law in 2020 that decriminalized the possession of small amounts of illegal substances. “Measure 110” expanded funding and access to addiction treatment. It uses tax revenue from expected savings resulting from reduced arrests and incarceration. One downside to this new approach is the impact it may have on the medical community, potentially stressing resources to handle and increase in overdose patients. Nonetheless, the radical change in the way law enforcement handles possession of substances is supportive to finding alternatives to incarceration. Many times, the only way to receive treatment for substance use treatment is by being arrested or coming into contact with the criminal justice system. This has detrimental impacts on an individual’s life and ability to hold employment. Measure 110 has offered another pathway by treating possession like a traffic ticket and opening the door to treatment instead of incarceration. <ref>https://www.npr.org/2021/06/18/1007022652/oregons-pioneering-drug-decriminalization-experiment-is-now-facing-the-hard-test</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''Treatment and Family Support Locator''' is a SAFE Project and University of Maryland created resource designed to allow users seeking substance use/mental health treatment to search the SAMHSA Treatment Locator database using more specific criteria to help find the best options available.<ref>https://safelocator.org/en/search</ref>
*'''SAFE Choices.''' This SAFE Project program focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.<ref>https://www.safeproject.us/safe-choices/</ref>
*See the wiki titled "Expand Law Enforcement Assisted Diversion and Deflection Programs" for more detailed information on diversion and deflection programs that aim to redirect individuals away from the justice system, particularly those with behavioral health needs, to reduce recidivism, address personal needs, and optimize justice system resources.<ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs#Available_Tools_and_Resources</ref>

'''The US Department of Justice''' has published "Criminal Conduct & Substance Abuse Treatment: Strategies for Self-Improvement and Change Pathways to Responsible Living." <ref>https://www.ojp.gov/ncjrs/virtual-library/abstracts/criminal-conduct-substance-abuse-treatment-strategies-self</ref>

'''BJA''' manages the Residential Substance Abuse Treatment Program (RSAT) which offers training and technical assistance to county and states <ref>https://www.rsat-tta.com/</ref> and "Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals." <ref>https://www.cossup.org/Content/Documents/JailResources/Guidelines_for_Managing_Substance_Withdrawal_in_Jails_6-6-23_508.pdf</ref>

'''The National Institute of Corrections''' provides training for correctional professionals. One of these is Residential Substance Abuse Training (RSAT). <ref> https://nicic.gov/training</ref>

'''Oregon.''' Two hotlines provide support:
* "Lines for Life" is a 24/7 helpline that is dedicated to preventing substance use and suicide. They provide free and confidential drug-prevention education and treatment referral services. <ref>https://www.linesforlife.org</ref>

*Addiction Recovery Center is also open 24/7. It provides assessments, care planning, links to services, and connects callers with crisis care and emergency care if needed. <ref>https://www.oregon.gov/oha/HSD/AMH/Pages/Measure110.aspx</ref>

= Promising Practices =

'''Georgia.''' The Adult Felony Drug Court Program in Clayton County is an 18-to-24-month program that gives nonviolent drug offenders with a substance use disorder the chance to avoid incarceration. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>.

'''Massachusetts.''' This video titled "Reforming Criminal Justice to Help Inmates Live a Life of Dignity, not Dependency" highlights a positive case study associated with fostering musical talent in a Worcester prison. <ref>https://alec.org/article/video-reforming-criminal-justice-to-help-inmates-live-a-life-of-dignity-not-dependency/</ref>

'''New York.''' An innovative triage approach called Buffalo Opioid Court, reduced the risk of overdose deaths and substance use by providing funding for court staff and treatment programs such as addiction counseling and medical interventions. The court staff has the ability to deploy a Rapid Integration Team that connects individuals with immediate treatment, assessment, and access to a licensed professional counselor. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>

= Sources =

Improve Links to Treatment for People who Experience Non-Lethal Overdoses or Naloxone Revivals

2024-10-23T20:14:15Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

The National Survey on Drug Use and Health reports that 4 out 5 Americans with a SUD do not receive proper treatment, despite a decades-long epidemic. <ref>https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-addressing-addiction-and-the-overdose-epidemic/</ref> Drug overdose is one of the leading causes of death for those with a SUD, and those who experience at least one non-fatal overdose have a heavy increase of dying from a subsequent overdose. <ref>https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00538-9</ref> The treatment community has a powerful role to play in reversing these negative statistics. It can encourage providers, clinicians, and insurance agencies to learn about the impacts of overdose and the benefits of prevention, treatment, and harm reduction. Likewise, treatment providers can help to expand access to and education about Naloxone, even if the patient doesn’t have a current opioid prescription. This article builds upon the SAFE Solutions article on harm reduction titled "Increase Access to Overdose Reversal Medications." <ref>https://www.yoursafesolutions.us/wiki/Increase_Access_to_Overdose_Reversal_Medications</ref>

= Key Information =

'''Social Impact of Overdose'''

Non-lethal overdoses and substance use disorders come at a great social cost when left ineffectively treated. Community consequences include productivity losses and healthcare and treatment costs and incarceration costs. Approximately 65% of inmates qualify as having a substance use disorder. <ref>https://eac-network.org/substance-abuse-treatment-benefits/</ref> Communities that employ various harm reduction services, such as access to Naloxone, Fentanyl testing strips, syringe service programs (SSP), mental health services, and MAT see improvements that impact the individual and the community as a whole. <ref>https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-addressing-addiction-and-the-overdose-epidemic/</ref> <ref>https://eac-network.org/substance-abuse-treatment-benefits/</ref> Benefits of access to treatment for nonlethal overdose include:
*Health seeking behaviors - access to a SSP has shown a five-fold increase in the number of people seeking treatment for their SUD. <ref>https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-addressing-addiction-and.the-overdose-epidemic/</ref>
*Cost benefit - SUD treatment is cheaper than incarceration, with every $1 spent on treatment saving $4 in health care costs. <ref>https://eac-network.org/substance-abuse-treatment-benefits/</ref>
*Improvement in job performance - Ohio programs saw 91% decrease in absenteeism). <ref>https://eac-network.org/substance-abuse-treatment-benefits/</ref>

The opioid epidemic is being made considerably more dangerous with the spike in Fentanyl-related overdoses. It is a highly addictive pain medication, and it is commonly added to other drugs to enhance potency and decrease costs. <ref>https://www.cdc.gov/stopoverdose/fentanyl/index.html</ref> The addition of Fentanyl is made even more deadly because it is often added to illicit drugs without the consumer being aware, and just a small amount can trigger an overdose. <ref>https://www.cdc.gov/stopoverdose/fentanyl/index.html</ref> It is virtually undetectable to the unsuspecting user, as it can not be seen, tasted, or smelled. <ref>https://www.cdc.gov/stopoverdose/fentanyl/index.html</ref>

'''Risk Factors for Overdose'''

In order to provide comprehensive, effective treatment options, it is critical for clinicians and community leaders to be aware of risk factors surrounding non-lethal overdoses. The following have been linked to increasing the risk of a person experiencing a non-lethal overdose: <ref>https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00007-4/fulltext</ref> <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf</ref>
*Recent release from prison or hospital, with heightened risk periods for non-lethal overdose including the day of admission to prison and 1-4 weeks after release from prison
*1-2 weeks after hospital discharge
*being dispensed opioids or Benzodiazepines for pain
* 3 or more weeks after discontinuation of antipsychotics
*Polysubstance use of Benzodiazepine and opioids, decreasing the efficacy of Naloxone
*Use of opioids for long-term pain management
*Rotating opioid medication regimens (incomplete cross-tolerance)
* History of SUD or prescription misuse and need for pain relief medication
*Completion of detoxification or abstinence (reduced tolerance & high risk of return to use)

'''Types of Treatment for Overdose'''

Recognizing the signs of an overdose is the first critical step to treatment and prevention of it becoming lethal. Signs of an overdose that everyone should be aware of include: <ref>https://nida.nih.gov/publications/drugfacts/naloxone</ref>
*unconsciousness
*very small pupils
*slow or shallow breathing
*vomiting
*inability to speak
*faint heartbeat
*limp arms and legs
*pale skin
*purple lips and fingernails

If an overdose is suspected, call 911 immediately; administer Naloxone if available; move the person to their side and remain with them; and administer CPR if necessary until a first responder arrives. Naloxone is an opioid antagonist which rapidly reverses the symptoms of an opioid overdose by quickly restoring normal breathing. <ref>https://nida.nih.gov/publications/drugfacts/naloxone</ref> It is important to note that Naloxone is a treatment for opioid overdose and NOT for opioid use disorder. It is available as an injection or a nasal spray and can be administered by first responders, family, and friends. Co-prescription of Naloxone and opioids has been shown in some research to reduce the risk of overdose, even if the Naloxone prescription doesn’t get filled, indicating that its prescription serves as an effective educational strategy. <ref>https://nida.nih.gov/publications/drugfacts/naloxone</ref>

Once the emergency of the overdose has passed, the individual is at an increased risk of subsequent overdosing, making the discharge period a critical time for an intervention. Comprehensive treatment addresses many physical and mental health implications of nonlethal overdose. Treatment may look different for each individual, including the following:
*'''MAT''' is clinically effective in treating substance use. For alcohol use disorder, common medications include Disulfiram, Naltrexone, and Acamprosate. FDA-approved options for opioid addiction include Methadone, Buprenorphine, and Naltrexone. The use of MAT has been shown to decrease opioid cravings and “help to sever the ties between opioid use and established situational or emotional triggers.” <ref>https://www.ncbi.nlm.nih.gov/books/NBK541393/</ref> MAT has been clinically found to be the safest option for treating opioid use disorder, therefore access is vital.
*'''Behavioral Therapy in Conjunction with MAT''' targets the broad range of issues and problems that medication doesn’t address, and addresses the “limitations associated with each form of medication.” <ref>https://www.ncbi.nlm.nih.gov/books/NBK541393/</ref> The combination of behavioral therapy and medication is appropriate for individuals whose drug use is the result of extenuating factors such as stress, trauma, resource insecurity, etc., and is seen as an effective addition for those with comorbidities. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541393/</ref>
*'''Individual and Group Substance Use Treatment Therapy.''' Targeted group therapy provides support, witness to recovery, education, resources, accountability, stability, and a model of appropriate behavior. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00371-0</ref> <ref>https://drugabuse.com/treatment/therapy/group/</ref> Individual and family therapies have been shown to reduce use, promote prosocial behaviors, and improve family functioning. <ref>https://health.ri.gov/publications/guides/MasterListOfEvidenceBasedAndInnovativeInterventionsForDrugOverdosePrevention.pdf</ref>
*'''Harm Reduction Services.''' The CDC reports that providing access to evidence-based harm reduction services such as Naloxone, 911, Good Samaritan Laws, SSPs, and MAT can greatly reduce future overdoses. <ref>https://www.cdc.gov/drugoverdose/featured-topics/evidence-based-strategies.html</ref>

= Relevant Research =

*This study found a demographic shift in overdose populations. Nonlethal overdose had primarily been seen in the non-Hispanic white community. However, the epidemic has broadened, and non-Hispanic Black men have seen the highest increase in opioid overdoses. At the time of the study, there was no difference in the likelihood of nonlethal overdose between non-Hispanic White or Black men. This suggests a marked need to address the causes of this change and treatment implementation. <ref>https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00538-9</ref>

*This article examines the unintended effects of drug-reducing policies designed to tackle the opioid epidemic by inhibiting the practice of over-prescribing. Research revealed a reduction in misuse of prescription drugs, but it also found an increase in opioid deaths related to the illicit drug market, suggesting that those who had their prescriptions restricted sought out drugs from an illegal third party. <ref>https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776301</ref>

*This article documents the efficacy of the OdRi Questionnaire that assesses risk factors for an overdose to be used in the medical and mental health fields. The tool shows promise in identifying those at risk for an overdose based upon key components addressing personal, situational, and organizational factors. Results showed mental health, specifically depression, to be a positive predictor of overdoses, along with early-life trauma and stress. Lack of treatment for illicit drug use was a positive predictor for overdoses. <ref>https://www.frontiersin.org/articles/10.3389/fphar.2021.693673/full</ref>

= Impactful Federal, State, and Local Policies =

Policy progress is being made at the federal level. An ACA Medicaid expansion now allows those leaving incarceration to have Medicaid coverage, expanding their access to MAT and other treatment options upon release from jail or prison. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541389/</ref> The Centers for Medicare & Medicaid Services has been working toward federal implementation of PDMPs for prescriptions under Medicare’s Part D plan. <ref>https://drfirst.com/resources/regulatory-mandates/</ref> However, outpatient Methadone treatment can only be used when the patient is enrolled in a state or federally certified opioid treatment program which usually requires a daily visit. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541393/</ref>

Most states have also made considerable progress in the policy domain. However, there is substantial variability in state policies. For example, every state provides ‘’criminal liability’’ protections for first responders and laypersons who administer Naloxone, but 46 states & D.C. provide ‘’civil liability’’ protections, 37 states offer’’ criminal liability’’ protections, and 41 offer ‘’civil liability’’ protections for prescribing or distributing Naloxone. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf </ref> <ref>https://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx</ref> Likewise, 47 states plus D.C. have some form of Good Samaritan Law, but Wyoming, Kansas & Texas do not. Finally, requirements for reporting of non-fatal overdoses vary from state-to-state. <ref>https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00007-4/fulltext </ref>

= Available Tools and Resources =

* SAMHSA has developed the “Opioid Overdose Prevention Toolkit” which provides steps for first responders, information for prescribers, safety advice for patients and family, and information on recovering from an opioid overdose. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf)</ref> It also provides a state-by-state directory of opioid treatment programs. <ref>https://dpt2.samhsa.gov/treatment/</ref> SAMHSA also has a resource for drug-free workplace on policies, testing, employee help and education, supervisor training, and program implementation. Its goal is to assist employers and employees in working towards treating/preventing drug misuse and improve testing that will help with gainful employment rather than punitive termination. <ref>https://www.samhsa.gov/workplace/resources/drug-free-helpline</ref>

*'''SAFE Project:'''
**'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
**'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>
**'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
**See the wiki titled "Increase Access to Overdose Reversal Medications" for more detailed information on increasing community awareness about the importance of Naloxone to reverse opioid overdoses.<ref>https://www.yoursafesolutions.us/wiki/Increase_Access_to_Overdose_Reversal_Medications/</ref>

*The CDC has published “Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States.” <ref>https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf</ref> CDC manages the DOSE program which provides a national dashboard on trends of drug overdoses. <ref>https://www.cdc.gov/overdose-prevention/data-research/facts-stats/dose-dashboard-nonfatal-surveillance-data.html?CDC_AAref_Val=https://www.cdc.gov/drugoverdose/nonfatal/dashboard/index.html</ref>

*The Rhode Island Department of Health has published a “Master List of Evidence-Based and Innovative Interventions for Drug Overdose Prevention,” covering the pillars of prevention, rescue, treatment, and recovery. <ref>https://health.ri.gov/publications/guides/MasterListOfEvidenceBasedAndInnovativeInterventionsForDrugOverdosePrevention.pdf</ref>

*Warm Handoffs offers a wide range of resources for the overdose survivor to help prevent future overdoses and negative health outcomes. This is a cross-disciplinary effort involving medical and health care professionals, law enforcement, and social workers. Successful warm handoff interventions have included provision of Naloxone, post-overdose outreach and follow-up, and emergency department-based screening and referral. <ref>https://preventionsolutions.edc.org/sites/default/files/attachments/Now-What-Role-of-Prevention-Following-a-Nonfatal-Opioid-Overdose_0.pdf</ref>

* CHESS Health provides E-Recovery and mobile health connections to support people with opioid use disorder and to promote positive behavioral change. <ref>https://health.ri.gov/publications/guides/MasterListOfEvidenceBasedAndInnovativeInterventionsForDrugOverdosePrevention.pdf</ref> <ref>https://www.chess.health/solutions/</ref>

= Promising Practices =

Florida’s PDMP is coupled with the implementation of regulated pain clinics and a ban on providers from giving prescription opioids in their offices. This effort resulted in a 50% decrease in overdose deaths. <ref>https://www.cdc.gov/overdose-prevention/?CDC_AAref_Val=https://www.cdc.gov/drugoverdose/policy/successes.html</ref>

= Sources =

Strengthen Peer Recovery Support Services and Programs

2024-10-23T20:08:47Z

Charliekapinos: /* Available Tools and Resources */

 

= Introductory Paragraph =

Peer recovery support services and programs are designed to provide social support throughout the recovery process. These services are provided by those who have experienced substance use disorder and recovery themselves. There has been proven success in peer support and recovery programs, primarily because these services are designed and delivered by peers who have been successful in the recovery process. A peer holds a vast amount of personal experience and knowledge, often referred to as “lived experience.” They are equipped to support their peers along the recovery path with a true understanding of the journey via shared life experiences. Peer Recovery Support Specialists also provide lived experience with mental health and with co-occurring disorders.

= Key Information =

The Substance Abuse and Mental Health Services Administration (SAMHSA) published a guidebook titled "What are Peer Recovery Services?" The guidebook is an all-encompassing coverage of recovery programs. It defines the use of the term peer "to refer to all individuals who share the experiences of addiction and recovery, either directly or as family members or significant others. In a peer-helping-peer service alliance, a peer leader in stable recovery provides social support." <ref>https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers</ref> Peers provide hope and inspire change by walking together with an individual on their recovery path and providing practical and emotional support. There are four types of social support that peers bring to their work: emotional, informational, instrumental, and affiliational support. These are types of support vs. delivery service models and have been found useful with assisting with community-based peer-to-peer services: <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma09-4454.pdf</ref>

* '''Emotional - '''Demonstrate empathy, caring, or concern to bolster person’s self-esteem and confidence. This Includes peer-led support groups and peer mentoring.
* '''Informational - '''Share knowledge and information and/or provide life or vocational skills training. This includes parenting classes, job preparedness, and wellness seminars.
* '''Instrumental - '''Provide concrete assistance to help others accomplish tasks. This includes transportation, childcare, and assistance with accessing community health and social services. Social support peers are often referred to as “walking resources." It is a peer's ethical responsibility to become familiar with and educated about resources offered in their community and to provide linkage to those resources. Peer support is a person-centered, mentoring approach rather than "doing for" the recoveree. The peer builds self-efficacy within the recoveree so as to maintain their recovery.
* '''Affiliational - '''Facilitate contacts with other people to promote learning of social and recreational skills, create community, and acquire a sense of belonging. This includes opportunities within the community and participation in sports and in alcohol and drug-free social events.

Peer support may also be referred to as coaching, peer leadership, or peer mentoring. Delivery of peer support adapts to meet individuals at their current stage in the recovery process. It works throughout all of the different stages of change in the recovery process. Peers work in many settings, such as health departments, social services, child welfare systems, veteran services, youth & family centers, treatment programs, recovery centers, emergency departments, and jails and prison systems. Peers often work on a clinical or programmatic team and, in ideal settings, have well-defined roles. However, one of the challenges to the efficacy of this field is to enhance workplace definition of roles and scope of work of Peer Support Specialists. This is especially true when peers work in a non-recovery-oriented environment. It is critical for them to have adequate support and an understanding from their supervisors regarding their roles. Whether working in a peer-run recovery organization (PRO) or recovery community organization (RCO) or delivering services in a recovery and wellness center or contracting with a drug court, peers face a myriad of hiring options, operational standards, and supervisory concerns. SAMSHA has developed a set of peer core competencies to help guide service delivery of peer support programs and best practices for service delivery. These core competencies were developed by a diverse swath of national experts and peer constituencies. The values and principles are recovery-oriented, person-centered, relationship-focused, and trauma-informed. Guidance is also directed to promote success for behavioral health peer support. <ref>https://www.samhsa.gov/peer-recovery-center-of-excellence</ref>

= Relevant Research =

*'''SAMHSA:'''
**A summary of research on the effectiveness of peer support programs. <ref>https://www.opioidlibrary.org/wp-content/uploads/2021/01/value-of-peers-2017.pdf</ref>
**"Peer Recovery." This infographic summarizes findings from ten articles on peers. <ref>https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/peers-supporting-recovery-substance-use-disorders-2017.pdf</ref>

*'''"Distinguishing Between Recovery Coach and Peer Support Specialists."''' This book provide an overview of the range of professionals involved in provision of recovery services, and it provides an introduction to the work of six foundational thinkers in recovery. <ref> Killeen, M (2020) Recovery Coaching: A Guide to Coaching People in Recovery from Addictions (Second Edition), Kindle Direct Publishing.</ref>

*'''"Peer Support and RCOs."''' This article provides an extensive compilation of research that has been done on harm reduction and the role of RCOs in underserved communities. <ref>https://www.sciencedirect.com/science/article/pii/S0306460319302011?casa_token=SJAHdQwJpmAAAAAA:2IguaCr1U0Op50yboCWsNSTRdiOn0_Z1tmOUWw9jeoSyvpCgrY2J5b29P_ow6eX__dNkw8fV3nQ</ref>

*'''A systematic review''' of nine different studies that examined peer-delivered recovery support services. <ref>https://addictionrecoverytraining.org/wp-content/uploads/2016/08/PeerRecoveryEffectiveness.pdf</ref>

*'''This article''' gives alternatives to 12-step programs. <ref>https://americanaddictioncenters.org/therapy-treatment/12-step-alternatives</ref>

= Impactful Federal, State, and Local Policies =

* The Substance Abuse Prevention and Treatment Block Grant (SABG) provides funds and technical assistance to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, 6 Pacific jurisdictions, and 1 tribal entity. Grantees use the funds to plan, implement, and evaluate activities that prevent and treat substance abuse and promote public health. SABG funds are increasingly being used to hire peers through county health departments (who receive state funding). Likewise, other entities, such as SUD treatment programs contract with the single state agency (SSA) that manages the block grant. <ref>https://www.samhsa.gov/grants/block-grants</ref>

* Child Welfare and Recovery Support Specialist programs have utilized federal funding under Title IV-E Foster Care and Adoption Assistance Program. Waivers were implemented by the Administration for Children and Families (ACF), which allowed states to use funds more flexibly to test innovative approaches for child welfare service delivery and financing. <ref>https://www.acf.hhs.gov/cb/programs/child-welfare-waivers</ref> Other examples of on-going federal funding which were used by these programs include ACF’s Regional Partnership Grants, Temporary Assistance for Needy Families (TANF) and Office of Justice Programs’ Victims of Crime Act. <ref>https://www.acf.hhs.gov/ofa/programs/temporary-assistance-needy-families-tanf</ref>

* The Center for Medicare & Medicaid Services has guidelines and requirements for Medicaid funding for Recovery Peer Support Programs. <ref>https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd081507a.pdf</ref> The guidance and requirements include the following:
** States must identify the Medicaid authority to be used for coverage and payment, as well as describe the service, the provider of the service and their qualifications, and all applicable utilization review and reimbursement methodologies.
** Peer providers must complete a training and certification program as defined by the state.
** Peer providers must receive supervision from a “competent mental health professional.” Such supervision may be provided through direct oversight or periodic care consultation.
** Reimbursement must be based on an identified unit of service and be provided by a single peer provider, based on an approved plan of care. <ref> https://www.gao.gov/assets/gao-20-616.pdf</ref>

* Peer and recovery specialist programs can be financed through a variety of policy-based funding streams. Communities may use existing state and county funds via state Departments of Alcohol and Drug Programs, Mental Health Services, Child Welfare Services, and County Boards of Supervisors’ funds.

= Available Tools and Resources =

* '''SAMHSA''' National Model Standards for Peer Support Certification <ref>https://www.samhsa.gov/about-us/who-we-are/offices-centers/or/model-standards</ref>

*'''SAFE Project:'''
**'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
**See the wiki titled "Improve Access to Recovery Coaches for Parents of Newborns" for more detailed information on the effectiveness of the lived experience and training of a recovery coach to provide comprehensive SUD treatment for new mothers.<ref>https://www.yoursafesolutions.us/wiki/Improve_Access_to_Recovery_Coaches_for_Parents_of_Newborns/</ref>

* '''The Veterans Health Administration''' generated a toolkit for VA Peer Support Specialists, in responses to an executive order to employ 800 peer support specialists. <ref>https://www.mirecc.va.gov/visn4/docs/Peer_Specialist_Toolkit_FINAL.pdf</ref>

* '''National Center of Substance Abuse and Child Welfare''' provides resources and information for peer support and recovery within the child welfare systems including program models and funding resources. <ref>https://ncsacw.samhsa.gov/</ref>

* '''Mental Health America''' provides a certification career roadmap. <ref>https://www.mhanational.org/sites/default/files/NCPS%20Roadmap%20Final_0.pdf</ref> They also offer an online directory of training and certification requirements. <ref>https://www.mhanational.org/how-become-peer-support-specialist</ref>

* '''The Southern Plains Tribal Health Board''' provides a toolkit to assist tribal programs in determining how peer specialists can best serve their tribal organizations and communities. <ref>https://issuu.com/spthb/docs/peer_support_toolkit_booklet</ref>

* '''The New York State Office of Alcoholism and Substance Abuse Services''' provides the New York State Peer Integration Toolkit to assist the integration of peer services into the service delivery system. <ref>https://oasas.ny.gov/system/files/documents/2019/08/PeerIntegrationToolKit-DigitalFinal.pdf</ref>

* '''The City of Philadelphia''' has an interactive toolkit to support behavioral health treatment agencies with the process of integrating peer providers into their service settings. <ref>https://dbhids.org/peer-support-toolkit/</ref>

* ''''The Unity Recovery Organization of Philadelphia''' provides a technology-based program that includes a tele-recovery guide for peer support. <ref>https://www.opioidlibrary.org/wp-content/uploads/2020/04/Unity-Recovery-Telerecovery-RSS-Guide-03-26-2020.pdf</ref>

* '''The College for Behavioral Health Leadership''' in collaboration with Optum Health provides a peer support toolkit that includes peer support job definitions. <ref>https://mhanational.org/sites/default/files/Peer_Services_Toolkit%204-2015.pdf</ref>

* '''Recovery Live''' is on Youtube and includes a variety of virtual events, including this one on strategies to provide supervision of Peer Support Recovery Specialists. <ref>https://www.youtube.com/watch?v=v49QD-UaQK4&list=PLBXgZMI_zqfSRZVtxRBWg7cDja_qy2e-M&index=6</ref>

* '''SMI Advisor''' offers "Building New Horizons: Opening Career Pathways" for peers with criminal justice backgrounds. <ref>https://smiadviser.org/wp-content/uploads/2023/07/Building-New-Horizons-Peer-Hiring-Guide-FINAL.pdf</ref>

* '''Youth Move National''' published a report titled "Operationalizing and Funding for Youth-Based Peer Support Programs." It includes an overview on the delivery of youth-based services via state-based Medicaid. <ref>https://youthmovenational.org/wp-content/uploads/2020/07/Operationalizing-Peer-Support-FINAL-electronic.pdf</ref>

= Promising Practices =

This report highlights four programs that have demonstrated positive child welfare and recovery outcomes for families. <ref>https://ncsacw.samhsa.gov/files/peer19_brief.pdf</ref>

= Sources =

Support and Advance Effective Treatment

2024-10-23T20:06:49Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

According to a 2022 national survey, about 48.7 million people ages 12 and over in the United States had a substance use disorder within the past year. <ref>https://www.hhs.gov/about/news/2023/11/13/hhs-samhsa-release-2022-national-survey-drug-use-health-data.html</ref> Only about 11% receive treatment. <ref>https://drugfree.org/drug-and-alcohol-news/new-data-show-millions-of-americans-with-alcohol-and-drug-addiction-could-benefit-from-health-care-reform/</ref> There is an increasingly important need to provide options for individuals who may benefit from quality and affordable alcohol and drug treatment programs. The demand for treatment is met with a shortage of quality recovery centers in America, which makes it difficult for individuals ''and their families'' to receive the care they need. The small populations in rural communities, for example, cannot support the specialized treatment or trained primary care practitioners who are willing to treat individuals living with addiction. This leads many individuals to either go without care or join waitlists for treatment.

Those living with substance use disorders are among the highest cost of healthcare users. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Overdose patients in particular place a heavy burden on first responders, emergency departments, and the foster care system. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Some options to solve this issue could include innovations such as expanded use of online tools and assessments, integration of primary care treatment, and virtual reality. <ref>Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine, 370(22), 2063–2066. https://doi.org/10.1056/NEJMp1402780</ref>

There are several evidence-based therapies for alcohol and drug misuse, with most common being talk therapy, medications, and support groups. Evidence-based therapies include cognitive behavioral therapy and 12 step-programs. Medication-assisted treatment has also proven effective in treatment of opioid use disorder. Medication in combination with talk therapy can reduce withdrawal symptoms and promote long-term recovery.

= Key Information =

There are multiple effective pathways leading to long-term recovery and improvements in work, family, relationships, and overall mental health and well-being. Substance use disorders treatments which meet the needs of the individual may include the following:<ref>https://www.goodrx.com/conditions/substance-use-disorder/best-therapies-for-alcohol-and-drug-use</ref>
*Therapy (individual, group, couples & families)
*Medications
*A combination of therapy and medications
*Peer support programs
*12-step or recovery programs
*Family support and family recovery programs

'''Treatment Options'''

There are inpatient treatment choices, such as residential treatment, and outpatient options, depending on what is best suited for the level of care for an individual. Treatment may require detox on either an outpatient or inpatient basis, depending upon professional medical advice. Other treatment programs include recovery coaching, recovery housing, recovery management, peer-led recovery community centers, and recovery-based education. Specific evidence-based treatments that have been researched and scientifically proven include:

*Cognitive behavioral therapy (CBT) provides one-to-one attention by a a therapist. CBT has been proven to reduce substance use and to have a positive impact for life improvements. CBT has also been proven to be effective with trauma which often coincides with substance use disorders. <ref>https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral</ref>

*12-step therapy programs, such as Alcoholics Anonymous and Narcotics Anonymous, are self-help group programs which are evidence-based in assisting with maintaining sobriety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/</ref> While quite common, there is some controversy associated with an emphasis on total abstinence, which limits advancing multiple pathways. Likewise, the documentary "The Business of Recovery" maintains that 12-step programs are typically only helpful for 5-10% of people who partake in them. <ref> Inside The $35 Billion Addiction Treatment Industry. (n.d.). Retrieved December 5, 2019, from https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry/#c20c67817dc9</ref>

*Medication-assisted treatment (MAT) is available in accredited and certified private and public clinics across the United States. It is a combination of medications and talk therapy. Depending on the substance, MAT is an evidence-based option for recovery from alcohol and opioid use. <ref>https://www.samhsa.gov/medication-assisted-treatment</ref> MAT A combination of medication, counseling, and behavioral therapy is regarded as the most effective in treating opioid dependency. <ref>https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions</ref> The Substance Abuse and Mental Health Administration (SAMHSA) is responsible for overseeing the certification of opioid treatment programs which use Buprenorphine, Methadone, and Naltrexone. <ref>https://www.samhsa.gov/medication-assisted-treatment</ref>

'''Implementing Treatment in the Primary Care Setting'''

Primary care providers are highly likely to come in contact with individuals who are struggling with substance use disorders, but only about 3,600 physicians are board-certified in treating addiction. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Approximately 4% of all physicians nationwide are certified to prescribe medication for opioid use disorder. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> A majority of individuals who use MAT must obtain their medication from Methadone clinics. While these clinics are helpful in assisting people in getting their medication, it is difficult for specialty clinics to meet the demand for services. This calls for more primary care providers to obtain the training and certifications to treat complex cases of substance use disorders. One possible solution for getting more primary care physicians to assist in this issue is to incentivize the screening and treatment of addiction. There are many challenges that primary care providers may face when choosing to treat addiction patients, including stigma, the complexity of this population, and reimbursement for services.

= Relevant Research =

'''HHS''' has a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." This study addresses the models of care, quality improvement interventions, and best practices used by higher-performing health plans to improve initiation and engagement in SUD treatment. It also describes the provider, beneficiary, and market factors that affect their ability to successfully initiate and engage beneficiaries in substance use treatment services. <ref>https://aspe.hhs.gov/sites/default/files/private/pdf/260791/BestSUD.pdf</ref>

'''This NIDA article''' provides a literature review of treatment communities, such as community lodges and sober houses that have seen themselves as a mutual self-help alternative to medically oriented strategies to address addiction. <ref> "Therapeutic Communities Research Report - What Are Therapeutic Communities?" https://nida.nih.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities</ref>

'''This book''' is in its third edition and is titled "Principles of Drug Addiction Treatment: A Research-Based Guide." It offers health professionals and other stakeholders information on principles of effective drug addiction treatment, answers to frequently asked questions, an overview of the drug addiction treatment landscape in the United States, and an outline of evidence-based treatment approaches. <ref>https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf</ref>

'''This book''' provides a set of analyses focused on the evaluation of alcohol and drug treatment programs. <ref>https://books.google.com/books?hl=en&lr=&id=LgclBQAAQBAJ&oi=fnd&pg=PP1&dq=Support+and+Advance+Effective+Treatment+substance+use&ots=z6SXDo7zXf&sig=5s1IZ8fM_dRUr9R4uusM9d7Tlas#v=onepage&q=Support%20and%20Advance%20Effective%20Treatment%20substance%20use&f=false</ref>

'''This article''' provides a comprehensive review of empirical studies that have addressed differences in patient outcomes and retention rates and their correlation to the effectiveness of the therapists. It notes that the differences appear to be independent of both the therapists' professional background and the patient factors at the start of therapy and that the primary therapist characteristic associated with higher effectiveness is the possession of strong interpersonal skills. <ref>https://pubmed.ncbi.nlm.nih.gov/8069169/</ref>

'''This article''' provides a review and meta-analysis of treatment services for patients with alcohol use disorders. The research found that pharmaceutical interventions when used with psychosocial co-interventions, resulted in better outcomes. This supports the advantage of the strategy of adding medication to treatment programs for opioid users. <ref>Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings: A Systematic Review and Meta-analysis | Research, Methods, Statistics | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/1869208</ref>

'''Cost/Benefit Analysis.''' Drug treatment programs are known for being expensive and difficult to find. Current research suggests that when people are able to enroll in treatment, the benefits impact not only on individuals living with a substance use disorder but also healthcare administrations, law enforcement, and the criminal justice system. Recent data suggests that every dollar spent on substance use treatment centers saves $4 in health care costs and $7 in criminal justice and law enforcement involvement. <ref>https://americanaddictioncenters.org/rehab-guide/public-assistance</ref> Over $8,200 can be saved on health care and productivity costs per individual who spends at least 60 days in a quality substance abuse treatment program. <ref>https://americanaddictioncenters.org/rehab-guide/public-assistance</ref> Thus, it is effective to invest taxpayer dollars and government resources to implement accessible, affordable, and quality treatment centers -- regardless of access to insurance or financial status.

= Impactful Federal, State, and Local Policies =

'''The STOP Act.''' The Sober Truth on Preventing (STOP) Underage Drinking Act of 2006 which was reauthorized in 2016 as part of the 21st Century Cures Act. It mandates community coalition enhancement grants, epidemiological research on excessive and underage drinking, and the annual report to Congress on state underage drinking and enforcement activities. It also launched a national adult-oriented media campaign managed by the Interagency Coordinating Committee to Prevent Underage Drinking (ICCPUD). <ref>https://www.cadca.org/stop-act</ref>

'''Facing Addiction in America: The Surgeon General's Report''' provides a review of prevention, treatment, and recovery policies and programs and discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment. <ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref>

'''California.''' The Safe Neighborhoods and Schools Act (Proposition 47) reclassified certain theft and drug charges from felonies to misdemeanors enabling focus on more violent crimes and serious offenses. This resulted in monetary savings being directed to school programs, victim services, and mental health. The creation of new drug treatment programs offered a way to decrease recidivism and to support those with newly classified misdemeanor drug possession charges to have more options for recovery. <ref>https://crimesolutions.ojp.gov/ratedprograms/740</ref>

= Available Tools and Resources =

'''SAMHSA''' has numerous resources including:
*Behavioral Health Treatment Services Locator -- a confidential and anonymous source of information for persons seeking treatment facilities for substance use/addiction and/or mental health problems. FindTreatment.gov allows users to search for treatment centers while filtering for treatment type, location, and payment options to include private health insurance, Medicaid, or free or no-cost care. There are also filters for special populations such as veterans, LGBTQ+, differently abled individuals, age groups, and language preference. <ref>https://findtreatment.gov/locator</ref>
*The Evidence-Based Practices Resource Center which provides communities, clinicians, policy-makers, and others with information and tools to incorporate evidence-based practices into their communities or clinical settings. <ref>https://www.samhsa.gov/resource-search/ebp</ref>
*"Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." This resource places the selection of programs and practices within the broader context of evidence-based prevention and covers the value of embedding program and practice selection in a strategic planning process. It provides information on programs and practices, how to choose among them, and tips for their adoption, adaptation, and implementation, and continual improvement. <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

'''SAFE Project:'''
*'''Treatment and Family Support Locator''' is a SAFE Project and University of Maryland created resource designed to allow users seeking substance use/mental health treatment to search the SAMHSA Treatment Locator database using more specific criteria to help find the best options available.<ref>https://safelocator.org/en/search</ref>
*'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>

'''BJA''' has published "Promising Practices Guidelines for Residential Substance Abuse Treatment." This aims to assist correctional administrators and practitioners at the state and county levels in establishing and maintaining programs that adhere to the promising practices suggested by current research and standards for substance-use disorder treatment and criminal justice programming. <ref>https://bja.ojp.gov/library/publications/promising-practices-guidelines-residential-substance-abuse-treatment</ref>

'''The National Association of Addiction Treatment Providers''' has a web page titled "Navigate Treatment Options" which provides addiction and treatment FAQs. It evaluates new methods based on developments in neurobiology and behavioral health. It integrates best practices within the bio-psycho-social-spiritual treatment model. <ref>https://www.naatp.org/addiction-treatment-resources/types-treatment</ref>

'''American Addiction Centers''' provides "Treatment Solutions," an online resource dedicated to helping people find solutions to meet their specific treatment needs. <ref>https://treatmentsolutions.com/admissions/</ref> Its website describes how and where to locate free or low-cost drug rehabilitation programs and highlights options for state-funded drug treatment programs, who qualifies for services, and how to local find state-funded treatment options. <ref>https://americanaddictioncenters.org/rehab-guide/free</ref> It also gives information about other possible payment options for treatment such as scholarships, loans, insurance, and how to ask friends and family for support. American Addiction Centers also provides a succinct overview of SAMHSA programs, grants, and treatment services. <ref>https://treatmentsolutions.com/treatment/rehab-guide/samhsa/</ref>

'''Advanced Recovery Systems''' is a behavioral health company focused on helping people on their path to recovery from substance abuse and mental health issues. It operates a network of inpatient and outpatient addiction and mental health treatment facilities and hosts a website that provides a assistance in navigating insurance for treatment. <ref>http://Drugrehab.com</ref> and a tool that checks if your insurance provider covers addiction care. <ref>https://www.drugrehab.com/insurance-check/</ref>

'''Pew Trusts''' 10 Ways That States Can Improve Substance Use Treatment. <ref>https://www.pewtrusts.org/en/research-and-analysis/articles/2023/09/18/10-ways-that-states-can-improve-substance-use-treatment</ref>

'''Apps and Online Resources:'''
*'''Life Recovery Program''' is an online program that could be a useful option for people who live in rural areas or for people who are incarcerated. The program consists of bi-weekly online video/audio workshops and practical tools, along with homework exercising, grounding techniques, and supportive emails. It is designed to last 3 to 6 months. <ref>https://www.liferecoveryprogram.org/</ref>
*'''myStrength''' is an online and smartphone platform that can enhance the capacity of mental health service providers by enabling them to serve more people more effectively. It can also provide tools to support people between professional consultations. There is solid and growing research on the value and effectiveness of the platform. <ref>http://mystrength.com/outcomes</ref>
*'''reSET-O.''' Digital Therapeutics Alliance developed this eFORMULATIONS treatment tool for opiate dependence. It is a mobile medical application that is used in conjunction with pharmaceutical therapies to treat opioid dependence. Clinical trials have shown reSET-O to be a promising solution to opiate dependence, showing that reSET-O plus pharmacotherapy achieved enhanced abstinence from opioids, reduced drop-outs in treatment, and reduced required clinical intervention when compared to traditional face-to-face therapy. <ref>https://dtxalliance.org/products/reset-o/</ref>
*'''ShoutOut''' is an app developed by Recovery Centers of America Telehealth. It delivers comprehensive and evidence-based outpatient treatment for addiction and co-occurring disorders. There are three available levels of treatment available to serve each individual’s needs. Group, individual, and family options are implemented into the program. <ref>https://recoverycentersofamerica.com/outpatient/</ref>

= Promising Practices =

'''Kentucky.''' In Kenton County, the prison has become an important treatment facility. Instead of focusing on punishing people with substance use issues, the Kenton County Detention Center envisions turning a time of incarceration into a time for much-needed treatment. Leaders in Kenton County believe that jail may be the best place to initiate recovery. People often end up in jail for minor crimes, long before they commit more serious crimes which warrant a prison sentence. Kenton County is one of over 20 Kentucky county jails that have started full-time therapeutic communities that focus on rehabilitation within their walls, providing inmates the type of services that private treatment centers offer on the outside. <ref>Opinion | Addicts Need Help. Jails Could Have the Answer. - The New York Times. (n.d.). https://www.nytimes.com/2017/06/16/opinion/sunday/opioid-epidemic-kentucky-jails.html</ref>

'''Maryland.''' The Baltimore County Health Department provides treatment through community providers for substance users and their families. It develops, coordinates, and monitors a countywide network of substance use prevention and disorder treatment services. The Health Department also operates a dedicated phone line staffed with clinical social workers with specialized training in helping people with substance use issues move toward recovery. <ref>https://www.baltimorecountymd.gov/departments/health/health-services/substance-use/</ref>

'''Massachusetts.''' Boston Medical Center opened its Faster Paths to Treatment Opioid Urgent Care Center in 2016. This center, which is specifically for treating patients addicted to prescription painkillers, is located next to the hospital emergency room, giving patients immediate access to comprehensive care including counseling, case management, home visits, and transportation to detox. <ref>https://www.bmc.org/faster-paths-treatment</ref>

= Sources =

Support and Advance Effective Treatment

2024-10-23T20:06:05Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

According to a 2022 national survey, about 48.7 million people ages 12 and over in the United States had a substance use disorder within the past year. <ref>https://www.hhs.gov/about/news/2023/11/13/hhs-samhsa-release-2022-national-survey-drug-use-health-data.html</ref> Only about 11% receive treatment. <ref>https://drugfree.org/drug-and-alcohol-news/new-data-show-millions-of-americans-with-alcohol-and-drug-addiction-could-benefit-from-health-care-reform/</ref> There is an increasingly important need to provide options for individuals who may benefit from quality and affordable alcohol and drug treatment programs. The demand for treatment is met with a shortage of quality recovery centers in America, which makes it difficult for individuals ''and their families'' to receive the care they need. The small populations in rural communities, for example, cannot support the specialized treatment or trained primary care practitioners who are willing to treat individuals living with addiction. This leads many individuals to either go without care or join waitlists for treatment.

Those living with substance use disorders are among the highest cost of healthcare users. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Overdose patients in particular place a heavy burden on first responders, emergency departments, and the foster care system. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Some options to solve this issue could include innovations such as expanded use of online tools and assessments, integration of primary care treatment, and virtual reality. <ref>Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine, 370(22), 2063–2066. https://doi.org/10.1056/NEJMp1402780</ref>

There are several evidence-based therapies for alcohol and drug misuse, with most common being talk therapy, medications, and support groups. Evidence-based therapies include cognitive behavioral therapy and 12 step-programs. Medication-assisted treatment has also proven effective in treatment of opioid use disorder. Medication in combination with talk therapy can reduce withdrawal symptoms and promote long-term recovery.

= Key Information =

There are multiple effective pathways leading to long-term recovery and improvements in work, family, relationships, and overall mental health and well-being. Substance use disorders treatments which meet the needs of the individual may include the following:<ref>https://www.goodrx.com/conditions/substance-use-disorder/best-therapies-for-alcohol-and-drug-use</ref>
*Therapy (individual, group, couples & families)
*Medications
*A combination of therapy and medications
*Peer support programs
*12-step or recovery programs
*Family support and family recovery programs

'''Treatment Options'''

There are inpatient treatment choices, such as residential treatment, and outpatient options, depending on what is best suited for the level of care for an individual. Treatment may require detox on either an outpatient or inpatient basis, depending upon professional medical advice. Other treatment programs include recovery coaching, recovery housing, recovery management, peer-led recovery community centers, and recovery-based education. Specific evidence-based treatments that have been researched and scientifically proven include:

*Cognitive behavioral therapy (CBT) provides one-to-one attention by a a therapist. CBT has been proven to reduce substance use and to have a positive impact for life improvements. CBT has also been proven to be effective with trauma which often coincides with substance use disorders. <ref>https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral</ref>

*12-step therapy programs, such as Alcoholics Anonymous and Narcotics Anonymous, are self-help group programs which are evidence-based in assisting with maintaining sobriety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/</ref> While quite common, there is some controversy associated with an emphasis on total abstinence, which limits advancing multiple pathways. Likewise, the documentary "The Business of Recovery" maintains that 12-step programs are typically only helpful for 5-10% of people who partake in them. <ref> Inside The $35 Billion Addiction Treatment Industry. (n.d.). Retrieved December 5, 2019, from https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry/#c20c67817dc9</ref>

*Medication-assisted treatment (MAT) is available in accredited and certified private and public clinics across the United States. It is a combination of medications and talk therapy. Depending on the substance, MAT is an evidence-based option for recovery from alcohol and opioid use. <ref>https://www.samhsa.gov/medication-assisted-treatment</ref> MAT A combination of medication, counseling, and behavioral therapy is regarded as the most effective in treating opioid dependency. <ref>https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions</ref> The Substance Abuse and Mental Health Administration (SAMHSA) is responsible for overseeing the certification of opioid treatment programs which use Buprenorphine, Methadone, and Naltrexone. <ref>https://www.samhsa.gov/medication-assisted-treatment</ref>

'''Implementing Treatment in the Primary Care Setting'''

Primary care providers are highly likely to come in contact with individuals who are struggling with substance use disorders, but only about 3,600 physicians are board-certified in treating addiction. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Approximately 4% of all physicians nationwide are certified to prescribe medication for opioid use disorder. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> A majority of individuals who use MAT must obtain their medication from Methadone clinics. While these clinics are helpful in assisting people in getting their medication, it is difficult for specialty clinics to meet the demand for services. This calls for more primary care providers to obtain the training and certifications to treat complex cases of substance use disorders. One possible solution for getting more primary care physicians to assist in this issue is to incentivize the screening and treatment of addiction. There are many challenges that primary care providers may face when choosing to treat addiction patients, including stigma, the complexity of this population, and reimbursement for services.

= Relevant Research =

'''HHS''' has a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." This study addresses the models of care, quality improvement interventions, and best practices used by higher-performing health plans to improve initiation and engagement in SUD treatment. It also describes the provider, beneficiary, and market factors that affect their ability to successfully initiate and engage beneficiaries in substance use treatment services. <ref>https://aspe.hhs.gov/sites/default/files/private/pdf/260791/BestSUD.pdf</ref>

'''This NIDA article''' provides a literature review of treatment communities, such as community lodges and sober houses that have seen themselves as a mutual self-help alternative to medically oriented strategies to address addiction. <ref> "Therapeutic Communities Research Report - What Are Therapeutic Communities?" https://nida.nih.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities</ref>

'''This book''' is in its third edition and is titled "Principles of Drug Addiction Treatment: A Research-Based Guide." It offers health professionals and other stakeholders information on principles of effective drug addiction treatment, answers to frequently asked questions, an overview of the drug addiction treatment landscape in the United States, and an outline of evidence-based treatment approaches. <ref>https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf</ref>

'''This book''' provides a set of analyses focused on the evaluation of alcohol and drug treatment programs. <ref>https://books.google.com/books?hl=en&lr=&id=LgclBQAAQBAJ&oi=fnd&pg=PP1&dq=Support+and+Advance+Effective+Treatment+substance+use&ots=z6SXDo7zXf&sig=5s1IZ8fM_dRUr9R4uusM9d7Tlas#v=onepage&q=Support%20and%20Advance%20Effective%20Treatment%20substance%20use&f=false</ref>

'''This article''' provides a comprehensive review of empirical studies that have addressed differences in patient outcomes and retention rates and their correlation to the effectiveness of the therapists. It notes that the differences appear to be independent of both the therapists' professional background and the patient factors at the start of therapy and that the primary therapist characteristic associated with higher effectiveness is the possession of strong interpersonal skills. <ref>https://pubmed.ncbi.nlm.nih.gov/8069169/</ref>

'''This article''' provides a review and meta-analysis of treatment services for patients with alcohol use disorders. The research found that pharmaceutical interventions when used with psychosocial co-interventions, resulted in better outcomes. This supports the advantage of the strategy of adding medication to treatment programs for opioid users. <ref>Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings: A Systematic Review and Meta-analysis | Research, Methods, Statistics | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/1869208</ref>

'''Cost/Benefit Analysis.''' Drug treatment programs are known for being expensive and difficult to find. Current research suggests that when people are able to enroll in treatment, the benefits impact not only on individuals living with a substance use disorder but also healthcare administrations, law enforcement, and the criminal justice system. Recent data suggests that every dollar spent on substance use treatment centers saves $4 in health care costs and $7 in criminal justice and law enforcement involvement. <ref>https://americanaddictioncenters.org/rehab-guide/public-assistance</ref> Over $8,200 can be saved on health care and productivity costs per individual who spends at least 60 days in a quality substance abuse treatment program. <ref>https://americanaddictioncenters.org/rehab-guide/public-assistance</ref> Thus, it is effective to invest taxpayer dollars and government resources to implement accessible, affordable, and quality treatment centers -- regardless of access to insurance or financial status.

= Impactful Federal, State, and Local Policies =

'''The STOP Act.''' The Sober Truth on Preventing (STOP) Underage Drinking Act of 2006 which was reauthorized in 2016 as part of the 21st Century Cures Act. It mandates community coalition enhancement grants, epidemiological research on excessive and underage drinking, and the annual report to Congress on state underage drinking and enforcement activities. It also launched a national adult-oriented media campaign managed by the Interagency Coordinating Committee to Prevent Underage Drinking (ICCPUD). <ref>https://www.cadca.org/stop-act</ref>

'''Facing Addiction in America: The Surgeon General's Report''' provides a review of prevention, treatment, and recovery policies and programs and discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment. <ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref>

'''California.''' The Safe Neighborhoods and Schools Act (Proposition 47) reclassified certain theft and drug charges from felonies to misdemeanors enabling focus on more violent crimes and serious offenses. This resulted in monetary savings being directed to school programs, victim services, and mental health. The creation of new drug treatment programs offered a way to decrease recidivism and to support those with newly classified misdemeanor drug possession charges to have more options for recovery. <ref>https://crimesolutions.ojp.gov/ratedprograms/740</ref>

= Available Tools and Resources =

'''SAMHSA''' has numerous resources including:
*Behavioral Health Treatment Services Locator -- a confidential and anonymous source of information for persons seeking treatment facilities for substance use/addiction and/or mental health problems. FindTreatment.gov allows users to search for treatment centers while filtering for treatment type, location, and payment options to include private health insurance, Medicaid, or free or no-cost care. There are also filters for special populations such as veterans, LGBTQ+, differently abled individuals, age groups, and language preference. <ref>https://findtreatment.gov/locator</ref>
*The Evidence-Based Practices Resource Center which provides communities, clinicians, policy-makers, and others with information and tools to incorporate evidence-based practices into their communities or clinical settings. <ref>https://www.samhsa.gov/resource-search/ebp</ref>
*"Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." This resource places the selection of programs and practices within the broader context of evidence-based prevention and covers the value of embedding program and practice selection in a strategic planning process. It provides information on programs and practices, how to choose among them, and tips for their adoption, adaptation, and implementation, and continual improvement. <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

'''SAFE Project:'''
*'''Treatment and Family Support Locator''' is a SAFE Project and University of Maryland created resource designed to search the SAMHSA Treatment Locator database using more criteria to help find the best/more specific options available.<ref>https://safelocator.org/en/search</ref>
*'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>

'''BJA''' has published "Promising Practices Guidelines for Residential Substance Abuse Treatment." This aims to assist correctional administrators and practitioners at the state and county levels in establishing and maintaining programs that adhere to the promising practices suggested by current research and standards for substance-use disorder treatment and criminal justice programming. <ref>https://bja.ojp.gov/library/publications/promising-practices-guidelines-residential-substance-abuse-treatment</ref>

'''The National Association of Addiction Treatment Providers''' has a web page titled "Navigate Treatment Options" which provides addiction and treatment FAQs. It evaluates new methods based on developments in neurobiology and behavioral health. It integrates best practices within the bio-psycho-social-spiritual treatment model. <ref>https://www.naatp.org/addiction-treatment-resources/types-treatment</ref>

'''American Addiction Centers''' provides "Treatment Solutions," an online resource dedicated to helping people find solutions to meet their specific treatment needs. <ref>https://treatmentsolutions.com/admissions/</ref> Its website describes how and where to locate free or low-cost drug rehabilitation programs and highlights options for state-funded drug treatment programs, who qualifies for services, and how to local find state-funded treatment options. <ref>https://americanaddictioncenters.org/rehab-guide/free</ref> It also gives information about other possible payment options for treatment such as scholarships, loans, insurance, and how to ask friends and family for support. American Addiction Centers also provides a succinct overview of SAMHSA programs, grants, and treatment services. <ref>https://treatmentsolutions.com/treatment/rehab-guide/samhsa/</ref>

'''Advanced Recovery Systems''' is a behavioral health company focused on helping people on their path to recovery from substance abuse and mental health issues. It operates a network of inpatient and outpatient addiction and mental health treatment facilities and hosts a website that provides a assistance in navigating insurance for treatment. <ref>http://Drugrehab.com</ref> and a tool that checks if your insurance provider covers addiction care. <ref>https://www.drugrehab.com/insurance-check/</ref>

'''Pew Trusts''' 10 Ways That States Can Improve Substance Use Treatment. <ref>https://www.pewtrusts.org/en/research-and-analysis/articles/2023/09/18/10-ways-that-states-can-improve-substance-use-treatment</ref>

'''Apps and Online Resources:'''
*'''Life Recovery Program''' is an online program that could be a useful option for people who live in rural areas or for people who are incarcerated. The program consists of bi-weekly online video/audio workshops and practical tools, along with homework exercising, grounding techniques, and supportive emails. It is designed to last 3 to 6 months. <ref>https://www.liferecoveryprogram.org/</ref>
*'''myStrength''' is an online and smartphone platform that can enhance the capacity of mental health service providers by enabling them to serve more people more effectively. It can also provide tools to support people between professional consultations. There is solid and growing research on the value and effectiveness of the platform. <ref>http://mystrength.com/outcomes</ref>
*'''reSET-O.''' Digital Therapeutics Alliance developed this eFORMULATIONS treatment tool for opiate dependence. It is a mobile medical application that is used in conjunction with pharmaceutical therapies to treat opioid dependence. Clinical trials have shown reSET-O to be a promising solution to opiate dependence, showing that reSET-O plus pharmacotherapy achieved enhanced abstinence from opioids, reduced drop-outs in treatment, and reduced required clinical intervention when compared to traditional face-to-face therapy. <ref>https://dtxalliance.org/products/reset-o/</ref>
*'''ShoutOut''' is an app developed by Recovery Centers of America Telehealth. It delivers comprehensive and evidence-based outpatient treatment for addiction and co-occurring disorders. There are three available levels of treatment available to serve each individual’s needs. Group, individual, and family options are implemented into the program. <ref>https://recoverycentersofamerica.com/outpatient/</ref>

= Promising Practices =

'''Kentucky.''' In Kenton County, the prison has become an important treatment facility. Instead of focusing on punishing people with substance use issues, the Kenton County Detention Center envisions turning a time of incarceration into a time for much-needed treatment. Leaders in Kenton County believe that jail may be the best place to initiate recovery. People often end up in jail for minor crimes, long before they commit more serious crimes which warrant a prison sentence. Kenton County is one of over 20 Kentucky county jails that have started full-time therapeutic communities that focus on rehabilitation within their walls, providing inmates the type of services that private treatment centers offer on the outside. <ref>Opinion | Addicts Need Help. Jails Could Have the Answer. - The New York Times. (n.d.). https://www.nytimes.com/2017/06/16/opinion/sunday/opioid-epidemic-kentucky-jails.html</ref>

'''Maryland.''' The Baltimore County Health Department provides treatment through community providers for substance users and their families. It develops, coordinates, and monitors a countywide network of substance use prevention and disorder treatment services. The Health Department also operates a dedicated phone line staffed with clinical social workers with specialized training in helping people with substance use issues move toward recovery. <ref>https://www.baltimorecountymd.gov/departments/health/health-services/substance-use/</ref>

'''Massachusetts.''' Boston Medical Center opened its Faster Paths to Treatment Opioid Urgent Care Center in 2016. This center, which is specifically for treating patients addicted to prescription painkillers, is located next to the hospital emergency room, giving patients immediate access to comprehensive care including counseling, case management, home visits, and transportation to detox. <ref>https://www.bmc.org/faster-paths-treatment</ref>

= Sources =

Improve Access to Recovery Coaches for Parents of Newborns

2024-10-23T20:01:28Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

New motherhood is an incredibly stressful period of life for women. They must heal from the birth, adjust to the physical and mental demands of caring for a newborn, and make peace with their new lifestyle. There are a myriad of outside factors that influence this new phase, and new life hurdles are exacerbated for mothers with a substance use disorder who are trying to get to or maintain sobriety on top of having a new baby. During the first year after their baby is born, the relapse rate for new mothers is incredibly high at 80%. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387084/</ref> Becoming sober and maintaining sobriety is no easy feat by itself, just as new motherhood is not. The combination of both circumstances is one which clinicians need to address with the utmost care, respect, and diligence. This critical time period can be profoundly improved by the addition of a recovery coach to the new mother's support team. SUDs are one of the main contributors to child removal and failed reunification of the child and parent, and the help of recovery coaches in reaching and maintaining sobriety has been shown to greatly impact the outcomes of parental-child cohabitation. <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref> <ref>https://evidencebasedprograms.org/programs/recovery-coaches/</ref> The effectiveness of the lived experience and the training of the recovery coach cannot be understated in its value to comprehensive SUD treatment for new mothers. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

=Key Information=

'''The Definition of a Recovery Coach.'''

''The NC Pregnancy and Opioid Exposure Project'' defines a recovery coach as a “paraprofessional who assists parents in obtaining needed benefits, coordinates child welfare and substance abuse treatment staff, and connects the family with treatment providers.” <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref> While they are independent of these agencies, they will often be at home visits with agents from child welfare and substance abuse treatment programs. <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref>

''The U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation (OPRE)'' describes recovery coaches who work in the child welfare system as those who work with parents who have had a child or are at risk of having a child removed from their care due to SUD. They, “increase access to and engagement in treatment and other services to support parents’ recovery, coordinate with child welfare agency staff, and ensure treatment and recovery progress is incorporated into plans to either maintain children with their families of origin or place them with other permanent families.” <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref>

The specific responsibilities of recovery coaches will vary from program to program. Some programs may require a bachelor’s degree. Many others employ peer recovery coaches who have lived experience, whether they have had success in SUD recovery and new parenting or have been directly involved with a loved one in that situation. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref> <ref>https://www.medstarhealth.org/-/media/project/mho/medstar/pdf/msh-ch-peer-recovery-coach-brochure_final.pdf</ref>

''SAMHSA'' has published ethical guidelines for peer-based recovery when the recovery coach is not a licensed clinician. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>
These guidelines provide a clear-cut picture of the competencies and responsibilities of a recovery coach and are intended to prevent any role confusion and potential unqualified treatment, because many programs presents overlapping duties between recovery coaches and other treatment players. According to these guidelines, employed peer recovery coaches are meant to provide emotional, informational, and instrumental support along with companionship in recovery. A recovery coach following these guidelines fulfills a mix of the following roles: <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

*Outreach worker
*Motivator and cheerleader
**Offers a living example of hard work/recovery success
**Encourages & celebrates recovery milestones
**Encourages & models self-advocacy and self-sufficiency
*Ally & confidant - can be trusted, cares, and listens
*Truthteller - provides honest, constructive feedback on recovery progress
*Role model & mentor
*Planner
*Problem solver
*Resource broker
*Monitor
*Tour guide
*Advocate
*Educator
*Community organizer
*Lifestyle consultant/guide
*Friend

The SAMHSA guidelines note that a recovery coach is NOT a sponsor, therapist/counselor, nurse/physician, or a member of the clergy. Tasks that fall into the wheelhouse of these professions should not be permitted and always referred out by the recovery coach. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

Substance use disorder and postpartum depression are commonly identified as having comorbidity, regardless of which condition came first. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref> It is important that the recovery coach not blur the lines in giving clinical advice regarding postpartum depression and maintain services that align to their training. However, the co-occurrence of the two conditions may indicate a greater need for the recovery coach, as they can alleviate some of the burdens of finding resources while providing social support which is critical for those with depression. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref> <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518627/</ref>

'''Role of Recovery Coaches in the Postpartum Period.'''

Sobriety during pregnancy is an important goal, and about 85% of pregnant women with a substance use disorder are able to maintain abstinence from at least one substance while they are carrying their baby. <ref>https://www.recoveryanswers.org/research-post/stopping-starting-substance-use-pregnancy/</ref> However, the first year of postpartum is very dangerous for women who struggle with SUD. Mothers who have an SUD face challenges which may propel them towards relapses, such as food insecurities, legal troubles, the threat of infant removal, and domestic turmoil. Resources to aid the new mother in her recovery need to extend beyond birth and be tailored to the unique situations these mothers face with their addiction. Mothers with an SUD are a priority for substance treatment while pregnant, as the continued use can have a major impact on the fetus. However, many women, regardless of insurance status, see their treatment options dwindle postpartum, as the shift of medical attention goes from the mother to the infant. <ref>https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/08/14/for-addicted-women-the-year-after-childbirth-is-the-deadliest</ref>

Programs implementing recovery coaching have seen success with achieving and maintaining postpartum sobriety because the coach has unique, lived experience which they provide to help navigate these struggles. With so much stigma surrounding new mothers with an SUD, a primary goal of recovery coaching is to empower the mother without judgment. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref> The coach’s lived experience can bring a sense of hope and trust to the new mother, upon seeing a peer who has gone through similar circumstances have success in maintaining sobriety. Because the recovery coach has had life experience coupled with paraprofessional training, they provide a unique and knowledgeable insight into the ins and outs of recovery and all the agencies and resources involved with recovery and child welfare.

Testimonials from mothers on the impact of their coach on their recovery document the importance of building a strong relationship with mutual understanding and unwavering support -- outside the stressors of therapies and agencies. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref> Recovery coaches play an integral role in building esteem, giving support, and providing inter-agency resources. This helps to bolster the effects of treatment for new mothers and gives them the tools to work towards sobriety.

=Relevant Research=

There is not a lot of statistical research on the effectiveness of recovery coaches postpartum. One reason is that many mothers have access to these programs while pregnant, but lose it postpartum due to insurance restrictions. Thus, some of the information provided below is not specific to postpartum recovery coaching, but on the impact of recovery coaching on aiding SUD treatment. Research is needed on the effectiveness of recovery coaches during pregnancy and could provide a springboard for advocacy in postpartum treatment.

*An evidence-based review of an Illinois program found that parents with their baby removed from care who had access to a postpartum recovery coach had a 15% increase in parent-child reunification and a 14% increase in having foster-care cases closed. It is important to note that there was no evidence of adverse impact in the increased and quicker reunifications and case-closures. <ref>https://evidencebasedprograms.org/programs/recovery-coaches/</ref>

*This article highlights the high risk of relapse (28.3%) in the first three months postpartum, especially amongst those with comorbid mental illness. <ref>https://www.sciencedirect.com/science/article/pii/S0920996418304833</ref>

*The U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation (OPRE) made a comprehensive review of nine recovery coaching interventions. OPRE evaluated the replicability, success, and readiness of the programs and documents the strengths, weaknesses, and evidence-based practice implications of each model. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref>

*This article provides a systematic review of peer recovery support services and recovery coaching. It highlights the potential of recovery coaching in SUD treatment. It recommends that more extensive research be done to empirically support the inclusion of recovery coaching and to provide a clear role definition. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585590/</ref>

*This article evaluates an intervention delivered by peer recovery coaches in a medically underserved community in Baltimore City. <ref>https://psycnet.apa.org/record/2021-20460-001</ref>

*This article examines the cyclical effects of postpartum depression, both unrelated and related to substance use. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref>

=Impactful Federal, State, and Local Policies=

'''Federal.''' Recovery support services, including recovery coaches, were included in the Comprehensive Addiction Recovery Act (CARA), but not funded. There is not a federal definition of recovery services.

'''States.''' Implementation access requirements vary from state to state.
*17 states discontinue Medicaid coverage 60 days postpartum. <ref>https://www.macpac.gov/wp-content/uploads/2019/07/Recovery-Support-Services-for-Medicaid-Beneficiaries-with-a-Substance-Use-Disorder.pdf</ref> Those people who do retain their coverage face challenges in navigating postpartum coverage changes, in finding new doctors to give them SUD treatment referrals, and in dealing with new and confusing paperwork.
*One state-level policy advance is reflected in Virginia, which provides a scholarship to help cover fees in becoming a Certified Peer Recovery Specialist. <ref>https://virginiapeerspecialistnetwork.org/getting-started/</ref>

=Available Tools and Resources=

'''SAMHSA''' provides a state-by-state directory of training and certification programs for peer recovery coaching. <ref>https://c4innovates.com/brsstacs/BRSS-TACS_State-by-State-Directory-of-Peer-Recovery-Coaching-Training-and-Certification-Programs_8_26_2020.pdf</ref> It was generated in 2018 by BRSS-TACS (Bringing Recovery Supports to Scale Technical Assistance Center Strategy).

'''SAFE Project''' has a dedicated website for Addiction and Mental Health Resources for Women that includes a number of support resources during and after pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

'''"Supporting Substance-Using Caregivers: Pregnancy, Birth, and Early Childhood"''' is a Harvard Kennedy School Government Performance Lab written report that explores ways to better support substance using caregivers and their families on the journey to recovery.<ref>https://govlab.hks.harvard.edu/sites/hwpi.harvard.edu/files/govlabs/files/supporting_substance-using_caregivers_vf.pdf?m=1727274424/</ref>

'''The National Center on Substance Abuse and Child Welfare''' has published a guide, “The Use of Peers and Recovery Specialists in Child Welfare Settings.” This covers models, implementation, funding, qualifications/training, supervision, and much more. It is a good tool for those wishing to implement recovery coaches and peer support. <ref>https://ncsacw.acf.hhs.gov/files/peer19_brief.pdf</ref>

'''KFF''' formerly know as the Kaiser Family Foundation, provides a breakdown of postpartum Medicaid coverage state-by-state. It addresses gaps, disparities, and needs. Medicaid coverage greatly impacts new mothers with an SUD, who are more likely to need continuity of coverage to aid in their recovery. <ref>https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/</ref>

'''The Montgomery County Office of Mental Health''' has published its recovery coaching guidelines. It is a comprehensive guide on how to effectively implement recovery coaching in the community to address a wide array of vulnerable populations. <ref>https://www.montcopa.org/DocumentCenter/View/13037/Recovery-Coaching-Practice-Guidelines?bidId=</ref>

=Promising Practices=

'''California.''' The Sobriety Treatment and Recovery Teams (START) is an intensive child welfare program for families with substance use and child abuse or neglect. START is built on cross-system collaboration and integrated service delivery. It utilizes peer recovery coaches in long-term recovery in conjunction with families, treatment providers, and court systems to provide a “system-of-care and shared decision-making approach.” This program is both child welfare and SUD treatment centered and uses trauma-informed care to help maintain safety, reduce child-removal-of-care, achieve and maintain parental sobriety, improve parenting skills, and improve inter-agency collaboration. The site includes program goals, their logic model, components, delivery, training/manuals, implementation, and published research. <ref>https://www.cebc4cw.org/program/sobriety-treatment-and-recovery-teams/detailed</ref>

'''Georgia.''' The Certified Addiction Recovery Empowerment Specialist (CARES) program was developed by the Georgia Council on Substance Abuse. CARES provides training, examination, and continuing education to maintain a strengths-based approach in peer recovery support services that builds on client’s strengths. CARES has an emergency department that provides recovery coaches to those experiencing an overdose or other substance-related incident and in need of immediate aid. They also offer a warm line -- a call line to aid those are struggling and need to talk to someone but want to remain anonymous. <ref>Link: https://gasubstanceabuse.org/cares-program/</ref>

=Sources=

Reduce Stigma for Pregnant People with SUDs

2024-10-23T20:01:13Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Reducing stigma and perception surrounding pregnancy and SUDs will increase access to care. Pregnant women with SUDs may face feelings of shame and guilt on top of their challenges with childcare, social service involvement, and access to care. These difficulties are amplified by stigma.

It should be noted that pregnant women with an SUD are not one uniform group in their behavior. Some are actively using, others are in recovery, and others my be engaged in harm reduction, such as medicated assisted treatment. Nonetheless, as a sub-population they face similar hardships around stigma.

= Key Information =

SAMSHA defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMSHA lists health, home, purpose, and community as essential dimensions of support for a life in recovery. <ref> https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> Stigma is a barrier in recovery. When a person with substance use disorder reaches out for help, he or she is often met with judgmental responses which are less than helpful. This is the result of stigma and can be overt or more subtle. Stigma comes in the form of language used, pity, disdain, silence, or rejection. Persons with mental health and substance use problems are exposed to an array of stigma components which interact to endanger their mental health. These components include stereotypes, prejudice, and discrimination. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625. Retrieved at https://pubmed.ncbi.nlm.nih.gov/15491256/</ref>

Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people in recovery need -- especially those in early recovery. Outside stigma can become internalized, leading people in recovery to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. <ref> https://attcnetwork.org</ref> Women have different experiences with SUD both biologically as well as culturally, as they are seen as caregivers and mothers. Barriers and challenges include: <ref>https://infantcrier.mi-aimh.org/perinatal-substance-use-an-update-and-reflection-on-the-importance-of-relationship/#respond</ref>

*Women are at highest risk for developing SUDs during reproductive years
*Poly-substance use is common
*Unintended pregnancy rate among women with SUD is approximately 80%
*Substance use in pregnancy is connected to many complications and negative health outcomes for mother and baby
*As many as 70% of women entering addiction treatment have children and primary responsibility for children
*Family responsibilities can interfere with regular attendance in treatment sessions, including challenges with childcare
*Hesitancy to seek treatment for fear of legal action or legal issues, including child protective services
*Covid-19 made barriers to access to care more challenging
*Transportation issues
*Past trauma may impact stigma and reaching out for care

Other areas of stigma for pregnant women with SUDs include those seeking medication-assisted treatment and those with HIV or other infectious diseases. Educating providers and communities about pregnancy and substance use can assist with reducing harm and facilitate pregnant women getting access to care and services. <ref>https://www.astho.org/globalassets/brief/stigma-reinforces-barriers-to-care-for-pregnant-and-postpartum-women-with-substance-use-disorders.pdf</ref>

= Relevant Research =

*'''This qualitative study''' used interviews to explore common factors that motivate pregnant women with SUD to seek comprehensive care during pregnancy and common hesitations and barriers to treatment. <ref>https://pubmed.ncbi.nlm.nih.gov/31704383/</ref>

*'''This guideline''' titled "Substance Use Disorder Treatment in Pregnant Adults," contains an extensive review of the literature. It was developed by the New York State Department of Health AIDS Institute in order to establish a statewide standard of care. The goal was to ensure that healthcare providers in New York provide appropriate options for SUD treatment during pregnancy. <ref>https://www.ncbi.nlm.nih.gov/books/NBK572854/</ref>

*'''This article''' provides recommendations specific to expanding and improving treatment care for pregnant women with opioid use disorder. <ref>https://link.springer.com/article/10.1007/s13669-016-0168-9</ref>

=Impactful Federal, State, and Local Policies=

Policies surrounding pregnant women with SUD vary from state to state. These state-level policy variations include:
*Reporting and testing requirements
*Standards for child abuse
*Grounds for civil commitment
*Targeted program created
*Pregnant people given priority access in general programs
*Pregnant people protected from discrimination in publicly funded programs

'''The National Academy for State Health Policy''' has published a document titled, "State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder." This provides information on funding streams for state initiatives. <ref>https://nashp.org/wp-content/uploads/2018/10/NOSLO-Opioids-and-Women-Final.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA's Addiction Technology Transfer Center Network (ATTC)''' has published "Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma." <ref>https://attcnetwork.org/sites/default/files/2019-04/Anti-Stigma%20Toolkit.pdf</ref> It has also created a downloadable Powerpoint presentation titled, "Reducing Stigma in Pregnant & Parenting Women with Substance Use Disorder." <ref>https://www.ndsu.edu/fileadmin/centers/americanindianhealth/files/Maternal_Health_Learning_Collaborative_Session_2.pdf</ref>

*'''Safe Project:'''
**'''"No Shame Pledge"''' is a SAFE Project campaign created to end stigma and support others in speaking up about their own disorders and to get help without judgement. Participants receive a certificate in acknowledgement of their commitment to saving lives by fighting stigma. <ref>https://www.safeproject.us/noshame-mental-health-addiction/</ref>
**See the Wiki titled "Reduce Stigma" for more detailed information on the reduction of stigma for those experiencing substance use issues. <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>

*'''"Supporting Substance-Using Caregivers: Pregnancy, Birth, and Early Childhood"''' is a Harvard Kennedy School Government Performance Lab written report that explores ways to better support substance using caregivers and their families on the journey to recovery.<ref>https://govlab.hks.harvard.edu/sites/hwpi.harvard.edu/files/govlabs/files/supporting_substance-using_caregivers_vf.pdf?m=1727274424/</ref>

*'''From Research to Recovery Town Hall''' brings together speakers from across the country to address mental health, substance use and other facets of behavioral and emotional health. One example includes this YouTube titled “Gender & Use, Misuse, Treatment and Recovery," by Dr. Mishka Terplan, MD, MPH, Professor of Obstetrics and Gynecology and Psychiatry and the Associate Director of Addiction Medicine at Virginia Commonwealth University. It addresses how developing addiction to opioids and other drugs vary across gender, and how expectations impact the conception of treatment and stigma around use. <ref>https://www.youtube.com/watch?v=siC6Cd4Q3MQ&t=33s</ref>

= Promising Practices =

'''Maryland.''' "Refocus: Look Again" is a public education campaign from the Anti-Stigma Project within On Our Own of Maryland. It is designed to challenge misconceptions and assumptions associated with mental health and substance use. Their goal is to foster change through awareness and dialogue about the real and damaging impact of stigma. <ref>https://refocuslookagain.org/</ref> An example iof their online content is an anti-stigma interview with Adina Weissman titled, "Medicated Assisted Treatment and Pregnancy." <ref>https://www.distortedperceptions.org/articles-main/2022/4/4/medicated-assisted-treatment-and-pregnancy-an-anti-stigma-interview-with-adina-weissman?fbclid=IwAR1rkj3LV5sbgU6TLPUwq7MVfesTfokhEbUHT2GTS85ko5SbDF-YzWXU-zU</ref> They also have an online pledge to challenge perceptions, to speak out, and to become an agent of change. <ref>https://www.distortedperceptions.org/take-the-pledge</ref>

= Sources =

Expand Perinatal Treatment and Support for People with SUDs

2024-10-23T20:00:43Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

It is extremely important for infants to be well-nourished and well-cared for in so that the baby to thrive. While this is critically important to both mother and baby, making healthy choices isn’t so clear-cut for some pregnant women. Those who become pregnant while facing a substance use disorder face great challenges in caring for their body and the baby they are carrying. Substance use at any time, but especially during pregnancy, is a highly stigmatized issue which has worsened over the decades. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116049/</ref> Substance use during pregnancy can have detrimental health effects on the baby and the mother, but the stigma may prevent the mother from seeking prenatal care or substance use treatment. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref>.

Most doctors recommend that pregnant women with a substance use disorder undergo a long-term treatment plan called drug-assisted stabilization using Methadone. This harm reduction therapy remains financially sustainable for a woman after she has given birth, because it is covered under Medicaid. So new mothers can still access the treatment, even after their six-week Medicaid-provided postnatal care is done. In addition, the treatment does not subject a woman's mind and body to the stress of full withdrawal, allowing her to focus on caring for herself and her baby.

= Key Information =
===Statistical Prevalence ===

The CDC reports that the most commonly substances used during pregnancy include tobacco, alcohol, marijuana, and opioids, each carrying its own risks. <ref>https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm</ref> The prevalence of alcohol and substance use amongst pregnant women is a growing problem, with 10% using alcohol and 4.5% reporting binge drinking during pregnancy. Of these women, 40% also reported using one or more substances, the highest of which is tobacco, and 5% reported use of illicit drugs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5 </ref> The majority of use occurs during the first trimester, a vulnerable phase for the baby, making intervention during the first trimester a critical time frame to minimize potential harm.

===Risk Factors===

While substance abuse occurs within every demographic, there are certain factors which create higher risk of use during pregnancy. It is important to note that demographic data collection is scarce, should be taken as a “minimum” amount, and is highly biased based on policies that disproportionately threaten young ages and women of color and low socioeconomic status. Most available data are taken from enacted policies, discussed below, which are meant to deter prenatal substance use but instead promote maternal prosecution. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref> The following reflects non-prosecutorial risk factor data indicating categories of being high risk to use substances while pregnant: <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref> <ref>https://www-clinicalkey-com.echo.louisville.edu/#!/content/playContent/1-s2.0-S170121631730508X?returnurl=null&referrer=null</ref>

* ages 15-24
* education level high school or below
* at or below the poverty level
* concurrent psychiatric disorders (mood/anxiety & eating disorders most common)
* history of trauma (childhood or adulthood sexual/domestic/interpersonal abuse)
* poly-substance use
* family history of substance use
* women of color and women on public health insurance had higher rates of prenatal substance use <ref> https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref>

===Impacts===

Prenatal habits are vital to the healthy development of the baby and the maintained health of the mother. Alcohol and drug use during pregnancy has many negative effects on both. Much of the research focuses on the physical effects of prenatal substance use on the fetus, but there are important impacts on the mother that must also be considered. One list of the potential negative consequences of substance use for mothers includes: <ref> Jocelynn L. Cook, Courtney R. Green, Sandra de la Ronde, Colleen A. Dell, Lisa Graves, Alice Ordean, James Ruiter, Megan Steeves, Suzanne Wong, Epidemiology and Effects of Substance Use in Pregnancy, Journal of Obstetrics and Gynaecology Canada, Volume 39, Issue 10, 2017, Pages 906-915. </ref>
*psychosocial decline (stress, reduced social support, partner violence, isolation, financial/legal troubles, self harm),
*physical issues (vascular complications, infections, bodily trauma), and
*reduced frequency of prenatal care.

Impacts on the fetus are vast and vary by the specific substance. Consuming alcohol, however minor the amount, increases the baby’s risk of Fetal Alcohol Syndrome, preterm birth, teratogenicity, neurodevelopmental disorders, miscarriage, and stillbirth. Fetal Alcohol Syndrome impacts the baby’s physical growth and appearance, along with its emotional, behavioral, and cognitive health. Exposure to illicit drugs may have the following consequences: <ref>https://www.fountainhillsrecovery.com/blog/pregnancy-and-addiction/</ref>

* low birth weight and growth restriction
* preterm birth
* miscarriage
* stillbirth
* sudden infant death syndrome
* exaggerated startles and diminished crying response
* neonatal withdrawal or abstinence symptoms
* transient central and automatic nervous system symptoms
* congenital heart malformations
* abnormal physical developments

Postnatal impacts on the mother and baby extend beyond physio-social consequences. Mothers who use substances throughout pregnancy are at an increased risk of having the child removed from their care after birth. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> These child removals have been shown to lead to an increase in maternal drug use and mental health complications, especially in Black and Indigenous women. <ref>https://www.nationalpartnership.org/our-work/health/moms-and-babies/substance-use-disorder-hurts-moms-and-babies.html</ref> Those who do retain custody of their infants and continue substance use are at risk of atypical maternal-infant bonding and attachment, which is linked to adverse child outcomes. <ref>https://www.frontiersin.org/articles/10.3389/fpubh.2019.00045/full</ref>

===Barriers===

There is a lot of debate among providers of various professions as to whether substance use screening should be universal in prenatal care. Early detection and treatment is critical to protecting the health of both the baby and the mother. However, the fact that many states make prenatal substance use a punitive offense can cause women to not seek prenatal care, which is detrimental in its own right. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> There are substantial barriers to prenatal substance abuse treatment that have lasting consequences for the mother and baby. Since 2000, the number of states that criminalize prenatal substance use has more than doubled, with 25 states plus D.C. classifying it as child abuse, and the same amount has medical reporting requirements. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> These laws had the intention of deterring prenatal substance use, but have instead had severe adverse effects. With so few states offering pre-or postnatal drug treatment programs as an alternative to prosecution due to liability issues, many mothers have instead reported self-isolation and avoidance of both prenatal medical appointments and substance use treatments. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> Substance-using pregnant women who “do receive prenatal care experience more positive birth outcomes and have greater opportunities for other health-promoting interventions than women who do not receive care.” <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> However, the majority of pregnant substance-using women who receive appropriate care and intervention are older, white women with private health insurance that are less likely to be reported, creating significant disparities. Women who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> This lack of medical care and intervention of untreated prenatal substance use can lead to a greater likelihood of fetal substance dependency and ensuing fetal medical complications. It is vital to advocate and lobby for states to adopt impactful treatment policy, while also negating or varying the consequences of legal action taken against the mothers. See the Policies Section below for examples of states that have adopted successful legal policy that focus on pre-natal and post-natal SUD treatment to avoid infant removal and punitive action.

= Relevant Research =

* This website has a literature review in the form of an annotated bibliography on almost 50 topics on substance use during pregnancy. It highlights the main findings on a variety of topics, from prevalence and disparities to impacts and policy implications. <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref>

* This article identifies three dominant approaches to antenatal substance use -- contingency management, motivational interviewing, and cognitive-behavioral therapies. It notes that there is little research done on perinatal psychological interventions, but suggests that these practices may have similar benefits in perinatal treatment for substance use. It gives in-depth descriptions and benefits of each modality. <ref>https://www.nursingcenter.com/ce_articleprint?an=00005237-201407000-00006</ref>

*This article provides support for use of pharmacotherapy as an effective treatment and lists its benefits. For pregnant women with opioid use, Methadone and Buprenorphine is the standard of pharmacotherapy. <ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/what-treatment-available-pregnant-mothers-their-babies</ref>

= Impactful Federal, State, and Local Policies =

'''Federal.''' The Family First Prevention Services Act (FFPSA) permits states to use title IV-E foster care funding for children placed in foster care with their parent in a licensed residential family-based treatment facility for substance use. However, few states currently use this funding, due to barriers such as competing priorities and lack of facilities. <ref>https://aspe.hhs.gov/reports/ffpsa-room-board-brief</ref>

'''States.''' As noted above, half of the states plus D.C. have punitive policies that negatively impact mother and baby.
*Kentucky and Arizona, while having punitive laws, have also implemented an alternative to immediate criminal punishment, giving mothers 90 days to enroll in a treatment program while also giving them priority access to these programs. This shows promise in preventing continued drug use and infant removal from care.
*Texas offers prenatal and postnatal health support to women with substance use disorder and access to residential treatment centers for both mothers and their new infants.
*Montana has allowed women to seek treatment to avoid prosecution, as long as they maintain active treatment, but it isn’t clear if they provide available pathways.

'''The Guttmacher Institute''' provides a state-by-state index of policies on substance use during pregnancy and provides information on states that qualify prenatal substance use as child abuse, require reporting, have criminal commitment requirements, etc. This index currently reveals the following: <ref> https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref>
*24 states and the District of Columbia consider substance use during pregnancy to be child abuse under civil child-welfare statutes, and 3 states consider it grounds for civil commitment.
*25 states and the District of Columbia require health care professionals to report suspected prenatal drug use, and 8 states require them to test for prenatal drug exposure if they suspect drug use.
*19 states have either created or funded drug treatment programs specifically targeted to those who are pregnant, and 17 states and the District of Columbia provide pregnant people with priority access to state-funded drug treatment programs.
*10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people.

=Available Tools & Resources=

*'''SAMHSA''' has published "A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders." This manual offers best practices on collaborative treatment approaches for pregnant women living with opioid use disorders. It addresses the risks and benefits associated with medication-assisted treatment. <ref>https://store.samhsa.gov/product/collaborative-approach-treatment-pregnant-women-opioid-use-disorders/sma16-4978</ref>

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**"Addiction and Mental Health Resources for Women." It includes a series of resources for support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
**See the wiki titled "Improve Care for Babies Born Drug Dependent" for more information on babies who are born with Neonatal Abstinence Syndrome and how they can better receive compassionate treatment/care.<ref>https://www.yoursafesolutions.us/wiki/Improve_Care_for_Babies_Born_Drug_Dependent/</ref>

*'''"Supporting Substance-Using Caregivers: Pregnancy, Birth, and Early Childhood"''' is a Harvard Kennedy School Government Performance Lab written report that explores ways to better support substance using caregivers and their families on the journey to recovery.<ref>https://govlab.hks.harvard.edu/sites/hwpi.harvard.edu/files/govlabs/files/supporting_substance-using_caregivers_vf.pdf?m=1727274424/</ref>

*'''The Northern New England Perinatal Quality Improvement Network''' provides a comprehensive toolkit that includes best practices recommendations, treatment facilitation, screening tools, specific substance information, breastfeeding support, mental health access, social needs assessment, and implementation tools. <ref>https://www.nnepqin.org/a-toolkit-for-the-perinatal-care-of-women-with-opioid-use-disorders/</ref>

*'''Drugabuse.com ''' is a website that addresses the benefits of group therapy when led by a trained professional. It includes information on recovery education, social support, and motivation in recovery. It also provides observations on various issues and methods within recovery, such as peer empowerment and healthy coping skills to build a sense of optimism and connectedness. <ref>https://drugabuse.com/treatment/therapy/group/</ref>

= Promising Practices =

*'''Dartmouth Hitchcock Medical Center''' has a perinatal addiction treatment program based upon an integrated care model that includes maternity care, substance use treatment, behavioral health, and pediatrics. It has a participant-driven design that provides SBIRT screening and an 18-week parenting class. Outcome successes include an average gestational age of over 38 weeks, average birthweight in the normal range, and decreased NAS treatment rate. Two thirds of participants remain in treatment postpartum. <ref>https://www.dartmouth-hitchcock.org/about/</ref>

*'''Centering Pregnancy.''' While not specifically focusing on issues of addiction or substance misuse among pregnant women, the Centering Pregnancy approach has the potential to cost-effectively improve prenatal and perinatal care among women who may be using or be addicted to opioids or other substances. It is a group approach to prenatal and perinatal care. <ref>https://www.centeringhealthcare.org/what-we-do/centering-pregnancy</ref>

*'''Colorado.''' The Special Connections Project provides gender-responsive treatment for pregnant and parenting women who are Medicaid-eligible to maximize the chance of a healthy birth. They provide postpartum treatment services in order to maintain gains made during pregnancy. Special Connections providers offer pregnancy risk assessments, care coordination services, group counseling sessions, individual counseling sessions, health education groups, and residential SUD treatment in a women-only setting. <ref>https://hcpf.colorado.gov/special-connections</ref>

= <br/> Sources =
</div>
[[Category:SAFE-Treatment and Recovery]]

Expand Motivational Interviewing

2024-10-23T19:58:04Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph =

Motivational Interviewing (MI) is an evidence-based practice that is effective in helping people make decisions to stop negative behaviors and start positive ones. MI is a therapeutic tool intended for use in conjunction with other forms of therapy or addiction treatment. It has high potential to help women who are pregnant and using substances. Since MI is designed to inspire change in clients who may otherwise feel reluctant to change, it supports incremental choices toward recovery.

Although MI is a technique which works across the continuum of care, it is placed within a harm reduction context, because it "meets people where they are at." While useful for all populations, it is particularly relevant during pregnancy, because of the choice-space it creates -- an immediate benefit in relieving the challenges associated with pregnancy and SUD.

= Key Information =

MI was founded by Dr. William Miller and Dr. Stephen Rollnick. <ref>https://www.stephenrollnick.com/about-motivational-interviewing/</ref> It is a collaboration approach which is based on an interview process between the provider and the patient. MI patients are empowered to create their own goals, as opposed to goals imposed by a therapist, such as complete abstinence. <ref>https://www.addictioncenter.com/treatment/motivational-interviewing/</ref> When individuals in recovery feel as though they are in control of their own recovery, they take ownership of their success and move forward with their own goals. This encourages patient autonomy. When a patient feels responsible for their actions and is confident in their recovery, they are more likely to stay sober and to not relapse after treatment.

Motivational interviewing does not focus on the underlying causes of an addiction, such as past traumas or mental illnesses. It is intended to be used in addition to other forms of therapy, such as cognitive behavioral therapy. Although MI pulls from various therapeutic styles and theories, such as humanistic therapy, cognitive dissonance theory, therapeutic relationship building, and positive psychology, it is most effective when used in conjunction with one of these forms of treatment. MI is also an effective part of an inpatient treatment regimen, before seeking other recovery options.

Miller and Rollnick formulated four client-centered processes to help patients identify their goals and begin to work towards them. They are as follows: <ref>https://www.stephenrollnick.com/about-motivational-interviewing/</ref>
*Engaging – Getting to know the client and establishing a trusting and respectful alliance.
*Focusing – Coming to a shared idea about the main focus of a client’s recovery.
*Evoking – Bringing out the client’s own arguments for change.
*Planning – The client is willing and able to envision change and how they will manifest it.

= Relevant Research =

'''This literature review''' is titled, "Psychosocial Interventions for Substance Use During Pregnancy." The author notes the limited amount of research that has been done on MI with this population and focuses on early investigations into the practicality and efficacy of contingency management, motivational support, and cognitive behavioral therapies adapted for pregnant women. <ref>https://alliedhealth.ceconnection.com/files/PsychosocialInterventionsforSubstanceUseDuringPregnancy-1414431617928.pdf</ref>

'''This article''' documents the results of MI training for obstetric healthcare professionals working with obese pregnant women. Participants made more interventions towards the principles of motivational interviewing and asked fewer closed and more open questions than they had before the training. <ref>https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12401</ref>

= Impactful Federal, State, and Local Policies =

SAMHSA identifies MI as as a model of change and indicates that it aligns to the five "stages for change:" <ref>https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-02-014.pdf</ref>
*Precontemplation — Individuals currently using substances are not thinking of making a change now or in the future.
*Contemplation — Individuals currently using substances are aware that they need to make a change.
*Preparation — Individuals currently using substances begin weighing the pros and cons of making a change and preparing for how to deal with urges and triggers.
*Action — Individuals currently using substances decide to change their behavior and successfully attempt to do so.
*Maintenance — Individuals who changed their substance use behaviors are engaged in efforts to continue doing so over the long term.

= Available Tools and Resources=

*'''SAMHSA''' has published a guide titled "Using Motivational Interviewing in Substance Use Treatment." <ref>https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-02-014.pdf</ref> One of the Addiction Technology Centers (ATTC) in the SAMHSA Network focuses on family-centered behavioral health of pregnant and postpartum women. It includes three videos on MI in an integrated care setting -- for nurse practitioners, counselors, and social workers. <ref>https://attcppwtools.org/PPWProgram/Videos.aspx#MI</ref>

*'''SAFE Project:'''
**See the wiki titled "Reduce Stigma for Pregnant People with SUDs" for more detailed information on reducing stigma for substance use issues affecting pregnant populations and how the reduction of stigma will lead to better care.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma_for_Pregnant_People_with_SUDs/</ref>

*'''The Founders of MI''' provide a website that offers an instructional overview of the four MI processes, online trainings, and free resources. <ref>https://psychwire.com/motivational-interviewing/resources</ref>

*'''University of Arizona''' has a website dedicated to information on pregnant and post-partum women with SUDs. It includes a one-hour video training titled "Essentials of Motivational Interviewing." <ref>https://phoenixmed.arizona.edu/ppw-sud/trainings</ref>

*'''The National Harm Reduction Coalition''' has published "Pregnancy and Substance Use: A Harm Reduction Toolkit" that includes information on MI.<ref>https://harmreduction.org/issues/pregnancy-and-substance-use-a-harm-reduction-toolkit/</ref>

*'''SAFE Project''' has a dedicated website titled "Addiction and Mental Health Resources for Women." This includes various resources specifically r;evant for support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

= Promising Practices =

'''The Motivational Interviewing Network of Trainers (MINT)''' is an international organization of MI trainers. Trainers in MINT come to the non-profit from diverse backgrounds and apply MI in a variety of settings. Their central interest is to improve the quality and effectiveness of counseling and consultations with clients about behavior change. MINT was started in 1997 by a small group of trainers who were trained by Miller and Rollnick. The organization has since grown to represent 35 countries and more than 20 different languages. <ref>https://motivationalinterviewing.org/</ref>

'''Clinical Health Coach® Training''' provides online training through the Iowa Chronic Care Consortium (ICCC), a non-profit that specializes in population health consulting, training, and organization planning. Their mission is to build capacity with other organizations to deliver effective and personalized strategies for health improvement and chronic care. Clinical Health Coach Training Online is a flexible, 26-hour, self-paced, six to twelve week experience. It engages participants in an online learning platform for various topics, including MI. <ref>https://clinicalhealthcoach.com/</ref>

'''An MI App.''' Steven Ondersma, Ph.D., at Michigan State University has a primary research interest in computer-delivered assessment and motivational interventions for substance use and other risk factors among pregnant and postpartum women. He developed an MI app that runs on tablets and smart phones that uses a 3-D animated guide to walk patients through an intervention specific to their responses. The guide asks questions such as “what do you like about opioid use, why do you use opioids, and what do they do for you?” The guide then reflects their answers. At the end of the session, if the patient indicates a need for change, the guide in the app can help them develop a plan to change, send tailored text messages after they leave the doctor’s office, and suggest treatment options in their area. This type of intervention has shown success in some communities and is currently being tested to address opioids. This intervention could be very successful for four reasons:
*Using an electronic based system to ask these difficult questions could remove stigma from the situation.
*Most women will have access to a mobile device.
*It automates follow-up.
*It does not require additional MI training for doctors and decreases their time for screening. <ref>https://www.addictioncenter.com/treatment/motivational-interviewing/</ref>

= Sources<br/>   =
</div>
[[Category:SAFE-Full Spectrum Prevention]]

Improve Identification and Data Collection for NAS

2024-10-23T19:55:57Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=
One of the biggest challenges of addressing Neonatal Abstinence Syndrome (NAS) is that it is not consistently identified, and collection of data and reporting is inconsistent. Standardized data collection and surveillance in all states and territories would improve the ability to guide public health strategies and interventions.

= Key Information =

The Association of State and Territorial Health Officials (ASTHO) <ref>https://www.astho.org/</ref> has published guidance for standards for health agencies to improve current NAS surveillance. The document titled, ''Strengthening Health Agencies' Neonatal Abstinence Syndrome Surveillance through Consensus Data and Standards,'' includes the following key components for agencies to improve NAS data collection and surveillance: <ref>https://www.astho.org/globalassets/pdf/strengthening-health-agencies-nas-surveillance-through-consensus-driven-data-standards-practices.pdf</ref>
*Understand the landscape of NAS surveillance capacity.
*Enhance utility of Medicaid protocols
*Build a registry for NAS.
*Achieve consensus

'''Understand the Landscape.''' This involves documentation of how state and territory health agencies currently collect NAS data and conduct surveillance. This first step advanced in the ASTHO report is foundational to the identification of gaps in standards. Nationally standardized definitions of data and standardized diagnosis codes will improve collaboration and NAS reporting and interventions. In 2019, the Council of State and Territorial Epidemiologists (CSTE) proposed a nationally standardized case definition to capture surveillance measures across jurisdictions to inform clinical and public health treatment and prevention efforts. Some of the states surveyed in the ASTHO report are using these standards while other states are using ICD-9 (779.5) and ICD-10 (P96.1) codes.

'''Enhance Utility of Medicaid Protocols.''' This involves expanding Medicaid’s capacity to use NAS data. It also involves improvement of data sharing between public health agencies and Medicaid.

'''Build a Registry for NAS.''' This will promote collaboration in collecting data and provide standard information across the country. Steps to build a registry include: <ref>https://www.astho.org/globalassets/pdf/strengthening-health-agencies-nas-surveillance-through-consensus-driven-data-standards-practices.pdf</ref>
*Identify the purpose.
*Determine if a registry is an appropriate means to achieve the purpose.
*Identify key stakeholders and how they have used or interacted with registries for other conditions.
*Assess feasibility.
*Build a registry team.
*Establish a governance and oversight plan.
*Consider the scope and rigor needed.
*Define the core data set, patient outcomes, and target population (data element submission process).
*Develop a study plan or protocol.
*Develop a project plan.

'''Achieve Consensus.''' A tool for data element submission will advance the process of informing the development of national standards.

= Relevant Research =

* This report by the Council of State and Territorial Epidemiologists summarizes an environmental scan that was performed on NAS data sources, methods, surveillance and reporting. <ref>https://cdn.ymaws.com/www.cste.org/resource/resmgr/pdfs/pdfs2/NAS_Environmental_Scan_Repor.pdf</ref>

* This article documents a study in which the predictive value of an algorithm was used to identify cases of NAS using administrative Medicaid claims data. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317565/</ref>

* This article summarizes a study which was performed using publicly available information regarding NAS surveillance activities and definitions. Since current clinical case definitions use different combinations of clinician-observed signs of withdrawal and evidence of perinatal substance exposure, there is discordance in diagnosis codes used in surveillance definitions. This summary provides an understanding of the different clinical case and surveillance definitions which are used across the United States. <ref> Standardization of State Definitions for Neonatal Abstinence Syndrome Surveillance and the Opioid Crisis, retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687235/</ref>

= Impactful Federal, State, and Local Policies =

'''Protecting Our Infants Act of 2015 (POIA)''' addresses problems related to prenatal opioid exposure. It called for HHS to review planning and coordination of HHS activities related to prenatal opioid exposure and NAS and to study and develop recommendations for the prevention, identification, and treatment of NAS as well as the treatment of opioid use disorder in pregnant women. <ref>https://aspe.hhs.gov/reports/status-report-protecting-our-infants-act-implementation-plan-0#:~:text=IMPLEMENTATION%20STATUS%20OVERVIEW%20%20%20%20Recommendation%20Category,%20%20100%25%20%201%20more%20rows%20</ref>

'''The 2022 National Drug Control Strategy''' calls for developing a data plan and a consolidated database. One major source of administrative data within the data strategy includes the Healthcare Cost and Utilization Project (HCUP) on records of emergency department admissions and inpatient hospital stays from participating states compiled by the Agency for Healthcare Quality and Research (AHRQ). It provide data on drug overdoses and NAS. <ref>https://www.whitehouse.gov/wp-content/uploads/2022/04/National-Drug-Control-2022Strategy.pdf</ref>

'''Indiana State Department of Health (ISDH).''' In response to the high rate of opioid prescriptions, the Indiana General Assembly charged ISDH to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. In 2016, 26 of 89 Indiana Birthing Hospitals took part in this pilot screening program. ISDH noted that universal screening in a non-punitive environment would allow us to understand the true prevalence of perinatal substance use and NAS. ISDH established a task force which provided a standard clinical definition of NAS, stating that the infant must be symptomatic, have two or three consecutive modified Finnegan scores equal to or greater than a total of 24, and either a positive toxicology test OR a maternal history with a positive verbal screen or toxicology test. <ref>https://www.in.gov/children/files/cisc-2015-0218-Infant-NAS-_Final-_Report.pdf</ref>

=Available Tools and Resources=

'''SAFE Project:'''
*See the wiki titled "Improve Data Sharing, Analysis, and Monitoring" for more detailed information on the improvement of data collection/analysis to fight the substance use crisis.<ref>https://www.yoursafesolutions.us/wiki/Improve_Data_Sharing,_Analysis,_and_Monitoring/</ref>

'''The World Health Organization''' has published "Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy." It includes methods of data collection and analysis. <ref>http://apps.who.int/iris/bitstream/handle/10665/107130/9789241548731_eng.pdf;jsessionid=55AE69AD37E7</ref>

'''The Center for Health Care Strategies (CHCS)''' published "Data-Sharing Considerations for State Public Health Departments and Medicaid Agencies." This is a useful technical assistance brief that offers considerations, tips, and best practices to facilitate data sharing to support Medicaid-public health partnerships. It provides examples of jurisdictions that have set up effective data-sharing arrangements. <ref>http://www.618resources.chcs.org/wp-content/uploads/618-Data-Sharing-Resource-12.2.20.pdf</ref>

'''EMI Advisors''' provides a dashboard for NAS which includes a data element tool (DET). <ref>https://www.emiadvisors.net/nas-det-dashboard</ref>

'''Registries for Evaluating Patient Outcomes: A User's Guide.''' While not specific to NAS, this guide is useful to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. <ref>https://www.ncbi.nlm.nih.gov/books/NBK208616/</ref>

=Promising Practices=

'''The Florida Perinatal Quality Collaborative.''' The Maternal Opioid Recovery Effort (MORE) implemented an initiative on NAS that reflects a successful data collection process and key drivers of change. <ref>https://health.usf.edu/-/media/Files/Public-Health/Chiles-Center/FPQC/MORE-Webinar-DataCollection-Dec2019.ashx?la=en&hash=99CA53B2C91E9D8425A4908FE96B7CA02C2D9D2A</ref>

'''Kentucky''' established the Public Health Neonatal Abstinence Syndrome Reporting Registry. Their work documents prevention strategies and provides evidence of declining rates of NAS. <ref>https://chfs.ky.gov/agencies/dph/dmch/Documents/NASReport.pdf</ref>

'''Missouri Hospital Association.''' After the identification of a possible gap in the ability to accurately measure prevalence of NAS in Missouri, five strategies were developed to improve data capture of NAS and related maternal substance abuse by practitioners, clinical documentation specialists, and medical coding specialists. <ref>https://www.mhanet.com/mhaimages/sqi/brief/issue%20brief_triple%20aim_NAS_0918.pdf</ref>

= <span style="background-color: #ffffff">Sources</span> =

----

[[Category:Pages with broken file links]]

Improve Care for Babies Born Drug Dependent

2024-10-23T19:54:44Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

Babies who are born with Neonatal Abstinence Syndrome (NAS) experience discomfort and trauma. They may scream, have tremors, and struggle with eating and being comforted. Hospital staff are finding new opportunities to help these babies and their mothers. Approaches based on recent evidence-based research include moving from NICU and pharmacology treatment to a mother-centered approach. This keeps the mother-infant dyad together in a calm setting while encouraging frequent feedings, comforting, and swaddling to treat the baby's opioid dependence.

= Key Information =

Since the 1970s, pharmacology has been the standard for treating babies born with NAS, and physicians have utilized Methadone or Morphine in treatment. <ref>https://www.chcf.org/blog/opioid-dependent-newborns-get-new-treatment/</ref> Traditionally infants born drug dependent have been managed in the NICU due to concerns of complications. The Finnegan Score/Finnegan Tool has dictated the care level for babies born drug dependent. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786483/</ref> <ref>https://ncpoep.org/guidance-document/neonatal-abstinence-syndrome-overview/neonatal-abstinence-syndrome-nas/#:~:text=The%20Finnegan%20Neonatal%20Abstinence%20Scoring,Fletcher%20Allan%20Hospital%20of%20Vermont.</ref>

Complications from NAS can include: <ref>https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx#</ref>

*Low birthweight
*Jaundice
*Seizures
*Sudden infant death syndrome (also called SIDS).
*Developmental delays
*Motor problems
*Behavior and learning problems
*Speech and language problems
*Sleep problems
*Ear infections
*Vision problems

Treatment of infants showing signs of withdrawal includes a supportive care approach to treatment, such as creating a dark and quiet environment, swaddling the infant to improve self-stimulation, and providing frequent feedings to reduce infant stress. Other strategies include skin-to-skin contact for comfort and promotion of the infant’s attachment to the mother/caregiver, as well as other comforting techniques such as rocking or swaying the infant. Frequent feedings address hydration level. Breastfeeding has been proven to be an effective approach if the mother is receiving medication-assisted treatment and has no other complications which inhibit breastfeeding. Educating families on methods of care is important to provide ongoing supportive care of the infant.

'''Eat, Sleep, Console (ESC) Model'''

Recent research has introduced the ESC approach to treatment of babies born drug dependent. This is a mother-centered approach, based upon the following: <ref> https://www.nichq.org/insight/mother-centered-approach-treating-neonatal-abstinence-syndrome</ref>
*Eat: Is the baby feeding normally?
*Sleep: Is the baby able to sleep?
*Console: Can the baby be consoled within ten minutes of crying?

The ESC approach may be used alone or in conjunction with the Finnegan's model for scoring. The simple components of the approach have shown a decrease in overall length of hospitalization as well as a decrease in need for a pharmacological approach.

= Relevant Research =

'''This article''' documents the decreased impact of NAS associated with parental time spent at the infant's bedside. <ref>https://www.semanticscholar.org/paper/Impact-of-Parental-Presence-at-Infants%27-Bedside-on-Howard-Schiff/9880e862e325f5e443091b2d6961488f65d62ac5</ref>

'''This article''' is a literature review titled "Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome." It is an evidenced-based practice brief that summarizes and critically reviews emerging research on the ESC method. <ref>https://pubmed.ncbi.nlm.nih.gov/30855311/</ref>

'''This research study''' compared treatment decisions of 50 consecutive opioid-exposed infants managed on the inpatient unit at the Yale New Haven Children's Hospital. Infants managed by using the ESC approach were treated with Morphine significantly less frequently than they would have been by using the Finnegan Neonatal Abstinence Scoring System assessment approach. The article is titled, "A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome." <ref>https://pubmed.ncbi.nlm.nih.gov/29263121/</ref>

'''This literature review''' on ESC is part of a doctorate in nursing practice. It addresses:
*the need to improve NAS assessment practices
*the benefits of family-centered care
*the need to develop well-structured NAS treatment protocols <ref>https://openprairie.sdstate.edu/cgi/viewcontent.cgi?article=1115&context=con_dnp</ref>

= Impactful Federal, State, and Local Policies =

'''The Comprehensive Addiction and Recovery Act (CARA) of 2016''' amended the Child Abuse
and Prevention Treatment Act (CAPTA). This policy brief summarizes how states are required to serve infants and their families affected by prenatal substance exposure. It uses highlights form seven states to unpack the implications for notification and reporting requirements and for plans of safe care. <ref>https://ncsacw.acf.hhs.gov/files/prenatal-substance-exposure-brief1.pdf</ref>

'''West Virginia Advocacy.''' Lily's Place is a neonatal withdrawal center that offers workshops and trainings on legislation to support NAS centers and on planning and funding a NAS center. Its role in advocacy is grounded in direct experience. Lily's Place was the first nonprofit infant recovery center to provide services for parents and families struggling with addiction. The center is specifically designed for babies with NAS with small, quiet, dimly-lit nursery rooms and 24-hour nursing staff. Parents are trained to help their babies via therapeutic handling techniques and they learn CPR and basic child care as well as the specifics of NAS. <ref>http://www.lilysplace.org/presentations-and-workshops</ref>

=Available Tools & Resources=

'''SAFE Project:'''
*'''Addiction and Mental Health Resources for Women''' is a SAFE Project written guide that includes a number of support resources during and after pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
*See the wiki titled "Increase Awareness of Risks of SUD on the Baby" for more detailed information on increasing the awareness surrounding the possible risks of drug use during pregnancy and the potential treatment options for opioid use disorders.<ref>https://www.yoursafesolutions.us/wiki/Increase_Awareness_of_Risks_of_SUD_on_the_Baby#Available_Tools_and_Resources/</ref>

'''Canadian Provincial Health Resources, British Columbia''' provides a practice resource for healthcare providers titled, "Care of the Newborn Exposed to Substances During Pregnancy." <ref>http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/Practice%20Resource%20ESC_WEB%202020_11_20.pdf</ref>

'''Yale School of Medicine.''' This webinar is provided by the originator of ESC -- Matthew Grossman, MD, Associate Professor of Pediatrics, Yale-New Haven Children’s Hospital. <ref>https://wvperinatal.org/event/webinar-nas-the-eat-sleep-console-approach/</ref>

'''The Saskatchewan Health Authority''' created a handout on ESC for new parents. <ref>"Caring For Your Newborn At Risk For Substance Withdrawal with the Eat Sleep Console Method," https://momsandkidssask.saskhealthauthority.ca/sites/default/files/documents/esc-parent-handout.pdf</ref>

'''The California Healthcare Foundation''' has a blog that details the benefits of ESC in a highly accessible manner. It is titled "Opioid-Dependent Newborns Get New Treatment: Mom Instead of Morphine." <ref>https://www.chcf.org/blog/opioid-dependent-newborns-get-new-treatment/</ref>

'''ESC Toolkit.''' This downloadable guidebook resulted from a collaboration between doctors at Boston University School of Medicine, Children’s Hospital at Dartmouth-Hitchcock, and Yale University School of Medicine. <ref>https://docplayer.net/87738560-Caring-for-opioid-exposed-newborns-using-the-eating-sleeping-consoling-esc-care-tool.html</ref>

'''Women & Infants Clinical Institute''' has published an ESC guidebook that includes recommendations, approaches, and resources. The guidebook was developed through collaboration between Bakersfield Memorial Hospital in California, CHI Franciscan in Tacoma, Washington, and the Yale-New Haven Children’s Hospital. <ref>https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/CSH-ESCPlaybookElectronic.pdf</ref>

= Promising Practices =

'''Kentucky.''' In Louisville, healthcare workers are using a combination of pacifiers and music therapy to ease the pain of babies born to mothers who used opioids during their pregnancy. They use a special pressurized pacifier that plays music. A music therapist uses music and live-singing in the NICU, patting and rocking to match the baby's behavior state, ultimately training the child to soothe itself. This calming improved feeding and sleeping and decreased their crying -- eliminating three of the major symptoms which lead babies to need medication or hospital stay. <ref>http://www.wmur.com/article/new-device-helps-tiniest-victims-of-the-opioid-crisis/10370051</ref>

'''Maryland.''' The Maryland Patient Safety Center is working with 30 birthing centers to develop standardized care for babies suffering from NAS in order to reduce the length of stay for these babies. Standards include:
*A calming environment with little stimulation - quiet rooms and low lights
*Cuddle rooms where volunteers rock and soothe babies
*Massage and music therapy
*Some medicine (Morphine or Methadone)
*Treatment of mother's addiction and mental health in conjunction with babies' treatment

'''Pennsylvania.''' At Magee-Womens Hospital of UPMC, volunteers are helping babies born addicted to opioids by cuddling, nurturing, and comforting the babies as they go through withdrawal. Cuddlers provide them with additional comfort, as opposed to having to start an IV or give a baby Morphine. There are a growing number of programs that have volunteers come to the hospitals to cuddle the babies. This helps comfort the babies and reduces the stress on the nurses--two important benefits. <ref>https://www.insideedition.com/headlines/19669-hospital-recruits-volunteers-to-cuddle-with-drug-addicted-babies-going-through-withdrawal</ref>

= Sources =

----

Improve Care for Babies Born Drug Dependent

2024-10-23T19:54:35Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

Babies who are born with Neonatal Abstinence Syndrome (NAS) experience discomfort and trauma. They may scream, have tremors, and struggle with eating and being comforted. Hospital staff are finding new opportunities to help these babies and their mothers. Approaches based on recent evidence-based research include moving from NICU and pharmacology treatment to a mother-centered approach. This keeps the mother-infant dyad together in a calm setting while encouraging frequent feedings, comforting, and swaddling to treat the baby's opioid dependence.

= Key Information =

Since the 1970s, pharmacology has been the standard for treating babies born with NAS, and physicians have utilized Methadone or Morphine in treatment. <ref>https://www.chcf.org/blog/opioid-dependent-newborns-get-new-treatment/</ref> Traditionally infants born drug dependent have been managed in the NICU due to concerns of complications. The Finnegan Score/Finnegan Tool has dictated the care level for babies born drug dependent. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786483/</ref> <ref>https://ncpoep.org/guidance-document/neonatal-abstinence-syndrome-overview/neonatal-abstinence-syndrome-nas/#:~:text=The%20Finnegan%20Neonatal%20Abstinence%20Scoring,Fletcher%20Allan%20Hospital%20of%20Vermont.</ref>

Complications from NAS can include: <ref>https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx#</ref>

*Low birthweight
*Jaundice
*Seizures
*Sudden infant death syndrome (also called SIDS).
*Developmental delays
*Motor problems
*Behavior and learning problems
*Speech and language problems
*Sleep problems
*Ear infections
*Vision problems

Treatment of infants showing signs of withdrawal includes a supportive care approach to treatment, such as creating a dark and quiet environment, swaddling the infant to improve self-stimulation, and providing frequent feedings to reduce infant stress. Other strategies include skin-to-skin contact for comfort and promotion of the infant’s attachment to the mother/caregiver, as well as other comforting techniques such as rocking or swaying the infant. Frequent feedings address hydration level. Breastfeeding has been proven to be an effective approach if the mother is receiving medication-assisted treatment and has no other complications which inhibit breastfeeding. Educating families on methods of care is important to provide ongoing supportive care of the infant.

'''Eat, Sleep, Console (ESC) Model'''

Recent research has introduced the ESC approach to treatment of babies born drug dependent. This is a mother-centered approach, based upon the following: <ref> https://www.nichq.org/insight/mother-centered-approach-treating-neonatal-abstinence-syndrome</ref>
*Eat: Is the baby feeding normally?
*Sleep: Is the baby able to sleep?
*Console: Can the baby be consoled within ten minutes of crying?

The ESC approach may be used alone or in conjunction with the Finnegan's model for scoring. The simple components of the approach have shown a decrease in overall length of hospitalization as well as a decrease in need for a pharmacological approach.

= Relevant Research =

'''This article''' documents the decreased impact of NAS associated with parental time spent at the infant's bedside. <ref>https://www.semanticscholar.org/paper/Impact-of-Parental-Presence-at-Infants%27-Bedside-on-Howard-Schiff/9880e862e325f5e443091b2d6961488f65d62ac5</ref>

'''This article''' is a literature review titled "Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome." It is an evidenced-based practice brief that summarizes and critically reviews emerging research on the ESC method. <ref>https://pubmed.ncbi.nlm.nih.gov/30855311/</ref>

'''This research study''' compared treatment decisions of 50 consecutive opioid-exposed infants managed on the inpatient unit at the Yale New Haven Children's Hospital. Infants managed by using the ESC approach were treated with Morphine significantly less frequently than they would have been by using the Finnegan Neonatal Abstinence Scoring System assessment approach. The article is titled, "A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome." <ref>https://pubmed.ncbi.nlm.nih.gov/29263121/</ref>

'''This literature review''' on ESC is part of a doctorate in nursing practice. It addresses:
*the need to improve NAS assessment practices
*the benefits of family-centered care
*the need to develop well-structured NAS treatment protocols <ref>https://openprairie.sdstate.edu/cgi/viewcontent.cgi?article=1115&context=con_dnp</ref>

= Impactful Federal, State, and Local Policies =

'''The Comprehensive Addiction and Recovery Act (CARA) of 2016''' amended the Child Abuse
and Prevention Treatment Act (CAPTA). This policy brief summarizes how states are required to serve infants and their families affected by prenatal substance exposure. It uses highlights form seven states to unpack the implications for notification and reporting requirements and for plans of safe care. <ref>https://ncsacw.acf.hhs.gov/files/prenatal-substance-exposure-brief1.pdf</ref>

'''West Virginia Advocacy.''' Lily's Place is a neonatal withdrawal center that offers workshops and trainings on legislation to support NAS centers and on planning and funding a NAS center. Its role in advocacy is grounded in direct experience. Lily's Place was the first nonprofit infant recovery center to provide services for parents and families struggling with addiction. The center is specifically designed for babies with NAS with small, quiet, dimly-lit nursery rooms and 24-hour nursing staff. Parents are trained to help their babies via therapeutic handling techniques and they learn CPR and basic child care as well as the specifics of NAS. <ref>http://www.lilysplace.org/presentations-and-workshops</ref>

=Available Tools & Resources=

'''SAFE Project:'''
*'''Addiction and Mental Health Resources for Women'''' is a SAFE Project written guide that includes a number of support resources during and after pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
*See the wiki titled "Increase Awareness of Risks of SUD on the Baby" for more detailed information on increasing the awareness surrounding the possible risks of drug use during pregnancy and the potential treatment options for opioid use disorders.<ref>https://www.yoursafesolutions.us/wiki/Increase_Awareness_of_Risks_of_SUD_on_the_Baby#Available_Tools_and_Resources/</ref>

'''Canadian Provincial Health Resources, British Columbia''' provides a practice resource for healthcare providers titled, "Care of the Newborn Exposed to Substances During Pregnancy." <ref>http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/Practice%20Resource%20ESC_WEB%202020_11_20.pdf</ref>

'''Yale School of Medicine.''' This webinar is provided by the originator of ESC -- Matthew Grossman, MD, Associate Professor of Pediatrics, Yale-New Haven Children’s Hospital. <ref>https://wvperinatal.org/event/webinar-nas-the-eat-sleep-console-approach/</ref>

'''The Saskatchewan Health Authority''' created a handout on ESC for new parents. <ref>"Caring For Your Newborn At Risk For Substance Withdrawal with the Eat Sleep Console Method," https://momsandkidssask.saskhealthauthority.ca/sites/default/files/documents/esc-parent-handout.pdf</ref>

'''The California Healthcare Foundation''' has a blog that details the benefits of ESC in a highly accessible manner. It is titled "Opioid-Dependent Newborns Get New Treatment: Mom Instead of Morphine." <ref>https://www.chcf.org/blog/opioid-dependent-newborns-get-new-treatment/</ref>

'''ESC Toolkit.''' This downloadable guidebook resulted from a collaboration between doctors at Boston University School of Medicine, Children’s Hospital at Dartmouth-Hitchcock, and Yale University School of Medicine. <ref>https://docplayer.net/87738560-Caring-for-opioid-exposed-newborns-using-the-eating-sleeping-consoling-esc-care-tool.html</ref>

'''Women & Infants Clinical Institute''' has published an ESC guidebook that includes recommendations, approaches, and resources. The guidebook was developed through collaboration between Bakersfield Memorial Hospital in California, CHI Franciscan in Tacoma, Washington, and the Yale-New Haven Children’s Hospital. <ref>https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/CSH-ESCPlaybookElectronic.pdf</ref>

= Promising Practices =

'''Kentucky.''' In Louisville, healthcare workers are using a combination of pacifiers and music therapy to ease the pain of babies born to mothers who used opioids during their pregnancy. They use a special pressurized pacifier that plays music. A music therapist uses music and live-singing in the NICU, patting and rocking to match the baby's behavior state, ultimately training the child to soothe itself. This calming improved feeding and sleeping and decreased their crying -- eliminating three of the major symptoms which lead babies to need medication or hospital stay. <ref>http://www.wmur.com/article/new-device-helps-tiniest-victims-of-the-opioid-crisis/10370051</ref>

'''Maryland.''' The Maryland Patient Safety Center is working with 30 birthing centers to develop standardized care for babies suffering from NAS in order to reduce the length of stay for these babies. Standards include:
*A calming environment with little stimulation - quiet rooms and low lights
*Cuddle rooms where volunteers rock and soothe babies
*Massage and music therapy
*Some medicine (Morphine or Methadone)
*Treatment of mother's addiction and mental health in conjunction with babies' treatment

'''Pennsylvania.''' At Magee-Womens Hospital of UPMC, volunteers are helping babies born addicted to opioids by cuddling, nurturing, and comforting the babies as they go through withdrawal. Cuddlers provide them with additional comfort, as opposed to having to start an IV or give a baby Morphine. There are a growing number of programs that have volunteers come to the hospitals to cuddle the babies. This helps comfort the babies and reduces the stress on the nurses--two important benefits. <ref>https://www.insideedition.com/headlines/19669-hospital-recruits-volunteers-to-cuddle-with-drug-addicted-babies-going-through-withdrawal</ref>

= Sources =

----

Improve Care for Babies Born Drug Dependent

2024-10-23T19:53:56Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

Babies who are born with Neonatal Abstinence Syndrome (NAS) experience discomfort and trauma. They may scream, have tremors, and struggle with eating and being comforted. Hospital staff are finding new opportunities to help these babies and their mothers. Approaches based on recent evidence-based research include moving from NICU and pharmacology treatment to a mother-centered approach. This keeps the mother-infant dyad together in a calm setting while encouraging frequent feedings, comforting, and swaddling to treat the baby's opioid dependence.

= Key Information =

Since the 1970s, pharmacology has been the standard for treating babies born with NAS, and physicians have utilized Methadone or Morphine in treatment. <ref>https://www.chcf.org/blog/opioid-dependent-newborns-get-new-treatment/</ref> Traditionally infants born drug dependent have been managed in the NICU due to concerns of complications. The Finnegan Score/Finnegan Tool has dictated the care level for babies born drug dependent. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786483/</ref> <ref>https://ncpoep.org/guidance-document/neonatal-abstinence-syndrome-overview/neonatal-abstinence-syndrome-nas/#:~:text=The%20Finnegan%20Neonatal%20Abstinence%20Scoring,Fletcher%20Allan%20Hospital%20of%20Vermont.</ref>

Complications from NAS can include: <ref>https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx#</ref>

*Low birthweight
*Jaundice
*Seizures
*Sudden infant death syndrome (also called SIDS).
*Developmental delays
*Motor problems
*Behavior and learning problems
*Speech and language problems
*Sleep problems
*Ear infections
*Vision problems

Treatment of infants showing signs of withdrawal includes a supportive care approach to treatment, such as creating a dark and quiet environment, swaddling the infant to improve self-stimulation, and providing frequent feedings to reduce infant stress. Other strategies include skin-to-skin contact for comfort and promotion of the infant’s attachment to the mother/caregiver, as well as other comforting techniques such as rocking or swaying the infant. Frequent feedings address hydration level. Breastfeeding has been proven to be an effective approach if the mother is receiving medication-assisted treatment and has no other complications which inhibit breastfeeding. Educating families on methods of care is important to provide ongoing supportive care of the infant.

'''Eat, Sleep, Console (ESC) Model'''

Recent research has introduced the ESC approach to treatment of babies born drug dependent. This is a mother-centered approach, based upon the following: <ref> https://www.nichq.org/insight/mother-centered-approach-treating-neonatal-abstinence-syndrome</ref>
*Eat: Is the baby feeding normally?
*Sleep: Is the baby able to sleep?
*Console: Can the baby be consoled within ten minutes of crying?

The ESC approach may be used alone or in conjunction with the Finnegan's model for scoring. The simple components of the approach have shown a decrease in overall length of hospitalization as well as a decrease in need for a pharmacological approach.

= Relevant Research =

'''This article''' documents the decreased impact of NAS associated with parental time spent at the infant's bedside. <ref>https://www.semanticscholar.org/paper/Impact-of-Parental-Presence-at-Infants%27-Bedside-on-Howard-Schiff/9880e862e325f5e443091b2d6961488f65d62ac5</ref>

'''This article''' is a literature review titled "Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome." It is an evidenced-based practice brief that summarizes and critically reviews emerging research on the ESC method. <ref>https://pubmed.ncbi.nlm.nih.gov/30855311/</ref>

'''This research study''' compared treatment decisions of 50 consecutive opioid-exposed infants managed on the inpatient unit at the Yale New Haven Children's Hospital. Infants managed by using the ESC approach were treated with Morphine significantly less frequently than they would have been by using the Finnegan Neonatal Abstinence Scoring System assessment approach. The article is titled, "A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome." <ref>https://pubmed.ncbi.nlm.nih.gov/29263121/</ref>

'''This literature review''' on ESC is part of a doctorate in nursing practice. It addresses:
*the need to improve NAS assessment practices
*the benefits of family-centered care
*the need to develop well-structured NAS treatment protocols <ref>https://openprairie.sdstate.edu/cgi/viewcontent.cgi?article=1115&context=con_dnp</ref>

= Impactful Federal, State, and Local Policies =

'''The Comprehensive Addiction and Recovery Act (CARA) of 2016''' amended the Child Abuse
and Prevention Treatment Act (CAPTA). This policy brief summarizes how states are required to serve infants and their families affected by prenatal substance exposure. It uses highlights form seven states to unpack the implications for notification and reporting requirements and for plans of safe care. <ref>https://ncsacw.acf.hhs.gov/files/prenatal-substance-exposure-brief1.pdf</ref>

'''West Virginia Advocacy.''' Lily's Place is a neonatal withdrawal center that offers workshops and trainings on legislation to support NAS centers and on planning and funding a NAS center. Its role in advocacy is grounded in direct experience. Lily's Place was the first nonprofit infant recovery center to provide services for parents and families struggling with addiction. The center is specifically designed for babies with NAS with small, quiet, dimly-lit nursery rooms and 24-hour nursing staff. Parents are trained to help their babies via therapeutic handling techniques and they learn CPR and basic child care as well as the specifics of NAS. <ref>http://www.lilysplace.org/presentations-and-workshops</ref>

=Available Tools & Resources=

'''SAFE Project:'''
*Addiction and Mental Health Resources for Women that includes a number of support resources during and after pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
*See the wiki titled "Increase Awareness of Risks of SUD on the Baby" for more detailed information on increasing the awareness surrounding the possible risks of drug use during pregnancy and the potential treatment options for opioid use disorders.<ref>https://www.yoursafesolutions.us/wiki/Increase_Awareness_of_Risks_of_SUD_on_the_Baby#Available_Tools_and_Resources/</ref>

'''Canadian Provincial Health Resources, British Columbia''' provides a practice resource for healthcare providers titled, "Care of the Newborn Exposed to Substances During Pregnancy." <ref>http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/Practice%20Resource%20ESC_WEB%202020_11_20.pdf</ref>

'''Yale School of Medicine.''' This webinar is provided by the originator of ESC -- Matthew Grossman, MD, Associate Professor of Pediatrics, Yale-New Haven Children’s Hospital. <ref>https://wvperinatal.org/event/webinar-nas-the-eat-sleep-console-approach/</ref>

'''The Saskatchewan Health Authority''' created a handout on ESC for new parents. <ref>"Caring For Your Newborn At Risk For Substance Withdrawal with the Eat Sleep Console Method," https://momsandkidssask.saskhealthauthority.ca/sites/default/files/documents/esc-parent-handout.pdf</ref>

'''The California Healthcare Foundation''' has a blog that details the benefits of ESC in a highly accessible manner. It is titled "Opioid-Dependent Newborns Get New Treatment: Mom Instead of Morphine." <ref>https://www.chcf.org/blog/opioid-dependent-newborns-get-new-treatment/</ref>

'''ESC Toolkit.''' This downloadable guidebook resulted from a collaboration between doctors at Boston University School of Medicine, Children’s Hospital at Dartmouth-Hitchcock, and Yale University School of Medicine. <ref>https://docplayer.net/87738560-Caring-for-opioid-exposed-newborns-using-the-eating-sleeping-consoling-esc-care-tool.html</ref>

'''Women & Infants Clinical Institute''' has published an ESC guidebook that includes recommendations, approaches, and resources. The guidebook was developed through collaboration between Bakersfield Memorial Hospital in California, CHI Franciscan in Tacoma, Washington, and the Yale-New Haven Children’s Hospital. <ref>https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/CSH-ESCPlaybookElectronic.pdf</ref>

= Promising Practices =

'''Kentucky.''' In Louisville, healthcare workers are using a combination of pacifiers and music therapy to ease the pain of babies born to mothers who used opioids during their pregnancy. They use a special pressurized pacifier that plays music. A music therapist uses music and live-singing in the NICU, patting and rocking to match the baby's behavior state, ultimately training the child to soothe itself. This calming improved feeding and sleeping and decreased their crying -- eliminating three of the major symptoms which lead babies to need medication or hospital stay. <ref>http://www.wmur.com/article/new-device-helps-tiniest-victims-of-the-opioid-crisis/10370051</ref>

'''Maryland.''' The Maryland Patient Safety Center is working with 30 birthing centers to develop standardized care for babies suffering from NAS in order to reduce the length of stay for these babies. Standards include:
*A calming environment with little stimulation - quiet rooms and low lights
*Cuddle rooms where volunteers rock and soothe babies
*Massage and music therapy
*Some medicine (Morphine or Methadone)
*Treatment of mother's addiction and mental health in conjunction with babies' treatment

'''Pennsylvania.''' At Magee-Womens Hospital of UPMC, volunteers are helping babies born addicted to opioids by cuddling, nurturing, and comforting the babies as they go through withdrawal. Cuddlers provide them with additional comfort, as opposed to having to start an IV or give a baby Morphine. There are a growing number of programs that have volunteers come to the hospitals to cuddle the babies. This helps comfort the babies and reduces the stress on the nurses--two important benefits. <ref>https://www.insideedition.com/headlines/19669-hospital-recruits-volunteers-to-cuddle-with-drug-addicted-babies-going-through-withdrawal</ref>

= Sources =

----

Increase Awareness of SUD Impacts on a Fetus

2024-10-23T19:51:46Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as the potential treatment options for opioid use disorder.

=Key Information=

Opioid use in women aged 15–44 years has increased at a similar rate to the dramatic increase in opioid use in the United States. During 2008–2012, about 1 in 3 reproductive-aged women filled an opioid prescription each year. <ref>https://www.cdc.gov/pregnancy/opioids/basics.html</ref> As such, opioid use during pregnancy is not uncommon. There have been significant increases in opioid use disorder during pregnancy. For example, the number of women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014. Opioid exposure during pregnancy has been linked to negative health effects for both mothers and their babies. These include maternal death, stillbirth, and neonatal abstinence syndrome. Birth outcomes for infants exposed to opioids during pregnancy include an increased likelihood to:

*Be born preterm (born before 37 weeks of pregnancy)
*Have poor fetal growth
*Have longer hospital stays after birth
*Be re-hospitalized within 30 days of being born
*Possible birth defects

The effects of prenatal opioid exposure on children over time are largely unknown. However, using opioids as prescribed or for treatment of opioid use disorder during pregnancy may be necessary and may outweigh the risks.

'''Neonatal Abstinence Syndrome'''

Opioid use and medication assisted treatment for opioid use disorder during pregnancy can lead to NAS which is a group of conditions occurring when newborns withdraw from certain substances including opioids which they were exposed to before birth. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Withdrawal symptoms in newborns usually occur 48–72 hours after birth. Drug withdrawal symptoms may include:

*Tremors (trembling)
*Irritability, including excessive or high-pitched crying
*Sleep problems
*Hyperactive reflexes
*Seizures
*Yawning, stuffy nose, or sneezing
*Poor feeding and sucking
*Vomiting
*Loose stools and dehydration
*Increased sweating

The symptoms a newborn might experience and their severity depend on different factors. These include the type and amount of exposure before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to more than one substance before birth.

=Relevant Research=

*'''Opioid Use and Opioid Use Disorder in Pregnancy.''' This report provides an extensive literature review and includes recommendations and conclusions from the American College of Obstetricians and Gynecologists. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref>

*'''Longer-Term Developmental Outcomes.''' There is limited information about longer-term outcomes of children exposed to opioids prenatally, including those with or without NAS. Not all babies exposed to opioids during pregnancy experience signs of NAS, but they may still have longer-term outcomes which are not obvious at birth. Results from a recent study suggest that children with NAS were more likely to have a developmental delay or speech or language impairment in early childhood, compared with children without NAS. It is not clear if these impacts are due to opioids specifically, other substance exposures, or other environmental influences. Findings about long-term outcomes of children exposed to opioids during pregnancy are inconsistent. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.

*'''This article''' titled "Narcotic Addiction, Pregnancy, and the Newborn," provides a 19-year overview of cases at one hospital. Although it is dated (1978), it potentially provides a baseline for comparison to conditions five decades ago. <ref>https://jamanetwork.com/journals/jamapediatrics/article-abstract/507913</ref>

=Impactful Federal, State, and Local Policies=

*'''Medicaid.''' Numerous Medicaid authorities, including the state plan, waivers, and other demonstration programs, can be used to provide SUD treatment and recovery support services to pregnant women with SUD as well as specialized services for infants with NAS. <ref>https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf</ref>

*'''West Virginia''' has a state plan amendment on NAS services that provides for an all-inclusive prospective bundled payment based on the daily treatment of Medicaid beneficiaries. <ref>http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=SB288%20INTR.htm&yr=2020&sesstype=RS&i=288</ref>

=Available Tools and Resources=

*'''SAMHSA''' has published comprehensive clinical guidance for optimal management of pregnant and parenting women with opioid use disorder and their infants. <ref>"Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants." at https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054</ref>

*'''SAFE Project:'''
**'''"Addiction and Mental Health Resources for Women."''' This SAFE Project guide includes a variety of resources specifically providing support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
**See the wiki titled "Improve Care for Babies Born Drug Dependent" for more information on babies who are born with Neonatal Abstinence Syndrome and how they can better receive compassionate treatment/care.<ref>https://www.yoursafesolutions.us/wiki/Improve_Care_for_Babies_Born_Drug_Dependent/</ref>

*'''The American College of Obstetricians and Gynecologists (ACOG)''' has published a report titled, "Opioid Use and Opioid Use Disorder in Pregnancy." This provides recommendations and clinical guidance. <ref> https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> They also provide a FAQ sheet on "Opioid Use Disorder and Pregnancy" that identifies the most effective treatment for opioid use disorder during pregnancy to be opioid replacement medication, which includes medication-assisted treatment such as Methadone and Buprenorphine. The FAQ sheet also covers ways that behavioral therapy and counseling can assist with providing support and tools for ongoing recovery.<ref>https://www.acog.org/womens-health/faqs/opioid-use-disorder-and-pregnancy</ref>

*'''The University of Baltimore''' has published "Supporting Mothers and Infants Impacted by Perinatal Opioid Use: A Cross-Sector Assessment." This collaborative assessment resulted from a community-level intervention initiative that was funded by the Center for Drug Policy and Enforcement. The report provides information on process, lessons learned, and resources that may help others engaged in similar projects and collaboratives. <ref>https://www.texaschildrens.org/sites/default/files/uploads/documents/Perinatal%20Opioid%20Report%20Final_%20march%202019.pdf</ref>

*'''The Council on Recovery''' operates the Center for Recovering Families, a program that guides people who are seeking help to lasting and fulfilling recovery. <ref>https://www.councilonrecovery.org/treatment-programs/</ref>

*'''The National Center on Substance Abuse and Child Welfare (NCSACW)''' is a technical assistance resource. <ref>https://www.cffutures.org/files/fdc/A-Planning-Guide_-Steps-to-Support-a-Comprehensive-Approach-to-Plans-of-Safe-Care-3.21.18-final.pdf</ref>

=Promising Practices=

'''Baptist Health System.''' The Baptist Medical Center in San Antonio is a nationally recognized Center of Excellence for NAS Care. <ref> https://www.baptisthealthsystem.com</ref>

'''Maternal Opioid Misuse (MOM) Model''' is promoted through the Center for Medicare and Medicaid Innovations. The primary goals are to: <ref>https://innovation.cms.gov/innovation-models/maternal-opioid-misuse-model</ref>
*improve quality of care and reduce costs for pregnant and postpartum women with OUD as well as their infants
*expand access, service-delivery capacity, and infrastructure based on state-specific needs
*create sustainable coverage and payment strategies which support ongoing coordination and integration of care

= Sources =

Increase Awareness of SUD Impacts on a Fetus

2024-10-23T19:51:34Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as the potential treatment options for opioid use disorder.

=Key Information=

Opioid use in women aged 15–44 years has increased at a similar rate to the dramatic increase in opioid use in the United States. During 2008–2012, about 1 in 3 reproductive-aged women filled an opioid prescription each year. <ref>https://www.cdc.gov/pregnancy/opioids/basics.html</ref> As such, opioid use during pregnancy is not uncommon. There have been significant increases in opioid use disorder during pregnancy. For example, the number of women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014. Opioid exposure during pregnancy has been linked to negative health effects for both mothers and their babies. These include maternal death, stillbirth, and neonatal abstinence syndrome. Birth outcomes for infants exposed to opioids during pregnancy include an increased likelihood to:

*Be born preterm (born before 37 weeks of pregnancy)
*Have poor fetal growth
*Have longer hospital stays after birth
*Be re-hospitalized within 30 days of being born
*Possible birth defects

The effects of prenatal opioid exposure on children over time are largely unknown. However, using opioids as prescribed or for treatment of opioid use disorder during pregnancy may be necessary and may outweigh the risks.

'''Neonatal Abstinence Syndrome'''

Opioid use and medication assisted treatment for opioid use disorder during pregnancy can lead to NAS which is a group of conditions occurring when newborns withdraw from certain substances including opioids which they were exposed to before birth. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Withdrawal symptoms in newborns usually occur 48–72 hours after birth. Drug withdrawal symptoms may include:

*Tremors (trembling)
*Irritability, including excessive or high-pitched crying
*Sleep problems
*Hyperactive reflexes
*Seizures
*Yawning, stuffy nose, or sneezing
*Poor feeding and sucking
*Vomiting
*Loose stools and dehydration
*Increased sweating

The symptoms a newborn might experience and their severity depend on different factors. These include the type and amount of exposure before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to more than one substance before birth.

=Relevant Research=

*'''Opioid Use and Opioid Use Disorder in Pregnancy.''' This report provides an extensive literature review and includes recommendations and conclusions from the American College of Obstetricians and Gynecologists. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref>

*'''Longer-Term Developmental Outcomes.''' There is limited information about longer-term outcomes of children exposed to opioids prenatally, including those with or without NAS. Not all babies exposed to opioids during pregnancy experience signs of NAS, but they may still have longer-term outcomes which are not obvious at birth. Results from a recent study suggest that children with NAS were more likely to have a developmental delay or speech or language impairment in early childhood, compared with children without NAS. It is not clear if these impacts are due to opioids specifically, other substance exposures, or other environmental influences. Findings about long-term outcomes of children exposed to opioids during pregnancy are inconsistent. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.

*'''This article''' titled "Narcotic Addiction, Pregnancy, and the Newborn," provides a 19-year overview of cases at one hospital. Although it is dated (1978), it potentially provides a baseline for comparison to conditions five decades ago. <ref>https://jamanetwork.com/journals/jamapediatrics/article-abstract/507913</ref>

=Impactful Federal, State, and Local Policies=

*'''Medicaid.''' Numerous Medicaid authorities, including the state plan, waivers, and other demonstration programs, can be used to provide SUD treatment and recovery support services to pregnant women with SUD as well as specialized services for infants with NAS. <ref>https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf</ref>

*'''West Virginia''' has a state plan amendment on NAS services that provides for an all-inclusive prospective bundled payment based on the daily treatment of Medicaid beneficiaries. <ref>http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=SB288%20INTR.htm&yr=2020&sesstype=RS&i=288</ref>

=Available Tools and Resources=

*'''SAMHSA''' has published comprehensive clinical guidance for optimal management of pregnant and parenting women with opioid use disorder and their infants. <ref>"Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants." at https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054</ref>

*'''SAFE Project:'''
**"Addiction and Mental Health Resources for Women." This SAFE Project guide includes a variety of resources specifically providing support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
**See the wiki titled "Improve Care for Babies Born Drug Dependent" for more information on babies who are born with Neonatal Abstinence Syndrome and how they can better receive compassionate treatment/care.<ref>https://www.yoursafesolutions.us/wiki/Improve_Care_for_Babies_Born_Drug_Dependent/</ref>

*'''The American College of Obstetricians and Gynecologists (ACOG)''' has published a report titled, "Opioid Use and Opioid Use Disorder in Pregnancy." This provides recommendations and clinical guidance. <ref> https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> They also provide a FAQ sheet on "Opioid Use Disorder and Pregnancy" that identifies the most effective treatment for opioid use disorder during pregnancy to be opioid replacement medication, which includes medication-assisted treatment such as Methadone and Buprenorphine. The FAQ sheet also covers ways that behavioral therapy and counseling can assist with providing support and tools for ongoing recovery.<ref>https://www.acog.org/womens-health/faqs/opioid-use-disorder-and-pregnancy</ref>

*'''The University of Baltimore''' has published "Supporting Mothers and Infants Impacted by Perinatal Opioid Use: A Cross-Sector Assessment." This collaborative assessment resulted from a community-level intervention initiative that was funded by the Center for Drug Policy and Enforcement. The report provides information on process, lessons learned, and resources that may help others engaged in similar projects and collaboratives. <ref>https://www.texaschildrens.org/sites/default/files/uploads/documents/Perinatal%20Opioid%20Report%20Final_%20march%202019.pdf</ref>

*'''The Council on Recovery''' operates the Center for Recovering Families, a program that guides people who are seeking help to lasting and fulfilling recovery. <ref>https://www.councilonrecovery.org/treatment-programs/</ref>

*'''The National Center on Substance Abuse and Child Welfare (NCSACW)''' is a technical assistance resource. <ref>https://www.cffutures.org/files/fdc/A-Planning-Guide_-Steps-to-Support-a-Comprehensive-Approach-to-Plans-of-Safe-Care-3.21.18-final.pdf</ref>

=Promising Practices=

'''Baptist Health System.''' The Baptist Medical Center in San Antonio is a nationally recognized Center of Excellence for NAS Care. <ref> https://www.baptisthealthsystem.com</ref>

'''Maternal Opioid Misuse (MOM) Model''' is promoted through the Center for Medicare and Medicaid Innovations. The primary goals are to: <ref>https://innovation.cms.gov/innovation-models/maternal-opioid-misuse-model</ref>
*improve quality of care and reduce costs for pregnant and postpartum women with OUD as well as their infants
*expand access, service-delivery capacity, and infrastructure based on state-specific needs
*create sustainable coverage and payment strategies which support ongoing coordination and integration of care

= Sources =

Reduce Stigma for Pregnant People with SUDs

2024-10-23T19:50:26Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Reducing stigma and perception surrounding pregnancy and SUDs will increase access to care. Pregnant women with SUDs may face feelings of shame and guilt on top of their challenges with childcare, social service involvement, and access to care. These difficulties are amplified by stigma.

It should be noted that pregnant women with an SUD are not one uniform group in their behavior. Some are actively using, others are in recovery, and others my be engaged in harm reduction, such as medicated assisted treatment. Nonetheless, as a sub-population they face similar hardships around stigma.

= Key Information =

SAMSHA defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMSHA lists health, home, purpose, and community as essential dimensions of support for a life in recovery. <ref> https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> Stigma is a barrier in recovery. When a person with substance use disorder reaches out for help, he or she is often met with judgmental responses which are less than helpful. This is the result of stigma and can be overt or more subtle. Stigma comes in the form of language used, pity, disdain, silence, or rejection. Persons with mental health and substance use problems are exposed to an array of stigma components which interact to endanger their mental health. These components include stereotypes, prejudice, and discrimination. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625. Retrieved at https://pubmed.ncbi.nlm.nih.gov/15491256/</ref>

Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people in recovery need -- especially those in early recovery. Outside stigma can become internalized, leading people in recovery to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. <ref> https://attcnetwork.org</ref> Women have different experiences with SUD both biologically as well as culturally, as they are seen as caregivers and mothers. Barriers and challenges include: <ref>https://infantcrier.mi-aimh.org/perinatal-substance-use-an-update-and-reflection-on-the-importance-of-relationship/#respond</ref>

*Women are at highest risk for developing SUDs during reproductive years
*Poly-substance use is common
*Unintended pregnancy rate among women with SUD is approximately 80%
*Substance use in pregnancy is connected to many complications and negative health outcomes for mother and baby
*As many as 70% of women entering addiction treatment have children and primary responsibility for children
*Family responsibilities can interfere with regular attendance in treatment sessions, including challenges with childcare
*Hesitancy to seek treatment for fear of legal action or legal issues, including child protective services
*Covid-19 made barriers to access to care more challenging
*Transportation issues
*Past trauma may impact stigma and reaching out for care

Other areas of stigma for pregnant women with SUDs include those seeking medication-assisted treatment and those with HIV or other infectious diseases. Educating providers and communities about pregnancy and substance use can assist with reducing harm and facilitate pregnant women getting access to care and services. <ref>https://www.astho.org/globalassets/brief/stigma-reinforces-barriers-to-care-for-pregnant-and-postpartum-women-with-substance-use-disorders.pdf</ref>

= Relevant Research =

*'''This qualitative study''' used interviews to explore common factors that motivate pregnant women with SUD to seek comprehensive care during pregnancy and common hesitations and barriers to treatment. <ref>https://pubmed.ncbi.nlm.nih.gov/31704383/</ref>

*'''This guideline''' titled "Substance Use Disorder Treatment in Pregnant Adults," contains an extensive review of the literature. It was developed by the New York State Department of Health AIDS Institute in order to establish a statewide standard of care. The goal was to ensure that healthcare providers in New York provide appropriate options for SUD treatment during pregnancy. <ref>https://www.ncbi.nlm.nih.gov/books/NBK572854/</ref>

*'''This article''' provides recommendations specific to expanding and improving treatment care for pregnant women with opioid use disorder. <ref>https://link.springer.com/article/10.1007/s13669-016-0168-9</ref>

=Impactful Federal, State, and Local Policies=

Policies surrounding pregnant women with SUD vary from state to state. These state-level policy variations include:
*Reporting and testing requirements
*Standards for child abuse
*Grounds for civil commitment
*Targeted program created
*Pregnant people given priority access in general programs
*Pregnant people protected from discrimination in publicly funded programs

'''The National Academy for State Health Policy''' has published a document titled, "State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder." This provides information on funding streams for state initiatives. <ref>https://nashp.org/wp-content/uploads/2018/10/NOSLO-Opioids-and-Women-Final.pdf</ref>

= Available Tools and Resources =

*'''SAMHSA's Addiction Technology Transfer Center Network (ATTC)''' has published "Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma." <ref>https://attcnetwork.org/sites/default/files/2019-04/Anti-Stigma%20Toolkit.pdf</ref> It has also created a downloadable Powerpoint presentation titled, "Reducing Stigma in Pregnant & Parenting Women with Substance Use Disorder." <ref>https://www.ndsu.edu/fileadmin/centers/americanindianhealth/files/Maternal_Health_Learning_Collaborative_Session_2.pdf</ref>

*'''Safe Project:'''
**'''"No Shame Pledge"''' is a SAFE Project campaign created to end stigma and support others in speaking up about their own disorders and to get help without judgement. Participants receive a certificate in acknowledgement of their commitment to saving lives by fighting stigma. <ref>https://www.safeproject.us/noshame-mental-health-addiction/</ref>
**See the Wiki titled "Reduce Stigma" for more detailed information on the reduction of stigma for those experiencing substance use issues. <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>

*'''From Research to Recovery Town Hall''' brings together speakers from across the country to address mental health, substance use and other facets of behavioral and emotional health. One example includes this YouTube titled “Gender & Use, Misuse, Treatment and Recovery," by Dr. Mishka Terplan, MD, MPH, Professor of Obstetrics and Gynecology and Psychiatry and the Associate Director of Addiction Medicine at Virginia Commonwealth University. It addresses how developing addiction to opioids and other drugs vary across gender, and how expectations impact the conception of treatment and stigma around use. <ref>https://www.youtube.com/watch?v=siC6Cd4Q3MQ&t=33s</ref>

= Promising Practices =

'''Maryland.''' "Refocus: Look Again" is a public education campaign from the Anti-Stigma Project within On Our Own of Maryland. It is designed to challenge misconceptions and assumptions associated with mental health and substance use. Their goal is to foster change through awareness and dialogue about the real and damaging impact of stigma. <ref>https://refocuslookagain.org/</ref> An example iof their online content is an anti-stigma interview with Adina Weissman titled, "Medicated Assisted Treatment and Pregnancy." <ref>https://www.distortedperceptions.org/articles-main/2022/4/4/medicated-assisted-treatment-and-pregnancy-an-anti-stigma-interview-with-adina-weissman?fbclid=IwAR1rkj3LV5sbgU6TLPUwq7MVfesTfokhEbUHT2GTS85ko5SbDF-YzWXU-zU</ref> They also have an online pledge to challenge perceptions, to speak out, and to become an agent of change. <ref>https://www.distortedperceptions.org/take-the-pledge</ref>

= Sources =

Expand Perinatal Treatment and Support for People with SUDs

2024-10-23T19:48:17Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

It is extremely important for infants to be well-nourished and well-cared for in so that the baby to thrive. While this is critically important to both mother and baby, making healthy choices isn’t so clear-cut for some pregnant women. Those who become pregnant while facing a substance use disorder face great challenges in caring for their body and the baby they are carrying. Substance use at any time, but especially during pregnancy, is a highly stigmatized issue which has worsened over the decades. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116049/</ref> Substance use during pregnancy can have detrimental health effects on the baby and the mother, but the stigma may prevent the mother from seeking prenatal care or substance use treatment. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref>.

Most doctors recommend that pregnant women with a substance use disorder undergo a long-term treatment plan called drug-assisted stabilization using Methadone. This harm reduction therapy remains financially sustainable for a woman after she has given birth, because it is covered under Medicaid. So new mothers can still access the treatment, even after their six-week Medicaid-provided postnatal care is done. In addition, the treatment does not subject a woman's mind and body to the stress of full withdrawal, allowing her to focus on caring for herself and her baby.

= Key Information =
===Statistical Prevalence ===

The CDC reports that the most commonly substances used during pregnancy include tobacco, alcohol, marijuana, and opioids, each carrying its own risks. <ref>https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm</ref> The prevalence of alcohol and substance use amongst pregnant women is a growing problem, with 10% using alcohol and 4.5% reporting binge drinking during pregnancy. Of these women, 40% also reported using one or more substances, the highest of which is tobacco, and 5% reported use of illicit drugs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5 </ref> The majority of use occurs during the first trimester, a vulnerable phase for the baby, making intervention during the first trimester a critical time frame to minimize potential harm.

===Risk Factors===

While substance abuse occurs within every demographic, there are certain factors which create higher risk of use during pregnancy. It is important to note that demographic data collection is scarce, should be taken as a “minimum” amount, and is highly biased based on policies that disproportionately threaten young ages and women of color and low socioeconomic status. Most available data are taken from enacted policies, discussed below, which are meant to deter prenatal substance use but instead promote maternal prosecution. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref> The following reflects non-prosecutorial risk factor data indicating categories of being high risk to use substances while pregnant: <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref> <ref>https://www-clinicalkey-com.echo.louisville.edu/#!/content/playContent/1-s2.0-S170121631730508X?returnurl=null&referrer=null</ref>

* ages 15-24
* education level high school or below
* at or below the poverty level
* concurrent psychiatric disorders (mood/anxiety & eating disorders most common)
* history of trauma (childhood or adulthood sexual/domestic/interpersonal abuse)
* poly-substance use
* family history of substance use
* women of color and women on public health insurance had higher rates of prenatal substance use <ref> https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref>

===Impacts===

Prenatal habits are vital to the healthy development of the baby and the maintained health of the mother. Alcohol and drug use during pregnancy has many negative effects on both. Much of the research focuses on the physical effects of prenatal substance use on the fetus, but there are important impacts on the mother that must also be considered. One list of the potential negative consequences of substance use for mothers includes: <ref> Jocelynn L. Cook, Courtney R. Green, Sandra de la Ronde, Colleen A. Dell, Lisa Graves, Alice Ordean, James Ruiter, Megan Steeves, Suzanne Wong, Epidemiology and Effects of Substance Use in Pregnancy, Journal of Obstetrics and Gynaecology Canada, Volume 39, Issue 10, 2017, Pages 906-915. </ref>
*psychosocial decline (stress, reduced social support, partner violence, isolation, financial/legal troubles, self harm),
*physical issues (vascular complications, infections, bodily trauma), and
*reduced frequency of prenatal care.

Impacts on the fetus are vast and vary by the specific substance. Consuming alcohol, however minor the amount, increases the baby’s risk of Fetal Alcohol Syndrome, preterm birth, teratogenicity, neurodevelopmental disorders, miscarriage, and stillbirth. Fetal Alcohol Syndrome impacts the baby’s physical growth and appearance, along with its emotional, behavioral, and cognitive health. Exposure to illicit drugs may have the following consequences: <ref>https://www.fountainhillsrecovery.com/blog/pregnancy-and-addiction/</ref>

* low birth weight and growth restriction
* preterm birth
* miscarriage
* stillbirth
* sudden infant death syndrome
* exaggerated startles and diminished crying response
* neonatal withdrawal or abstinence symptoms
* transient central and automatic nervous system symptoms
* congenital heart malformations
* abnormal physical developments

Postnatal impacts on the mother and baby extend beyond physio-social consequences. Mothers who use substances throughout pregnancy are at an increased risk of having the child removed from their care after birth. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> These child removals have been shown to lead to an increase in maternal drug use and mental health complications, especially in Black and Indigenous women. <ref>https://www.nationalpartnership.org/our-work/health/moms-and-babies/substance-use-disorder-hurts-moms-and-babies.html</ref> Those who do retain custody of their infants and continue substance use are at risk of atypical maternal-infant bonding and attachment, which is linked to adverse child outcomes. <ref>https://www.frontiersin.org/articles/10.3389/fpubh.2019.00045/full</ref>

===Barriers===

There is a lot of debate among providers of various professions as to whether substance use screening should be universal in prenatal care. Early detection and treatment is critical to protecting the health of both the baby and the mother. However, the fact that many states make prenatal substance use a punitive offense can cause women to not seek prenatal care, which is detrimental in its own right. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> There are substantial barriers to prenatal substance abuse treatment that have lasting consequences for the mother and baby. Since 2000, the number of states that criminalize prenatal substance use has more than doubled, with 25 states plus D.C. classifying it as child abuse, and the same amount has medical reporting requirements. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> These laws had the intention of deterring prenatal substance use, but have instead had severe adverse effects. With so few states offering pre-or postnatal drug treatment programs as an alternative to prosecution due to liability issues, many mothers have instead reported self-isolation and avoidance of both prenatal medical appointments and substance use treatments. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> Substance-using pregnant women who “do receive prenatal care experience more positive birth outcomes and have greater opportunities for other health-promoting interventions than women who do not receive care.” <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> However, the majority of pregnant substance-using women who receive appropriate care and intervention are older, white women with private health insurance that are less likely to be reported, creating significant disparities. Women who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> This lack of medical care and intervention of untreated prenatal substance use can lead to a greater likelihood of fetal substance dependency and ensuing fetal medical complications. It is vital to advocate and lobby for states to adopt impactful treatment policy, while also negating or varying the consequences of legal action taken against the mothers. See the Policies Section below for examples of states that have adopted successful legal policy that focus on pre-natal and post-natal SUD treatment to avoid infant removal and punitive action.

= Relevant Research =

* This website has a literature review in the form of an annotated bibliography on almost 50 topics on substance use during pregnancy. It highlights the main findings on a variety of topics, from prevalence and disparities to impacts and policy implications. <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref>

* This article identifies three dominant approaches to antenatal substance use -- contingency management, motivational interviewing, and cognitive-behavioral therapies. It notes that there is little research done on perinatal psychological interventions, but suggests that these practices may have similar benefits in perinatal treatment for substance use. It gives in-depth descriptions and benefits of each modality. <ref>https://www.nursingcenter.com/ce_articleprint?an=00005237-201407000-00006</ref>

*This article provides support for use of pharmacotherapy as an effective treatment and lists its benefits. For pregnant women with opioid use, Methadone and Buprenorphine is the standard of pharmacotherapy. <ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/what-treatment-available-pregnant-mothers-their-babies</ref>

= Impactful Federal, State, and Local Policies =

'''Federal.''' The Family First Prevention Services Act (FFPSA) permits states to use title IV-E foster care funding for children placed in foster care with their parent in a licensed residential family-based treatment facility for substance use. However, few states currently use this funding, due to barriers such as competing priorities and lack of facilities. <ref>https://aspe.hhs.gov/reports/ffpsa-room-board-brief</ref>

'''States.''' As noted above, half of the states plus D.C. have punitive policies that negatively impact mother and baby.
*Kentucky and Arizona, while having punitive laws, have also implemented an alternative to immediate criminal punishment, giving mothers 90 days to enroll in a treatment program while also giving them priority access to these programs. This shows promise in preventing continued drug use and infant removal from care.
*Texas offers prenatal and postnatal health support to women with substance use disorder and access to residential treatment centers for both mothers and their new infants.
*Montana has allowed women to seek treatment to avoid prosecution, as long as they maintain active treatment, but it isn’t clear if they provide available pathways.

'''The Guttmacher Institute''' provides a state-by-state index of policies on substance use during pregnancy and provides information on states that qualify prenatal substance use as child abuse, require reporting, have criminal commitment requirements, etc. This index currently reveals the following: <ref> https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref>
*24 states and the District of Columbia consider substance use during pregnancy to be child abuse under civil child-welfare statutes, and 3 states consider it grounds for civil commitment.
*25 states and the District of Columbia require health care professionals to report suspected prenatal drug use, and 8 states require them to test for prenatal drug exposure if they suspect drug use.
*19 states have either created or funded drug treatment programs specifically targeted to those who are pregnant, and 17 states and the District of Columbia provide pregnant people with priority access to state-funded drug treatment programs.
*10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people.

=Available Tools & Resources=

*'''SAMHSA''' has published "A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders." This manual offers best practices on collaborative treatment approaches for pregnant women living with opioid use disorders. It addresses the risks and benefits associated with medication-assisted treatment. <ref>https://store.samhsa.gov/product/collaborative-approach-treatment-pregnant-women-opioid-use-disorders/sma16-4978</ref>

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**"Addiction and Mental Health Resources for Women." It includes a series of resources for support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
**See the wiki titled "Improve Care for Babies Born Drug Dependent" for more information on babies who are born with Neonatal Abstinence Syndrome and how they can better receive compassionate treatment/care.<ref>https://www.yoursafesolutions.us/wiki/Improve_Care_for_Babies_Born_Drug_Dependent/</ref>

*'''The Northern New England Perinatal Quality Improvement Network''' provides a comprehensive toolkit that includes best practices recommendations, treatment facilitation, screening tools, specific substance information, breastfeeding support, mental health access, social needs assessment, and implementation tools. <ref>https://www.nnepqin.org/a-toolkit-for-the-perinatal-care-of-women-with-opioid-use-disorders/</ref>

*'''Drugabuse.com ''' is a website that addresses the benefits of group therapy when led by a trained professional. It includes information on recovery education, social support, and motivation in recovery. It also provides observations on various issues and methods within recovery, such as peer empowerment and healthy coping skills to build a sense of optimism and connectedness. <ref>https://drugabuse.com/treatment/therapy/group/</ref>

= Promising Practices =

*'''Dartmouth Hitchcock Medical Center''' has a perinatal addiction treatment program based upon an integrated care model that includes maternity care, substance use treatment, behavioral health, and pediatrics. It has a participant-driven design that provides SBIRT screening and an 18-week parenting class. Outcome successes include an average gestational age of over 38 weeks, average birthweight in the normal range, and decreased NAS treatment rate. Two thirds of participants remain in treatment postpartum. <ref>https://www.dartmouth-hitchcock.org/about/</ref>

*'''Centering Pregnancy.''' While not specifically focusing on issues of addiction or substance misuse among pregnant women, the Centering Pregnancy approach has the potential to cost-effectively improve prenatal and perinatal care among women who may be using or be addicted to opioids or other substances. It is a group approach to prenatal and perinatal care. <ref>https://www.centeringhealthcare.org/what-we-do/centering-pregnancy</ref>

*'''Colorado.''' The Special Connections Project provides gender-responsive treatment for pregnant and parenting women who are Medicaid-eligible to maximize the chance of a healthy birth. They provide postpartum treatment services in order to maintain gains made during pregnancy. Special Connections providers offer pregnancy risk assessments, care coordination services, group counseling sessions, individual counseling sessions, health education groups, and residential SUD treatment in a women-only setting. <ref>https://hcpf.colorado.gov/special-connections</ref>

= <br/> Sources =
</div>
[[Category:SAFE-Treatment and Recovery]]

Minimize Substance Use During Pregnancy

2024-10-23T19:45:22Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

The unintended pregnancy rate among women with SUD is approximately 80%. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy#:~:text=Unintended%20pregnancy%20rates%20among%20women,than%20in%20the%20general%20population.</ref> 40% of pregnant women who drank alcohol during pregnancy reported co-using other substances, including tobacco, cannabis, cocaine, and heroin. <ref>England LJ, Bennett C, Denny CH, et al. (2020) Alcohol Use and Co-Use of Other Substances Among Pregnant Females Aged 12-44 Years - United States, 2015-2018. MMWR Morbidity and Mortality Weekly Report 69(31):1009-1014.</ref> Recently, the number of pregnant people using opioids has rapidly increased, in keeping with the increase observed in the general population. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref>

Pregnant women with substance abuse disorder face multiple challenges and obstacles. Lack of access to medical care, ineffective collaboration among social service systems, stigma, and fear of punishment further compound their challenges. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4426.pdf</ref> Current research suggests that a collaborative, integrated approach to managing SUD in pregnant women provides the best chance to counteract obstacles and minimize or eliminate substance use. A wraparound approach is backed up by evidential research and provides comprehensive services by social, family, criminal justice, social service, medical, and mental health professionals. <ref>https://canfasd.ca/wp-content/uploads/publications/FINAL-CCE_Report_Mar-8-for-web.pdf</ref>

=Key Information=

Studies suggest that pregnancy provides a unique opportunity for women to embrace recovery options. <ref>https://www.cdc.gov/pregnancy/polysubstance-use-in-pregnancy.html</ref> However, there are significant barriers for pregnant women seeking treatment. Quitting substance use, especially when an individual has SUD, can be difficult. Pregnant women might find quitting complicated by the fear that asking for help could lead to potential social and even legal consequences. Reporting requirements and administrative policies of service agencies may lead to mandatory involvement with child protective services, loss of child custody, or other legal consequences. Limited child care options may deter mothers from seeking treatment. Likewise, women in treatment may need help with handling the burdens of work, home, and other family responsibilities. <ref>https://www.hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.pdf</ref>

Stigma is a large barrier to treatment and recovery. The societal stigma toward women who abuse substances tends to be greater than that toward men, and the stigma amplifies significantly for pregnant drug users. Women's ascribed role and the expectations placed on them influences societal perceptions and reactions toward women with SUDs. Women who use alcohol and illicit drugs regularly feel shame and guilt, and they also often suffer from low levels of self-esteem and self-efficacy. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/</ref> Women with substance use issues often have high levels of comorbid mental health disorders. In 2019, there were 34.3M adult women who had a mental illness and/or SUD. <ref>https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health</ref>

Substance use disorders can manifest differently in women than in men. <ref>https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women</ref> In the past, women were not included in most clinical research. <ref>https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/importance-including-women-in-research</ref> Women may experience varying levels of discrimination in both healthcare and criminal justice systems that affect their substance use and may affect their recovery. Pregnant women using substances, particularly women of color and women in lower socioeconomic brackets, deal with increased surveillance and may face consequences, such as arrest and child removal. <ref>https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23</ref> Some women use substances to cope with these stresses of discrimination. Women dealing with SUD who struggle financially may have to deal with low-income unstable housing, lack of access to transportation and medical care, as well as poor nutrition. Less access to health care, and difficulty in funding treatment due to a lack of health insurance, can result in later referral for substance use treatment. Since residential treatment facilities are limited, pregnant women have reported several barriers to treatment and healthcare, including insufficient treatment options and difficulty locating and entering treatment.

Rural vs. urban geography also plays a role in substance use during pregnancy. Rates of substance use during pregnancy are typically higher in rural communities than in urban ones. However, most of the research on the prevalence, prevention, and treatment of substance abuse during pregnancy has focused on urban areas. Rural women are 9% more likely than urban women to face severe maternal morbidity mortality. They are also 59% more likely than urban women to have an SUD diagnosis at the time of birth. <ref> https://www.nationalpartnership.org/our-work/resources/health-care/maternity-care-in-the-united.pdf</ref> More opioids are prescribed in rural communities than in urban ones. This has led to prescription opioids being the most common type of drug abused by rural pregnant women. Noteworthy characteristics that make rural living more challenging are the lack of economic opportunity, transportation, and technological limitations.<ref>https://www.hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.pdf</ref> Rural communities often have limited resources for prevention and treatment and lack the resources needed to provide services to parents dealing with substance use.

'''Best Practices in Treatment and Therapy'''

Despite the fact pregnancy motivates some women to begin treatment, several studies indicate that pregnant women do not remain in treatment as long. Researchers have also linked retention to the stage of pregnancy and if the individual has co-occurring psychiatric disorders. Transitional programs and aftercare services can offer educational programs, vocational training, relapse prevention programs, childcare services, and housing options for women and their newborns to support a sustained recovery as well.

Offering holistic, integrated support for pregnant women with substance use concerns is an emerging best practice to support pregnant women with substance use concerns. These programs can be provided through various models including outreach, multi-service co-located agencies, or a network of community-based services. Research in this area has shown that integrated-support models can improve maternal and fetal outcomes and successfully support women to reduce alcohol use in pregnancy. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4426.pdf</ref> Best practices should take the following approaches into consideration:

*'''Evidence-Based Practice (EBP)''' is increasingly becoming more popular in many health care disciplines. One of its main characteristics is its focus on the interaction between hard scientific evidence, clinical expertise, and patient needs and choices. There are many different EBPs that are effective, including traditional programs (which center around the pregnancy period), comprehensive treatment, and home visitation. Contemporary approaches include newer methods such as motivational interviewing and contingency management. They concentrate on the mother-infant relationship, collaboration among social service systems, including child protective services and family treatment drug court, and pharmacotherapy. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC226388/</ref>

*'''Mental Health.''' Mental health care is an integral aspect of addiction treatment. There is a need to increase identification of co-occurring substance use and mental disorders, such as mood, anxiety, and eating disorders. Integrated treatment for co-occurring disorders differs from traditional approaches. For example, this would mean that there are assessments provided that screen for both mental illness and substance use. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/ebp-kit-building-your-program-10112019.pdf</ref> Behavioral therapies help to discover what may have prompted initial drug abuse, and they can teach participants new ways of thinking which will promote future healthy behaviors and habits. Another benefit for women is that counseling can help teach them how to manage childbirth and the pain and medical concerns which might occur during pregnancy and in childbirth. Creating a plan for these potential difficulties in combination with addiction treatment can be helpful. For example, after childbirth, pain medications may need to be monitored or switched for non-habit-forming ones. Such relational approaches take into consideration positive and negative familial and partner influences and relationships, and promote a safe and caring treatment environment.

*'''Trauma-Informed Approaches''' include screening and assessing women for trauma history. Many women with SUDs have experienced trauma which was perpetrated by someone close to them. This contributes to these women’s treatment needs.<ref>https://www.sciencedirect.com/science/article/abs/pii/S0091743520303273</ref>

*'''Integrated Treatment and Coordinated Care''' works with the whole person, including their family and parenting responsibilities. Integrated treatment programs include on-site pregnancy services, parenting services, or child-related services with addiction services. These were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. Collaborative care models offer a multidisciplinary approach to clinical care. Connection to psychosocial support services can improve the chances of treatment success for women with substance use disorders. Additionally, women can benefit from behavioral health referrals, connection with peer and community supports, services for addressing social determinants of health, such as housing or food insecurity.

*'''Medication-Assisted Treatment (MAT)''' is clinically driven and focuses on individualized patient care. Medications used to treat opioid use disorders include Methadone and Buprenorphine. Both of these medications stop and prevent opioid withdrawal and reduce opioid cravings, allowing the person to focus on other aspects of recovery. Research shows that a combination of medication and behavioral therapies is most successful for substance use disorder treatment. MAT provides a whole-patient approach and is a recommended best practice for the care of pregnant women with opioid use disorders. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> In considering the appropriate medications for pregnant women, Buprenorphine is safer than Naltrexone or Methadone to ensure better outcomes for newborn children.

*'''Group-Based Treatment & Peer Support.''' Comprehensive care includes individual or group therapy sessions. Group sessions may take place with other pregnant women and focus on specific issues for this population. Women can work together during group skills sessions to learn parenting techniques and healthy stress coping mechanisms. This serves to provide recognition of women’s cultural expectations and to help improve engagement and retention in treatment programs. In a study using online health communities, 58.5% of the pregnant women in the study expressed negative emotions, of whom only 10.2% wanted to address their emotional needs with the help of the online community. <ref>https://onlinelibrary.wiley.com/doi/epdf/10.1111/hsc.13335</ref> Five themes of self-management support needs were identified for online communities
**information regarding the potential adverse effects of gestational opioid use
**protocols for self-managed withdrawal
**pain management safety during pregnancy
**hospital policies and legal procedures related to child protection
**strategies for navigating offline support systems.

=Relevant Research=

*'''National Institute on Drug Abuse (NIDA)''' has published a research report on substance use by women. It includes sections associated with breastfeeding, as well as sex and gender differences in substance use. <ref>https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use</ref>

*'''CDC''' Publishes MMWR (The Morbidity and Mortality Weekly Report). One of these is titled "Substance Use During Pregnancy Alcohol Use and Co-Use of Other Substances Among Pregnant Females Aged 12–44 Years — the United States, 2015–2018." It breaks down some of the findings in the National Survey on Drug Use and Health (NSDUH). For example, 38.2% of pregnant respondents who reported current drinking also reported current use of one or more other substances -- primarily tobacco and marijuana.

*'''Public Health Agency of Canada''' funded a national evaluation of multi-service programs that reach pregnant women at risk. This report was completed by the Nota Bene Consulting Group in partnership with the Centre of Excellence for Women’s Health. The evaluation was designed around a a theory of change developed that was collaboratively developed by organizations which were guided by a similar set of theoretical approaches, including being trauma-informed, relationship-based, women-centered, culturally-grounded, and harm-reducing. <ref>Rutman, D., Hubberstey, C., Van Bibber, M., Poole, N., & Schmidt, R.A. (2021). Stories and Outcomes of Wraparound Programs Reaching Pregnant and Parenting Women at Risk. Victoria, BC: Nota Bene Consulting Group. retrieved at https://canfasd.ca/wp-content/uploads/publications/FINAL-CCE_Report_Mar-8-for-web.pdf</ref>

*'''This article''' is titled "Concurrent Opioid and Alcohol Use Among Women Who Become Pregnant: Historical, Current, and Future Perspectives." It highlights the historical context of opioid and alcohol use during pregnancy, summarizes the current knowledge of opioids and alcohol use during pregnancy, and details future directions in how health care providers could help. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545650/</ref>

*'''This article''' is titled "Pregnant women and substance use: fear, stigma, and barriers to care." The research was based on interviews with 30 recently-pregnant women who had used alcohol or other drugs during their pregnancies. It highlights their strategies for managing their risk of detection by health or criminal justice authorities. It also documents multiple barriers to treatment and healthcare. The findings suggest that policies that substance-using women find threatening discourage them from seeking comprehensive medical treatment during their pregnancies. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/</ref>

*'''Healthcare Cost and Utilization Project (H-CUP)''' generated a brief that presents statistics from the National Inpatient Sample (NIS) on delivery-related inpatient stays involving SUDs, for select types of substances (opioids, cocaine, and other stimulants), and for both urban and rural areas. <ref>Obstetric Delivery Inpatient Stays Involving Substance Use Disorders and Related Clinical Outcomes, 2016. retrieved at https://hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.pdf</ref>

*'''Parenting Outcomes.''' This article provides a literature review on parenting skills and parenting needs of women with substance use issues. <ref> Niccols, A., Milligan, K., Sword, W. et al. Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes. Harm Reduct J 9, 14 (2012). retrieved at https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-9-14</ref>

*'''This study''' documents the increase in overdose deaths during pregnancy. <ref>https://www.statnews.com/2023/11/22/opioid-crisis-hits-maternal-health-pregnancy-overdoses-rise/</ref>

=Impactful Federal, State, and Local Policies=

Any advances in public policy and public health strategies support the delivery of evidence-based care for pregnant women. A major policy need is in enhancing the training of professionals to be more attuned to the needs of pregnant women. Advocacy for comprehensive care and professional services would benefit women.

*'''The Comprehensive Addiction and Recovery Act of 2016 (CARA)''' established a coordinated strategy through enhanced grant programs which expand prevention and education efforts while also promoting treatment and recovery. Section 501 (Improving Treatment for Pregnant and Postpartum Women) reauthorizes the Residential Treatment Program for Pregnant and Postpartum Women. It also authorizes the creation of grants within CSAT to enhance a state's services for women who are pregnant and postpartum while suffering from substance use disorder.

*'''SUPPORT Act.''' The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act is federal legislation which addresses tighter oversight of opioid production and distribution. It imposes additional reporting and safeguards to address fraud, and it limits coverage of prescription opioids, while expanding coverage of and access to opioid addiction treatment services. The bill also authorizes a number of programs that seek to expand consumer education on opioid use and train additional providers to treat individuals with opioid use disorders. <ref>https://fas.org/sgp/crs/misc/R45405.pdf</ref> Section 503 of the SUPPORT Act (Infant Plan of Safe Care) requires HHS to produce information concerning best practices on developing plans for the safe care of infants born with substance use disorders or showing withdrawal symptoms. This section also requires that state plans address the health and SUD treatment needs of the infant. <ref>https://www.acf.hhs.gov/sites/default/files/documents/cb/im1605.pdf</ref>

*'''State Policy.''' Although federal public policy is advancing efforts to minimize substance use during pregnancy, there are many challenges with inconsistent efforts in state legislatures. This is driven by variations in geography, because federal grants give states the power to decide how to implement key elements of federal policies. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/</ref>
**One area that is gaining public support is in the domain of child welfare and prenatal substance use. Several states have expanded their civil child-welfare requirements to include prenatal substance use, so that prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. Further, some states, under the rubric of protecting the fetus, authorize civil commitment (such as forced admission to an inpatient treatment program) of pregnant women who use drugs. These policies sometimes also apply to alcohol use or other behaviors. A number of states require health care professionals to report or test for prenatal drug exposure, which can be used as evidence in child-welfare proceedings. And in order to receive federal child abuse prevention funds, states must require health care providers to notify child protective services when the provider cares for an infant affected by illegal substance use. <ref>https://fas.org/sgp/crs/misc/R45405.pdf</ref>
**The National Academy for State Health Policy has an overview of state options for promoting recovery among pregnant and parenting women. <ref> https://www.nashp.org/wp-content/uploads/2018/10/NOSLO-Opioids-and-Women-Final.pdf</ref>

=Available Tools and Resources=

'''SAFE Project:'''
*'''"Have A Safety Plan"''' is a SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
*See the wiki titled "Expand Motivational Interviewing for Pregnant People" for more detailed information on the evidence-based practice of motivational interviewing and how it inspires change for those who are pregnant and struggle with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Expand_Motivational_Interviewing_for_Pregnant_People/</ref>

'''SAMHSA''' provides a fact sheet titled "Pregnancy Planning for Women Being Treated for Opioid Use Disorder." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pre_pregnancy_factsheet_041919_508.pdf</ref>

'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting women, and those who are most likely to be targeted for state control and punishment — low-income women, women of color, and drug-using women. <ref>https://www.pregnancyjusticeus.org/</ref>

'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting women who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>

'''Drug Treatment and Referral Services:'''

*The American Psychological Association''' <ref>https://www.apa.org/pi/women/resources/treatment-resources-pregnant-women.pdf</ref>

*National Partnership for Women and Families: Maternity Care in the United States: We Can – and Must – Do Better <ref>https://www.nationalpartnership.org/our-work/resources/health-care/maternity-care-in-the-united.pdf</ref>

*Maternal, Infant and Early Childhood Home Visiting Program Funding <ref>https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview</ref>

*Healthy Safe Children <ref>https://healthysafechildren.org/trending-topics</ref>

*Obstetric-Fetal Pharmacology Research Centers <ref>https://www.utmb.edu/nichd-oprc/</ref>

*Alliance for Innovation on Maternal Health (AIM) <ref> https://www.acog.org/practice-management/patient-safety-and-quality/partnerships/alliance-for-innovation-on-maternal-health-aim</ref>

* Recovery Research Institute <ref> https://www.recoveryanswers.org/research-post/ob-gyns-say-opioid-use-disorders-pregnancy-provide-opportunities-life-changing-interventions/</ref>

=Promising Practices=

'''Center for Addiction and Pregnancy (CAP),''' at The Johns Hopkins Bayview Medical Center, offers an innovative approach to help mothers and infants deal with the physical, emotional, and social problems caused by addiction. CAP is an outpatient program with an available overnight housing unit for patients requiring a recovery-oriented domicile. It provides a comprehensive, coordinated, and multidisciplinary approach to drug-dependent mothers and their drug-affected babies. <ref>https://www.hopkinsmedicine.org/psychiatry/patient-information/bayview/substance-abuse/comprehensive-addiction-pregnancy</ref>

'''Massachusetts.''' Project RESPECT (Recovery, Empowerment, Social Services, Prenatal care, Education, Community and Treatment) is a high-risk obstetrical and addiction recovery medical home at Boston Medical Center and the Boston University School of Medicine. Project RESPECT provides a unique service of comprehensive obstetric and substance use disorder treatment for pregnant women and their newborns. <ref>https://www.bmc.org/obstetrics/pregnancy/addiction</ref>

'''New Jersey.''' The Child Protection Substance Abuse Initiative (CPSAI) is a program that targets parents engaged in the Division of Child Protection and Permanence. Although only 9% of the participants completed treatment, CPSAI is examining individual factors associated with successful treatment and continuing to facilitate treatment engagement for parents being evaluated by the child welfare system.
<ref>https://www.recoveryanswers.org/research-post/using-the-child-welfare-system-to-engage-parents-with-substance-use-disorders/</ref>

'''North Carolina.''' Project CARA is housed at MAHEC Ob/Gyn Specialists. It has supported over 800 women with substance use disorders since 2014. MAHEC first offered integrated substance use treatment services with obstetrical visits in the late 1990s. The Project CARA team has built on this early foundation to provide comprehensive substance use care using current evidence-based practices. <ref>https://mahec.net/patient-information/ob-gyn-care/project-cara-welcome</ref>

=Sources=

Adopt Harm Reduction Practices in Jails and Prisons

2024-10-23T19:43:20Z

Charliekapinos: /* Available Tools & Resources */

= Introductory Paragraph =

It is important to address harm reduction by offering treatment for HIV, Hepatitis and substance use disorder in prison. This is expected to reduce infectious diseases and lower SUD-related morbidity and mortality rates. Research has shown that the incarcerated are a high-risk population for potential medical issues and have barriers to access medical care. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235622/</ref> Syringes in prisons without an Needle Syringe Program (NSP) are sold on illicit markets and are very expensive, given high demand and scarcity. However, in prisons where NSPs operate, there has not been any illicit market reported where needles and syringes are accessible. <ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref> Harm reduction in prisons and jails requires partnerships among communities for a public health effort to reduce mortality rates and to prevent the spread of disease such as HIV and hepatitis among groups. Those partnerships include police, public health experts, and community groups.

= Key Information =

The level of Hepatitis C infection amongst US prisoners is substantially higher than the general population. Between 12 and 35 percent of prison inmates are infected with Hepatitis C, compared to between 1 and 2 percent of the general population. <ref>https://www.globalcommissionondrugs.org/hepatitis/gcdp_hepatitis_english.pdf</ref> Global HIV prevalence is up to 50 times higher among the prison population than in the general public, while one in four detainees worldwide is living with Hepatitis C. <ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref> There is increasing evidence that experience of imprisonment is a strong predictor of HIV and Hepatitis C transmission. Nor is this an issue confined to prison. A majority of prisoners serve short-term sentences, after which they return to the wider community having been at significantly higher risk of blood-borne virus transmission. They are subsequently more likely to pass on blood-borne viruses. For this reason prisons have been called HIV and Hepatitis C ''incubators''. <ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref>

'''Four main models.''' The primary models in prison needle exchange programs are:
*Hand-to-hand distribution. This is done by prison health staff, social workers, physicians, or nurses. This method is used in several Spanish and Swiss prisons. Used syringes are either exchanged at the cell door or in the medical unit.
*Hand-to-hand distribution by trained peers. Delivery by fellow prisoners ensure confidential and increases access to syringes. This system is mostly used in Moldovan prisons.
*Hand-to-hand distribution by external personnel. This may be performed by NGOs who also provide other harm reduction services.
*Automated dispensing machines. This is based upon a one-for-one syringe exchange and has been implemented in Germany and in Hindelbank women's prison in Switzerland.

= Relevant Research =

*'''WHO Study.''' The World Health Organization, in collaboration with the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), performed a review of the international evidence on NSPs. The study recommended that "prison authorities in countries experiencing or threatened by an epidemic of HIV infections among people who inject drugs should introduce and scale up Needle and Syringe Programs urgently." <ref> WHO/UNODC/UNAIDS, 2007, "Interventions to Address HIV in Prisons: Needle and Syringe Programmes and Decontamination Strategies," Geneva: World Health Organization, retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123257/</ref>

*'''European Analysis.''' This report titled "Ten Year of Experience with Needle and Syringe Exchange Programs in European Prisons" concluded that prison NSPs are not only feasible but effective, especially when embedded within a comprehensive prison-based harm reduction and health-promotion strategy." <ref>https://www.sciencedirect.com/science/article/abs/pii/S095539590300152X</ref> This article provides a review on the state of harm reduction in prisons in 30 European countries. <ref>https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00506-3</ref>

*'''Germany, Switzerland, and Spain.''' An evaluation of 19 NSP programs indicated: <ref>https://ndarc.med.unsw.edu.au/resource/prison-based-syringe-exchange-review-international-research-and-program-development</ref>
**Reduction in syringe sharing
**Subsequent reduction in blood-borne virus rates
**No increase in drug use
**No syringes used as weapons

* '''Documenting the Need.''' This article examines the correlation between U.S. incarceration rates and population health by using a novel approach of county-level data. <ref>https://www.sciencedirect.com/science/article/pii/S2352827319300874</ref>

* '''Delineating Solutions.''' This article outlines the benefits of integration of harm reduction therapy with traditional substance use treatment. <ref>https://www.tandfonline.com/doi/abs/10.1080/02791072.2001.10400463</ref>

*'''Harm Reduction in Prisons: A ‘Rights Based Analysis’''' This research article makes the case that governments have a legal obligation to provide prisoners the same level of healthcare that is provided in the community. This is in keeping with international human rights laws and guidelines which require that the health of prisoners is fully protected. <ref>https://www.tandfonline.com/doi/abs/10.1080/09581590400027478</ref>

*'''Harm Reduction International Study.''' This study on HIV, Hepatitis C, and Tuberculosis in prisons found that important factors in the success of prison NSPs include the right type of syringes, easy and confidential access to the service, and building trust with the prisoners accessing the program. It also found that prison NSPs:<ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref>
** Are feasible and affordable across a wide range of prison settings
** Are effective in decreasing syringe sharing among people who inject drugs in prison, thereby decreasing the risk of blood-borne virus transmission between prisoners and from prisoners to prison staff
** Are not associated with increased attacks on prison staff or other prisoners
** Do not lead to increased initiation of drug consumption or injection
** Contribute to workplace safety
** Facilitate referral to available drug-dependence treatment programs
** Can be delivered successfully via a range of methods in response to staff and inmate needs
** Are effective in a wide range of prison systems
** Can successfully coexist with other drug prevention and drug dependence treatment programs

= Impactful Federal, State, and Local Policies =

*'''Medicaid.''' This report provides policy guidance on mechanisms to utilize Medicaid funding to expand jail diversion programs, including harm reduction programs. <ref>https://www.prisonpolicy.org/scans/vera/public-health-and-policing.pdf</ref>

*'''The New York State Plan Amendment''' allows for Medicaid Coverage for harm reduction services to be reimbursed by both Medicaid Managed Care and Medicaid fee–for–service systems. <ref>https://www.health.ny.gov/diseases/aids/consumers/prevention/medicaid_harm_reduction.htm</ref>

=Available Tools & Resources=

'''SAFE Project:'''
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>

*See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>

'''Harm Reduction International''' is a non-profit organization that envisions "a world in which drug policies uphold dignity, health and rights." It has been hosting an annual conference since 1990. It has published "Harms of Incarceration - The Evidence Base and Human Rights Framework for Harm Reduction in Prisons," which provides a succinct 10-page overview of the inter-relationship between public issues associated with incarceration, equity, health safety, and human rights. <ref>https://www.hri.global/files/2021/06/14/HRI_Briefing_Prisons_June2021_Final1.pdf</ref>

'''The John Howard Society of Ontario''' is a non-profit organization dedicated to effective, just, and humane responses to crime and its causes. It has a 90-year track record of work across Canada and has published a fact sheet on harm reduction and mitigation of risk in prison populations. <ref>https://johnhoward.on.ca/wp-content/uploads/2014/09/facts-25-harm-reduction-and-prisoners-mitigating-risk-and-improving-health-march-2009.pdf</ref>

= Promising Practices =

'''The Gloucester ANGEL Initiative''' assures anyone who walks into the police station with the remainder of their drug equipment (needles, etc) or drugs and asks for help will not be charged. The program works to guide those who come to the program towards recovery. <ref>https://paariusa.org/</ref>

'''Law Enforcement and HIV Network (LEAHN)''' provides international examples of partnerships among health and law enforcement agencies to reduce HIV in the communities they serve. <ref>http://www.leahn.org/police-hiv-programs</ref>

= <br/> Sources =

----
</div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Adopt Harm Reduction Practices in Jails and Prisons

2024-10-23T19:42:48Z

Charliekapinos: /* Available Tools & Resources */

= Introductory Paragraph =

It is important to address harm reduction by offering treatment for HIV, Hepatitis and substance use disorder in prison. This is expected to reduce infectious diseases and lower SUD-related morbidity and mortality rates. Research has shown that the incarcerated are a high-risk population for potential medical issues and have barriers to access medical care. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235622/</ref> Syringes in prisons without an Needle Syringe Program (NSP) are sold on illicit markets and are very expensive, given high demand and scarcity. However, in prisons where NSPs operate, there has not been any illicit market reported where needles and syringes are accessible. <ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref> Harm reduction in prisons and jails requires partnerships among communities for a public health effort to reduce mortality rates and to prevent the spread of disease such as HIV and hepatitis among groups. Those partnerships include police, public health experts, and community groups.

= Key Information =

The level of Hepatitis C infection amongst US prisoners is substantially higher than the general population. Between 12 and 35 percent of prison inmates are infected with Hepatitis C, compared to between 1 and 2 percent of the general population. <ref>https://www.globalcommissionondrugs.org/hepatitis/gcdp_hepatitis_english.pdf</ref> Global HIV prevalence is up to 50 times higher among the prison population than in the general public, while one in four detainees worldwide is living with Hepatitis C. <ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref> There is increasing evidence that experience of imprisonment is a strong predictor of HIV and Hepatitis C transmission. Nor is this an issue confined to prison. A majority of prisoners serve short-term sentences, after which they return to the wider community having been at significantly higher risk of blood-borne virus transmission. They are subsequently more likely to pass on blood-borne viruses. For this reason prisons have been called HIV and Hepatitis C ''incubators''. <ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref>

'''Four main models.''' The primary models in prison needle exchange programs are:
*Hand-to-hand distribution. This is done by prison health staff, social workers, physicians, or nurses. This method is used in several Spanish and Swiss prisons. Used syringes are either exchanged at the cell door or in the medical unit.
*Hand-to-hand distribution by trained peers. Delivery by fellow prisoners ensure confidential and increases access to syringes. This system is mostly used in Moldovan prisons.
*Hand-to-hand distribution by external personnel. This may be performed by NGOs who also provide other harm reduction services.
*Automated dispensing machines. This is based upon a one-for-one syringe exchange and has been implemented in Germany and in Hindelbank women's prison in Switzerland.

= Relevant Research =

*'''WHO Study.''' The World Health Organization, in collaboration with the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), performed a review of the international evidence on NSPs. The study recommended that "prison authorities in countries experiencing or threatened by an epidemic of HIV infections among people who inject drugs should introduce and scale up Needle and Syringe Programs urgently." <ref> WHO/UNODC/UNAIDS, 2007, "Interventions to Address HIV in Prisons: Needle and Syringe Programmes and Decontamination Strategies," Geneva: World Health Organization, retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123257/</ref>

*'''European Analysis.''' This report titled "Ten Year of Experience with Needle and Syringe Exchange Programs in European Prisons" concluded that prison NSPs are not only feasible but effective, especially when embedded within a comprehensive prison-based harm reduction and health-promotion strategy." <ref>https://www.sciencedirect.com/science/article/abs/pii/S095539590300152X</ref> This article provides a review on the state of harm reduction in prisons in 30 European countries. <ref>https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00506-3</ref>

*'''Germany, Switzerland, and Spain.''' An evaluation of 19 NSP programs indicated: <ref>https://ndarc.med.unsw.edu.au/resource/prison-based-syringe-exchange-review-international-research-and-program-development</ref>
**Reduction in syringe sharing
**Subsequent reduction in blood-borne virus rates
**No increase in drug use
**No syringes used as weapons

* '''Documenting the Need.''' This article examines the correlation between U.S. incarceration rates and population health by using a novel approach of county-level data. <ref>https://www.sciencedirect.com/science/article/pii/S2352827319300874</ref>

* '''Delineating Solutions.''' This article outlines the benefits of integration of harm reduction therapy with traditional substance use treatment. <ref>https://www.tandfonline.com/doi/abs/10.1080/02791072.2001.10400463</ref>

*'''Harm Reduction in Prisons: A ‘Rights Based Analysis’''' This research article makes the case that governments have a legal obligation to provide prisoners the same level of healthcare that is provided in the community. This is in keeping with international human rights laws and guidelines which require that the health of prisoners is fully protected. <ref>https://www.tandfonline.com/doi/abs/10.1080/09581590400027478</ref>

*'''Harm Reduction International Study.''' This study on HIV, Hepatitis C, and Tuberculosis in prisons found that important factors in the success of prison NSPs include the right type of syringes, easy and confidential access to the service, and building trust with the prisoners accessing the program. It also found that prison NSPs:<ref>https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf</ref>
** Are feasible and affordable across a wide range of prison settings
** Are effective in decreasing syringe sharing among people who inject drugs in prison, thereby decreasing the risk of blood-borne virus transmission between prisoners and from prisoners to prison staff
** Are not associated with increased attacks on prison staff or other prisoners
** Do not lead to increased initiation of drug consumption or injection
** Contribute to workplace safety
** Facilitate referral to available drug-dependence treatment programs
** Can be delivered successfully via a range of methods in response to staff and inmate needs
** Are effective in a wide range of prison systems
** Can successfully coexist with other drug prevention and drug dependence treatment programs

= Impactful Federal, State, and Local Policies =

*'''Medicaid.''' This report provides policy guidance on mechanisms to utilize Medicaid funding to expand jail diversion programs, including harm reduction programs. <ref>https://www.prisonpolicy.org/scans/vera/public-health-and-policing.pdf</ref>

*'''The New York State Plan Amendment''' allows for Medicaid Coverage for harm reduction services to be reimbursed by both Medicaid Managed Care and Medicaid fee–for–service systems. <ref>https://www.health.ny.gov/diseases/aids/consumers/prevention/medicaid_harm_reduction.htm</ref>

=Available Tools & Resources=

'''SAFE Project:'''
*'''The Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training''' by SAFE Project is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>

*See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>

'''Harm Reduction International''' is a non-profit organization that envisions "a world in which drug policies uphold dignity, health and rights." It has been hosting an annual conference since 1990. It has published "Harms of Incarceration - The Evidence Base and Human Rights Framework for Harm Reduction in Prisons," which provides a succinct 10-page overview of the inter-relationship between public issues associated with incarceration, equity, health safety, and human rights. <ref>https://www.hri.global/files/2021/06/14/HRI_Briefing_Prisons_June2021_Final1.pdf</ref>

'''The John Howard Society of Ontario''' is a non-profit organization dedicated to effective, just, and humane responses to crime and its causes. It has a 90-year track record of work across Canada and has published a fact sheet on harm reduction and mitigation of risk in prison populations. <ref>https://johnhoward.on.ca/wp-content/uploads/2014/09/facts-25-harm-reduction-and-prisoners-mitigating-risk-and-improving-health-march-2009.pdf</ref>

= Promising Practices =

'''The Gloucester ANGEL Initiative''' assures anyone who walks into the police station with the remainder of their drug equipment (needles, etc) or drugs and asks for help will not be charged. The program works to guide those who come to the program towards recovery. <ref>https://paariusa.org/</ref>

'''Law Enforcement and HIV Network (LEAHN)''' provides international examples of partnerships among health and law enforcement agencies to reduce HIV in the communities they serve. <ref>http://www.leahn.org/police-hiv-programs</ref>

= <br/> Sources =

----
</div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Number of Safe Injection Sites

2024-10-23T19:31:13Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

A safe injection site is a specific location where people can safely inject an illicit drug under a medical professional's supervision. Everyday there are more than 100 people who overdose, and the objective of these sites is to provide a safe and clean environment to decrease the number of overdoses. These sites help to stop the spread of life-threatening infections, such as HIV or Hepatitis C. Safe injection sites have been in use in Europe, Australia, and Canada for decades. <ref>https://nursing.usc.edu/blog/supervised-injection-sites/</ref> However, the use of these sites is relatively new to the United States and there is still much debate on their use and whether states or the federal government should allow these sites to exist.

= Key Information =

Safe injection sites are important because they can lower the rate of overdoses in a community by having trained individuals at the site to assist and monitor those with substance use disorder while they inject. Safe injection sites also provide clean needles and other supplies to reduce risks. These sites are important because they can provide a safe and sterile environment for users to learn about proper injection and hygienic methods. This may lower infections which can easily be transmitted. Further, these sites may be the first place that someone with substance use disorder decides that they want help. Having individuals working at these sites who are trained in knowing the resources available can help a person get the help they need. <ref>https://www.infectiousdiseaseadvisor.com/home/advisor-channels/hiv-aids-advisor/supervised-injection-sites-pros-and-cons/</ref>

Injection sites are more than just a place for individuals to inject illicit drugs safely. These sites can provide classes, resources, therapy options, and programs. Class topics offered range from proper hygiene to product preparation. Having these classes and programs available helps to reduce overdose and the spread of infectious diseases. These sites also provide referral options for treatment and recovery. <ref>https://www.health.harvard.edu/blog/safe-injection-sites-reducing-stigma-addiction-2017060211826</ref>

Individuals who want to get involved and have a say on these programs can:
*Contact their local, state and federal legislature
*Watch for and vote on legislation that will allow these sites to operate
*Educate individuals on substance use disorder to remove stigma
*Once sites are opened, individuals can support the site and get word out that these programs are available in the community

= Relevant Research =

* A longitudinal study done in France on the practice of community-based safe injection sites had promising results. This study focused on providing education on safely injecting and safe hygiene practices at the sites. It found that using proper methods helps to reduce the risk of overdose and the risk of spreading infectious diseases. <ref>https://www.sciencedirect.com/science/article/abs/pii/S0376871618305003</ref>

* This article indicates that best evidence from cohort and modeling studies suggests safe injection sites are associated with lower overdose mortality, 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections. <ref>Ng J, Sutherland C, Kolber MR. Does evidence support supervised injection sites? Can Fam Physician. 2017 Nov;63(11):866. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/</ref>

* This report provides a literature review on safe consumption facilities. <ref>https://dbhids.org/wp-content/uploads/2018/01/OTF_LarsonS_PHLReportOnSCF_Dec2017.pdf</ref>

* This article documents the benefit of an unsanctioned supervised injection site in the U.S. <ref>Kral AH, Davidson PJ. Addressing the nation’s opioid epidemic: lessons from an unsanctioned supervised injection site in the U.S. Am J Prev Med 2017;53:919-922.</ref>

= Impactful Federal, State, and Local Policies =

*'''Federal Law.''' In January of 2021, the Third Circuit Appellate Court in the United States Department of Justice ruled that safe injection sites were illegal under federal law. <ref>https://www.justice.gov/opa/pr/appellate-court-agrees-government-supervised-injection-sites-are-illegal-under-federal-law</ref> This overturned a decision by the district court on the matter.<ref>https://www.boston25news.com/news/local/federal-development-safe-injection-sites-leaves-massachusetts-advocates-optimistic/YFZWESC22JDRRHWBYPWX7U6HKA/</ref> However, in February of 2022 the Department of Justice released a statement stating that they are evaluating such facilities. <ref>https://www.justice.gov/opa/pr/appellate-court-agrees-government-supervised-injection-sites-are-illegal-under-federal-law</ref>

*'''New York.''' In November of 2021, New York two safe injection sites began operating in Manhattan. New York currently has a proposal for the Safer Consumption Services Act. If this act passes into law it would allow New York to open more sites statewide. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref> As of 10/27/23, this bill is still in committee.

* '''Advocacy.''' A key part for communities to be able to expand safe injection sites in the United States is to continue to remove the stigma of addiction. Many individuals still believe that those with substance abuse disorders can just stop. We do not expect people with autoimmune disorders or other diseases to stop or figure it out on their own, and we should provide the same care and understanding to those with substance abuse disorders. Educating individuals on substance abuse disorders and how this disease can affect people is an important part of being able to get more legislation to open sites nationwide. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

= Available Tools and Resources =

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**See the wiki titled "The Linkage Between Syringe Use and Infectious Disease" for more detailed information on drug use and the concern for those with an SUD catching or spreading infectious diseases.<ref>https://www.yoursafesolutions.us/wiki/The_Linkage_Between_Syringe_Use_and_Infectious_Disease/</ref>

*'''The Canadian Centre on Substance Abuse''' provides a FAQ-sheet on supervised injection facilities. <ref>https://www.ccsa.ca/sites/default/files/2019-04/ccsa-010657-2004.pdf</ref>

*'''The British Columbia Ministry of Health''' has published a community guidebook providing an overview of harm reduction and various actions which can be taken at the municipal level to develop a strategy for mobilizing communities around harm reduction. It focuses on supporting the development of a community response using the traditional authority of municipal jurisdictions. <ref>https://www.health.gov.bc.ca/library/publications/year/2005/hrcommunityguide.pdf</ref>

= Promising Practices =

*'''The Transform Drug Policy Foundation''' documents almost 200 safe injection sites in operation across the world in fourteen countries including Canada, Germany, Switzerland, France, Portugal, Ukraine, Norway, the Netherlands, Australia, Belgium, Spain, Denmark, Iceland and the US. <ref>https://transformdrugs.org/drug-policy/uk-drug-policy/overdose-prevention-centres</ref>

*'''United States.''' A grant of more than $5 million over 4 years will go to New York University and Brown University in Providence, RI, to study 1,000 people at New York’s two sites, along with one set to open in Providence next year. <ref>https://www.pbs.org/newshour/health/effectiveness-of-safe-injection-sites-to-be-evaluated-in-government-backed-study</ref>

= Sources =

Increase Access to Syringe Services Programs

2024-10-23T19:31:05Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

Needle exchange programs (NEPs) distribute sanitized needles in exchange for contaminated or used needles. NEPs reduce the spread of blood-borne diseases like HIV and Hepatitis C. According to the CDC, syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to sterile syringes and injection equipment; and vaccination, testing, and referral to care and treatment for infectious diseases. <ref>https://www.cdc.gov/ssp/index.html</ref> NEPs and SSPs promote harm reduction to help protect the community by providing exchange programs and sterile supplies which help prevent the spread of infectious disease.

= Key Information =

Needle exchange programs have decades of evidence behind them - but not public support. <ref>https://opioidaction.org/2018/06/vox-a-new-study-shows-stigma-is-hurting-our-response-to-the-opioid-epidemic/</ref> Many organizations have endorsed needle exchange including NIH (National Institute of Health), CDC (Center for Disease Control), the American Bar Association, the American Medical Association, the American Psychological Association, and the World Health Organization. The NIH estimates that in the United States, between fifteen and twenty percent of injection drug users have HIV and at least seventy percent have Hepatitis C.<ref>https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.1840360703 </ref> As such, sharing needles has become the most common mode of HIV transmission among injection drug users. In addition, used syringes and needles are a potential biohazard. Harm reduction services such as the provision of sterile needles and syringes can effectively prevent Hepatitis C and HIV transmission among people who inject drugs, provided they are accessible and delivered at the required scale. Needle exchange programs help educate and inform injection drug users regarding injection practices, safety steps, non-sharing behavior, and other risk reduction methods. The CDC promotes SSPs and states that they "reduce HIV and HCV infections and are an effective component of comprehensive community-based prevention and intervention programs that provide additional services." <ref>https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html</ref>

There are currently several different models for syringe exchanges that have different advantages and limitations. The models include:

*'''Primary and Secondary Needle and Syringe Programs''' are fixed sites which are typically located in areas with high levels of injecting drug use. They can be found in community centers, pharmacies, or specialized voluntary counseling and testing centers. Those who attend will be able to receive clean paraphernalia and safely dispose of used paraphernalia. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Mobile or On-Call Service''' operate from a van or bus with clean needles which are distributed. Larger mobile programs typically provide testing and other healthcare services and operate along regular routes at fixed times, often at night when increased use occurs. Mobile services can also be smaller and choose to target specific populations. Mobile programs are more accessible to injection drug users and face less opposition from a community. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Dispensing Machine Distribution.''' Australia and countries in Europe have adopted a newer strategy and have begun to use syringe vending machines. They use non-currency tokens which are distributed by outreach workers to injection drug users in return for harm reduction packs. Australia’s machines include needles, syringes, alcohol swabs, cotton, wool, sterile water, and spoons. Others sometimes contain educational materials. Typically, these machines act in conjunction with fixed sites which provide needles and syringes 24 hours a day, 7 days a week. A clinical trial found that this strategy can be highly effective for reaching populations who are most marginalized or otherwise hard to reach. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Peer Service Distribution Networks.''' This is a strategy in which clients of needle exchanges provide services to their peers, distributing needles, syringes, and associated injection equipment. These clients are trained to assist peers to access exchangers, to distribute information about safer drug use and safer sex, and to facilitate referrals to other health services. This model, in addition to disseminating safer practices and helping make needle exchange programs reach a larger population, may have the psychological impact of making interventions more effective. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241304/</ref>

*'''Prison-Based Facilities''' are still a newly developing practice, only used in 3 of 24 UN countries that have needle exchange programs for the public. <ref>http://blogs.biomedcentral.com/on-health/wp-content/uploads/sites/8/2016/10/Prison-based-needle-and-syringe-programmes-PNSP-final.pdf</ref> They meet a high need because prison populations have more cases of Hepatitis C and HIV than the average population. <ref>http://blogs.biomedcentral.com/on-health/wp-content/uploads/sites/8/2016/10/Prison-based-needle-and-syringe-programmes-PNSP-final.pdf</ref>

= Relevant Research =

*'''Three Studies Documenting Positive Results.''' A review of needle exchange done by the office of the Surgeon General and the assistant secretary for health found that needle exchange did not cause an increase in drug injection, but rather typically led to a decrease in injection rates when these programs were used.<ref>http://www.csdp.org/research/surgeongennex.pdf</ref> Another study sought to answer the question "is the number of needles distributed from needle exchange programs proportionate to the number of needles returned to needle exchange programs?" It was found that in the United States the return rate was on average over 90% (~315,000 needles distributed and ~283,000 needles returned). <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/</ref> The National Research Council report on the topic states: “The need for and value of targeted education and behavior modification efforts directed at injection drug users at risk of HIV transmission have been clearly demonstrated in programs that do not include needle exchange.” <ref>https://www.ncbi.nlm.nih.gov/books/NBK232350/</ref>

*'''Two Cost-Benefit Analyses.''' Needle exchanges have been projected to be a cost-effective prevention practice. An analysis of the cost-effectiveness of a New York City needle syringe exchange estimated that the program would result in a baseline one year savings to the government of $1,300 to $3,000 per client. <ref>Belani, H.K. and P.A. Muennig, Cost-effectiveness of needle and syringe exchange for the prevention of HIV in New York City. Journal of HIV/AIDS & Social Services, 2008. 7(3): p. 229-240.</ref> Another analysis estimated that increasing access to clean syringes through an additional annual U.S. investment of $10 million would lead to a decrease of 194 HIV infections per year and a lifetime treatment cost savings of $75.8 million which would be a return on investment of $7.58 for every $1 spent. <ref>Nguyen, T.Q., et al., Syringe exchange in the United States: a national level economic evaluation of hypothetical increases in investment. AIDS and Behavior, 2014. 18(11): p. 2144-2155.</ref>

*'''Meta-Analysis on Community Impact.''' This literature review found that supplying injecting drug users with clean or sanitized needles does not lead to more "dirty" needles in a community. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/</ref>

= Impactful Federal, State, and Local Policies =

* '''The Consolidated Appropriations Act, 2016''' restricted the use of federal funds for programs distributing sterile needles or syringes for HHS programs. However, HHS also provides a guidance document that outlines how federal funds may be used for other aspects of SSPs based on evidence of a demonstrated need, in consultation with CDC. <ref>https://www.congress.gov/114/bills/hr2029/BILLS-114hr2029enr.pdf</ref>

* Currently each state has their own laws surrounding syringe exchange programs.

* '''A Comprehensive Guide to Syringe Services Programs and Syringe Possession Laws'''<ref>https://pdaps.org/datasets/syringe-services-programs-laws</ref> delineates how syringe possession polices impact ease of access to sterile syringes for injection drug users.

=Available Tools & Resources=

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**See the wiki titled "The Linkage Between Syringe Use and Infectious Disease" for more detailed information on drug use and the concern for those with an SUD catching or spreading infectious diseases.<ref>https://www.yoursafesolutions.us/wiki/The_Linkage_Between_Syringe_Use_and_Infectious_Disease/</ref>

*'''The World Health Organization''' has published a "Guide to Starting and Managing Needle and Syringe Programs." <ref>https://www.unodc.org/documents/hiv-aids/NSP-GUIDE-WHO-UNODC.pdf</ref>

*'''CDC''' provides a fact sheet on harm reduction to promote prevention of transmission of infectious disease, including blood-borne infections. <ref>https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html</ref> They have published a document titled "Syringe Services Programs: A Technical Package of Effective Strategies and Approaches for Planning, Design, and Implementation." <ref>https://www.cdc.gov/ssp/docs/SSP-Technical-Package.pdf</ref> They have also provided guidance to state, local, tribal, and territorial health departments to determine if they have adequately demonstrated need for SSPs according to federal law. <ref>https://www.cdc.gov/ssp/determination-of-need-for-ssp.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhiv%2Frisk%2Fssps.html</ref>

*'''SAMHSA''' provides specific guidance for Minority HIV/AIDS Initiative (MAI) Programs that are implementing SSPs. <ref>https://www.samhsa.gov/sites/default/files/grants/ssp-guidance-for-hiv-grants.pdf</ref>

*'''The National Association of County Health Officials (NACCHO).''' In collaboration with the CDC and in partnership with the University of Washington, NACCHO provides funding and technical assistance to local health departments and community-based SSPs. <ref>https://www.naccho.org/blog/articles/funding-opportunity-building-capacity-for-harm-reduction-monitoring-evaluation</ref>

*'''The North American Syringe Exchange Network''' provides a directory of locations for SSPs. <ref>https://www.nasen.org</ref>

*'''The Comer Family Foundation''' provides harm reduction grants for free sterile syringes. <ref>https://www.comerfamilyfoundation.org/syringe-service-program</ref> It has also published "A Guide to Establishing Syringe Services Programs in Rural, At-Risk Areas." <ref>https://www.comerfamilyfoundation.org/img/A-Guide-to-Establishing-Syringe-Services-Programs-in-Rural-At-Risk-Areas.pdf</ref>

*'''The Syringe Access Fund''' awards grants in two categories: 1) SSPs providing direct services, and 2) harm reduction organizations at the local, state and federal levels conducting community education and mobilization activities focused on legalizing or SSPs and other health interventions for people who use drugs. <ref>https://aidsunited.org/new-funding-opportunity-syringe-access-fund/</ref>

= Promising Practices =

*'''Miami, Florida.''' In three years of operation, Miami's pilot program pulled more than a quarter million used needles out of circulation. By handing out Narcan at the needle exchange, it has helped prevent more than a thousand overdoses. The program also offers clients testing for HIV and Hepatitis C and connects people to medical care and rehabilitation services. <ref>https://www.npr.org/sections/health-shots/2019/06/27/725462715/key-florida-republicans-now-say-yes-to-clean-needles-for-drug-users</ref>

*'''Philadelphia, Pennsylvania.''' A case study found that Prevention Point, a needle exchange located in Philadelphia helped prevent 10,000 people from contracting HIV over 10 Years. The researchers from George Washington University estimate that the total lifetime taxpayer savings from this needle exchange averting 10,000 cases of HIV saved them $1.8 billion. <ref>https://www.phillymag.com/news/2019/10/31/prevention-point-syringe-exchange-study/</ref>

*'''Scott County, Indiana.''' Before Scott County set up its syringe exchange program in 2015, this rural county was seeing 10-20 new HIV cases every week. Almost immediately, the number of new cases was slowed to 1-2 a month.

= Sources =

----
</div>
[[Category:SAFE-Full Spectrum Prevention]]

Increase Access to Syringe Services Programs

2024-10-23T19:30:21Z

Charliekapinos: /* Available Tools & Resources */

=Introductory Paragraph=

Needle exchange programs (NEPs) distribute sanitized needles in exchange for contaminated or used needles. NEPs reduce the spread of blood-borne diseases like HIV and Hepatitis C. According to the CDC, syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to sterile syringes and injection equipment; and vaccination, testing, and referral to care and treatment for infectious diseases. <ref>https://www.cdc.gov/ssp/index.html</ref> NEPs and SSPs promote harm reduction to help protect the community by providing exchange programs and sterile supplies which help prevent the spread of infectious disease.

= Key Information =

Needle exchange programs have decades of evidence behind them - but not public support. <ref>https://opioidaction.org/2018/06/vox-a-new-study-shows-stigma-is-hurting-our-response-to-the-opioid-epidemic/</ref> Many organizations have endorsed needle exchange including NIH (National Institute of Health), CDC (Center for Disease Control), the American Bar Association, the American Medical Association, the American Psychological Association, and the World Health Organization. The NIH estimates that in the United States, between fifteen and twenty percent of injection drug users have HIV and at least seventy percent have Hepatitis C.<ref>https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.1840360703 </ref> As such, sharing needles has become the most common mode of HIV transmission among injection drug users. In addition, used syringes and needles are a potential biohazard. Harm reduction services such as the provision of sterile needles and syringes can effectively prevent Hepatitis C and HIV transmission among people who inject drugs, provided they are accessible and delivered at the required scale. Needle exchange programs help educate and inform injection drug users regarding injection practices, safety steps, non-sharing behavior, and other risk reduction methods. The CDC promotes SSPs and states that they "reduce HIV and HCV infections and are an effective component of comprehensive community-based prevention and intervention programs that provide additional services." <ref>https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html</ref>

There are currently several different models for syringe exchanges that have different advantages and limitations. The models include:

*'''Primary and Secondary Needle and Syringe Programs''' are fixed sites which are typically located in areas with high levels of injecting drug use. They can be found in community centers, pharmacies, or specialized voluntary counseling and testing centers. Those who attend will be able to receive clean paraphernalia and safely dispose of used paraphernalia. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Mobile or On-Call Service''' operate from a van or bus with clean needles which are distributed. Larger mobile programs typically provide testing and other healthcare services and operate along regular routes at fixed times, often at night when increased use occurs. Mobile services can also be smaller and choose to target specific populations. Mobile programs are more accessible to injection drug users and face less opposition from a community. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Dispensing Machine Distribution.''' Australia and countries in Europe have adopted a newer strategy and have begun to use syringe vending machines. They use non-currency tokens which are distributed by outreach workers to injection drug users in return for harm reduction packs. Australia’s machines include needles, syringes, alcohol swabs, cotton, wool, sterile water, and spoons. Others sometimes contain educational materials. Typically, these machines act in conjunction with fixed sites which provide needles and syringes 24 hours a day, 7 days a week. A clinical trial found that this strategy can be highly effective for reaching populations who are most marginalized or otherwise hard to reach. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Peer Service Distribution Networks.''' This is a strategy in which clients of needle exchanges provide services to their peers, distributing needles, syringes, and associated injection equipment. These clients are trained to assist peers to access exchangers, to distribute information about safer drug use and safer sex, and to facilitate referrals to other health services. This model, in addition to disseminating safer practices and helping make needle exchange programs reach a larger population, may have the psychological impact of making interventions more effective. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241304/</ref>

*'''Prison-Based Facilities''' are still a newly developing practice, only used in 3 of 24 UN countries that have needle exchange programs for the public. <ref>http://blogs.biomedcentral.com/on-health/wp-content/uploads/sites/8/2016/10/Prison-based-needle-and-syringe-programmes-PNSP-final.pdf</ref> They meet a high need because prison populations have more cases of Hepatitis C and HIV than the average population. <ref>http://blogs.biomedcentral.com/on-health/wp-content/uploads/sites/8/2016/10/Prison-based-needle-and-syringe-programmes-PNSP-final.pdf</ref>

= Relevant Research =

*'''Three Studies Documenting Positive Results.''' A review of needle exchange done by the office of the Surgeon General and the assistant secretary for health found that needle exchange did not cause an increase in drug injection, but rather typically led to a decrease in injection rates when these programs were used.<ref>http://www.csdp.org/research/surgeongennex.pdf</ref> Another study sought to answer the question "is the number of needles distributed from needle exchange programs proportionate to the number of needles returned to needle exchange programs?" It was found that in the United States the return rate was on average over 90% (~315,000 needles distributed and ~283,000 needles returned). <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/</ref> The National Research Council report on the topic states: “The need for and value of targeted education and behavior modification efforts directed at injection drug users at risk of HIV transmission have been clearly demonstrated in programs that do not include needle exchange.” <ref>https://www.ncbi.nlm.nih.gov/books/NBK232350/</ref>

*'''Two Cost-Benefit Analyses.''' Needle exchanges have been projected to be a cost-effective prevention practice. An analysis of the cost-effectiveness of a New York City needle syringe exchange estimated that the program would result in a baseline one year savings to the government of $1,300 to $3,000 per client. <ref>Belani, H.K. and P.A. Muennig, Cost-effectiveness of needle and syringe exchange for the prevention of HIV in New York City. Journal of HIV/AIDS & Social Services, 2008. 7(3): p. 229-240.</ref> Another analysis estimated that increasing access to clean syringes through an additional annual U.S. investment of $10 million would lead to a decrease of 194 HIV infections per year and a lifetime treatment cost savings of $75.8 million which would be a return on investment of $7.58 for every $1 spent. <ref>Nguyen, T.Q., et al., Syringe exchange in the United States: a national level economic evaluation of hypothetical increases in investment. AIDS and Behavior, 2014. 18(11): p. 2144-2155.</ref>

*'''Meta-Analysis on Community Impact.''' This literature review found that supplying injecting drug users with clean or sanitized needles does not lead to more "dirty" needles in a community. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/</ref>

= Impactful Federal, State, and Local Policies =

* '''The Consolidated Appropriations Act, 2016''' restricted the use of federal funds for programs distributing sterile needles or syringes for HHS programs. However, HHS also provides a guidance document that outlines how federal funds may be used for other aspects of SSPs based on evidence of a demonstrated need, in consultation with CDC. <ref>https://www.congress.gov/114/bills/hr2029/BILLS-114hr2029enr.pdf</ref>

* Currently each state has their own laws surrounding syringe exchange programs.

* '''A Comprehensive Guide to Syringe Services Programs and Syringe Possession Laws'''<ref>https://pdaps.org/datasets/syringe-services-programs-laws</ref> delineates how syringe possession polices impact ease of access to sterile syringes for injection drug users.

=Available Tools & Resources=

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**See the wiki titled "The Linkage Between Syringe Use and Infectious Disease" for more detailed information on drug use and the concern for those with an SUD catching or spreading infectious diseases.<ref>https://www.yoursafesolutions.us/wiki/The_Linkage_Between_Syringe_Use_and_Infectious_Disease/</ref>

*'''The World Health Organization''' has published a "Guide to Starting and Managing Needle and Syringe Programs." <ref>https://www.unodc.org/documents/hiv-aids/NSP-GUIDE-WHO-UNODC.pdf</ref>

*'''CDC''' provides a fact sheet on harm reduction to promote prevention of transmission of infectious disease, including blood-borne infections. <ref>https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html</ref> They have published a document titled "Syringe Services Programs: A Technical Package of Effective Strategies and Approaches for Planning, Design, and Implementation." <ref>https://www.cdc.gov/ssp/docs/SSP-Technical-Package.pdf</ref> They have also provided guidance to state, local, tribal, and territorial health departments to determine if they have adequately demonstrated need for SSPs according to federal law. <ref>https://www.cdc.gov/ssp/determination-of-need-for-ssp.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhiv%2Frisk%2Fssps.html</ref>

*'''SAMHSA''' provides specific guidance for Minority HIV/AIDS Initiative (MAI) Programs that are implementing SSPs. <ref>https://www.samhsa.gov/sites/default/files/grants/ssp-guidance-for-hiv-grants.pdf</ref>

*'''The National Association of County Health Officials (NACCHO).''' In collaboration with the CDC and in partnership with the University of Washington, NACCHO provides funding and technical assistance to local health departments and community-based SSPs. <ref>https://www.naccho.org/blog/articles/funding-opportunity-building-capacity-for-harm-reduction-monitoring-evaluation</ref>

*'''The North American Syringe Exchange Network''' provides a directory of locations for SSPs. <ref>https://www.nasen.org</ref>

*'''The Comer Family Foundation''' provides harm reduction grants for free sterile syringes. <ref>https://www.comerfamilyfoundation.org/syringe-service-program</ref> It has also published "A Guide to Establishing Syringe Services Programs in Rural, At-Risk Areas." <ref>https://www.comerfamilyfoundation.org/img/A-Guide-to-Establishing-Syringe-Services-Programs-in-Rural-At-Risk-Areas.pdf</ref>

*'''The Syringe Access Fund''' awards grants in two categories: 1) SSPs providing direct services, and 2) harm reduction organizations at the local, state and federal levels conducting community education and mobilization activities focused on legalizing or SSPs and other health interventions for people who use drugs. <ref>https://aidsunited.org/new-funding-opportunity-syringe-access-fund/</ref>

= Promising Practices =

*'''Miami, Florida.''' In three years of operation, Miami's pilot program pulled more than a quarter million used needles out of circulation. By handing out Narcan at the needle exchange, it has helped prevent more than a thousand overdoses. The program also offers clients testing for HIV and Hepatitis C and connects people to medical care and rehabilitation services. <ref>https://www.npr.org/sections/health-shots/2019/06/27/725462715/key-florida-republicans-now-say-yes-to-clean-needles-for-drug-users</ref>

*'''Philadelphia, Pennsylvania.''' A case study found that Prevention Point, a needle exchange located in Philadelphia helped prevent 10,000 people from contracting HIV over 10 Years. The researchers from George Washington University estimate that the total lifetime taxpayer savings from this needle exchange averting 10,000 cases of HIV saved them $1.8 billion. <ref>https://www.phillymag.com/news/2019/10/31/prevention-point-syringe-exchange-study/</ref>

*'''Scott County, Indiana.''' Before Scott County set up its syringe exchange program in 2015, this rural county was seeing 10-20 new HIV cases every week. Almost immediately, the number of new cases was slowed to 1-2 a month.

= Sources =

----
</div>
[[Category:SAFE-Full Spectrum Prevention]]

The Linkage Between Syringe Use and Infectious Disease

2024-10-23T19:27:23Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

With drug use on the rise, a major concern for those with an SUD should be the potential catching or spreading infectious diseases. Infectious diseases associated with substance use, such as HIV, AIDS, and Hepatitis C are largely contracted through both unsafe substance use conditions and unprotected sexual intercourse, a high-risk behavior that may be attributed to impaired judgment. <ref>https://nida.nih.gov/publications/drugfacts/drug-use-viral-infections-hiv-hepatitis</ref> Infectious disease can be unknowingly passed to fellow users, sexual partners, an unborn baby, or to a baby through breastmilk. Those who have an SUD are often less likely to receive timely, routine health care needed for early diagnosis and treatment. <ref>https://pubmed.ncbi.nlm.nih.gov/32070807/</ref> Left untreated, these diseases can quickly decrease the quality of life and lead to serious health consequences as well as death.

= Key Information =

Hepatitis C virus (HCV) infections tripled between 2010 and 2015. Among people who inject drugs, Hepatitis C is three times more prevalent than HIV. In most countries, more than half the people who inject drugs live with Hepatitis C. Substance abuse and infectious diseases share common populations, risk factors, social determinants, and even contracting venues. <ref>https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html</ref> There is little collaboration between programs which provide services to these populations. <ref>https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html</ref> Methadone clinics would be optimal venues for service integration because 60% of the population served by these clinics are injection drug users. Further, they have medical staff performing brief health assessments for all new clients. Methadone clinics already have some infectious disease screenings in place, including routine tuberculosis testing and intermittent opt-in HIV testing. One study showed that 68% of opioid treatment programs nationwide had staff capacity for HCV testing, but only 33% actually offered on-site HCV testing. Awareness of HCV infection among this particular population may motivate them to reduce their consumption and related high-risk behaviors.

'''Types of Infectious Diseases Related to Substance Use'''

The most commonly known SUD-related infectious diseases include HIV, AIDS, and HCV. Substance use can also cause or contribute to many other infectious diseases which are life-threatening.
*'''Human Immunodeficiency Virus (HIV)''' infects the body’s immune cells that are needed to fight infections, making the person increasingly vulnerable to other infections and diseases and unable to effectively fight them off. HIV is most commonly spread through shared injection equipment and unprotected sex. While there is no current cure, the earlier it is diagnosed, the better and longer it can be managed with medication. <ref>https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids</ref> Symptoms of HIV may come and go, varying at different stages, or a person may be asymptomatic for years, increasing the likelihood of unknown transmission to others. <ref>https://www.healthline.com/health/hiv-aids/how-hiv-affects-the-body#chronic-hiv</ref> If HIV is left untreated, it can lead to AIDS.

*'''Acquired Immunodeficiency Syndrome (AIDS)''', the last stage of HIV, occurs when the immune system is severely damaged and leaves the person with less than 200 CD4 cells - white blood cells that are an essential part of the human immune system. The normal range is 500-1,600 CD4 cells, and with less than 200 CD4 cells, the person cannot fight off “opportunistic infections," such as pneumonia, tuberculosis, and toxoplasmosis. <ref>https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids</ref> Without treatment, a person with AIDS will have a life expectancy of 1-3 years. Opportunistic infections can still occur without the presence of HIV or AIDS. Continued substance use has been linked to “increased susceptibility to infections” and have “marked immunomodulatory effects” which prevent efficient healing and can increase the likelihood of spreading the infection. <ref>https://academic.oup.com/femspd/article/47/3/330/506577</ref> These infections can be viral, bacterial, fungal or parasitic and have devastating health effects when not diagnosed and treated in a timely manner and/ may be exacerbated by continued substance use. <ref>https://pubmed.ncbi.nlm.nih.gov/32070807/</ref>

*'''Hepatitis B''' is most commonly spread through injection drug use. It can be spread through contaminated needles as well as shared drug equipment. Hepatitis B is highly contagious and has no cure, but it can be managed with medication. Patients may be asymptomatic or experience acute symptoms (jaundice, fatigue, nausea vomiting). Those who develop a chronic infection are likely to develop cirrhosis of the liver. <ref>https://pubmed.ncbi.nlm.nih.gov/32070807/</ref>

*'''Hepatitis C''' is spread through the use of injected substances, from mother-to-baby during birth, and unprotected sexual intercourse. Hepatitis C is a blood-born infection, meaning it can spread through contact with the blood of an infected person, whether or not that person has any symptoms. It has a high transmission rate (50% of people with an SUD contract Hepatitis C). <ref>https://www.who.int/news-room/fact-sheets/detail/hepatitis-c</ref>. Data shows that 50-85% of patients with Hepatitis C will have chronic infections which can cause fibrosis and cirrhosis of the liver along with hepatic carcinoma. <ref>https://pubmed.ncbi.nlm.nih.gov/32070807/</ref> Early diagnosis is made difficult due to the fact that Hepatitis C can remain asymptomatic for an extended period of time.

*'''Sexually Transmitted Infections.''' STIs are a common comorbidity with SUDs and pose a significant public health issue. It has been well-documented that substance use disorder is associated with high-risk behaviors, such as engaging in unsafe sexual encounters, whether recreational or for the purpose of buying or selling drugs. <ref>https://www.cambridge.org/core/journals/bjpsych-advances/article/substance-use-disorders-and-sexually-transmitted-infections-a-public-health-perspective/65EC0021CB2675831FCB4F73E6B5FDEE</ref>. This, coupled with delayed healthcare, allows the spread of STIs to go undetected and untreated in vulnerable populations.

'''Implications.''' The consequences of a comorbid SUD and infectious disease are vast and impactful, both on the individual and the community. Below are just a few examples of the risks and implications of substance use-related infectious diseases:

*Comorbidity and SUD often go hand-in-hand, with patients often having more than one type of persistent infection or disease and increased likelihood to have other medical and psychiatric comorbidities which increase the likelihood of mortality. <ref>https://pubmed.ncbi.nlm.nih.gov/32070807/</ref> These can make it difficult to treat, as addiction treatment providers are often not trained to evaluate for infectious diseases.
*Lack of screening and testing increases likelihood of late presentation stages in SUD-related infectious diseases, causing unintended transmission to others and poorer health outcomes. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00439-5</ref>
*Continued drug use may make it easier for HIV to enter the brain, causing increased nerve cell damage and impaired cognition and memory
*A few examples of the social costs of SUD-related infectious diseases: <ref>https://www.cdc.gov/pwid/vulnerable-state-assessments.html</ref>
**Average lifetime medical cost of HIV is $510,000 per person
**A 2016 Hepatitis outbreak cost $367 million in hospital costs
**Invasive bacterial infections associated with drug use cost communities over $700 million in 2012

'''The need for improved screening''' for infectious diseases is well-documented: <ref>https://pubmed.ncbi.nlm.nih.gov/32070807/</ref>

*Globally, about ⅔ of injected drug users contract Hepatitis C
*More than 50% of persons in the United States who inject drugs have tested positive for Hepatitis C
*About 6 in 100 infants born to mothers with Hepatitis C become infected with the Hepatitis C virus. <ref>https://www.cdc.gov/nchhstp/pregnancy/effects/hcv.html#:~:text=HCV%20Infection&text=About%206%20in%20100%20infants,mother%20is%20also%20HIV%20positive</ref>
*Fewer than half of U.S. treatment facilities conduct infectious disease screenings <ref>https://www.infectioncontroltoday.com/view/infectious-disease-screening-not-performed-many-substance-abuse-treatment</ref>
*A study of young adults (18-25 years old) who had been diagnosed with an STI showed 38.4% had also used illicit drugs at the time of contraction <ref>https://journals.sagepub.com/doi/abs/10.1177/0956462420950603</ref>
*Increased use of injected opioids has been linked to 400% increase of Hepatitis C and 119% increase in Hepatitis B among 18-29 year olds
*People who inject drugs account for 9% of HIV diagnosis, and many states are experiencing a plateau in early reduction rates

Facilities most likely to provide on-site screenings are federally-funded facilities, opioid-specific treatment sites, and hospital inpatient sites. <ref>https://www.infectioncontroltoday.com/view/infectious-disease-screening-not-performed-many-substance-abuse-treatment</ref> Despite the prevalence and the personal and public health issues that result, fewer than half of all treatment facilities conduct infectious disease screenings as part of their standard-of-care. <ref>https://www.infectioncontroltoday.com/view/infectious-disease-screening-not-performed-many-substance-abuse-treatment</ref> It is imperative that early screening and education be expanded and improved in order to prevent the spread of infectious disease and to provide early intervention for those who are already infected.

= Relevant Research =

'''Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.''' Chapter 6 of this report titled, “Health Care Systems and Substance Use Disorders,” highlights the need to integrate SUD treatment and care with both mental and physical health care for a comprehensive, collaborative approach to treatment. Along with interagency collaboration, increasing health coverage for SUD treatment and expanding healthcare technology and accessibility is integral in reaching more people with an SUD and provide early detection of infectious diseases. <ref>https://www.ncbi.nlm.nih.gov/books/NBK424848/</ref> Chapter 7 of this report discusses the proposed public health approach model based on clinical evidence. <ref>https://www.ncbi.nlm.nih.gov/books/NBK424861/</ref>

'''The Johns Hopkins Center for Substance Use & Infectious Disease Care Integration''' is testing the efficacy of improving SUD and infectious disease treatment through collaborative and integrative efforts and innovative interdisciplinary efforts. Studies focus on peer-supportive collaborative care, outpatient links for MAT in emergency departments, tele-health access, and rapid HCV treatment approaches for people who inject drugs. <ref>https://www.cambridge.org/core/journals/bjpsych-advances/article/substance-use-disorders-and-sexually-transmitted-infections-a-public-health-perspective/65EC0021CB2675831FCB4F73E6B5FDEE</ref>

'''Literature Review.''' This article titled, "Infectious Diseases Occurring in the Context of Substance Use Disorders: A Concise Review," is user-friendly and accessible across disciplines. It covers the types of infectious diseases associated with SUD and the problems it poses for early detection, especially in the addiction treatment context. It also includes recommendations for providers. <ref>https://www.sciencedirect.com/science/article/abs/pii/S0022510X20300551</ref>

'''Infective Endocarditis''' is a potentially fatal inflammation of valves in the heart. This article documents a large, five-year (2012-2017) cohort study for SUD-related infective endocarditis. Those diagnosed with infective endocarditis and subsequently diagnosed with an SUD increased from 19.9% to 39.4%. Hospitalizations for infective endocarditis among those with an SUD more than doubled, and 50.3% of these hospitalizations also had a co-morbid Staphylococcus Aureus infection.

= Impactful Federal, State, and Local Policies =

* '''The CDC''' has launched State-led Vulnerability Assessments to use local data to identify high-risk areas, along with finding prevention and intervention gaps to develop plans to address these gaps and disparities. <ref>https://www.cdc.gov/pwid/vulnerable-state-assessments.html</ref>

*'''The Harm Reduction Grant Program''' is a federal program designed to help support community-based programs that focus on reducing the harmful impacts of opioid use. This includes overdose prevention, syringe services, and other harm reduction services. Communities can use this to implement proper and consistent screening protocols for infectious disease, comprehensive treatment, and educational outreach<ref>https://www.samhsa.gov/find-help/harm-reduction</ref>

* '''The Virginia Department of Health''' provides a Comprehensive Harm Reduction (CHR) program that allows CHR sites to be established in any Virginia jurisdiction. This removes several restrictions regarding safe syringe sites, referrals to treatment, testing, and access to many other services. CHR sites need authorization from the State Health Commissioner, and once approved, will be protected from prosecutorial actions regarding paraphernalia distribution (in line with treatment) and will no longer need support letters to apply. <ref>https://www.vdh.virginia.gov/disease-prevention/chr/</ref>

= Available Tools and Resources =

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**See the wiki titled "Increase Access to Syringe Exchange Programs" for more detailed information on Syringe Exchange Programs, a harm reduction approach to to help protect the community by providing exchange programs and sterile supplies which help prevent the spread of infectious disease.<ref>https://www.yoursafesolutions.us/wiki/Increase_Access_to_Syringe_Exchange_Programs/</ref>

*'''National Harm Reduction Technical Assistance (TA) Center.''' SAMHSA and the CDC have collaborated on this effort to move beyond education, in order to expand individual and community efforts in harm reduction. This means providing support for Naloxone distribution and administration, safer sex kits, HIV and viral hepatitis testing, COVID-19 response, reduction of community stigma, and opportunities for collaboration between harm reduction and other community efforts (e.g., peer-delivered recovery support efforts). <ref>https://www.samhsa.gov/find-help/harm-reduction</ref>

*'''Screening for Infectious Diseases Among Substance Abusers Treatment Improvement Protocol (TIP).''' A comprehensive toolkit created by SAMHSA's Center for Substance Abuse Treatment covers the definitions of substance abuse, infectious disease related to SUD, guidelines and recommendations for screening, implementation, role of the counselor, risk assessment, testing procedures (pre- and pos-), contract tracing, and much more. <ref>https://store.samhsa.gov/product/TIP-53-Addressing-Viral-Hepatitis-in-People-With-Substance-Use-Disorders/SMA11-4656</ref>

*'''TIP 53 Screening for Infectious Diseases Among Substance Users: Quick Guide For Clinicians''' is a quick pocket-guide based on the toolkit listed above for clinicians to reference. <ref>https://store.samhsa.gov/sites/default/files/pep20-06-04-004.pdf</ref>

= Promising Practices =

*''' Project ECHO''' (Extension for Community Healthcare Outcomes) was developed by the University of New Mexico Health Sciences Center. ECHO uses tele-health technology to bridge the gap in services for providers and patients in rural communities or areas without specialists. The model provides training and support for providers, as well as consultations with specialists. This model can easily integrate screening and treatment services which are hard to come by in rural and impoverished communities. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/11/innovative-approaches-can-help--improve-availability-of-opioid-use--disorder-treatment</ref>

*'''Philadelphia.''' This website is an example of a resource for people seeking to identify if they have hepatitis, next steps they can take, and where they can find care or assistance. <ref>phillyhepatits.org </ref>

*'''Tennessee.''' The "Test, Listen, Cure" (TLC) community awareness campaign for Hepatitis C provides information about how the Hepatitis infection is transmitted, risk factors for the disease, the importance of screening and treatment, and the availability of improved treatment for the disease. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342624/</ref>

*'''Vermont''' uses the hub-and-spoke model to integrate providers across primary, acute, and behavioral health settings to collaboratively treat patients with MAT while also addressing other physical, mental, and life problems. This interagency effort allows patient access to all necessary treatments in a systematic implementation, including medical assessment and treatment for infectious diseases. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/11/innovative-approaches-can-help--improve-availability-of-opioid-use--disorder-treatment</ref>

= Sources =

Expand Drug Testing Options

2024-10-23T19:24:39Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Fentanyl is a powerful synthetic opioid used for the treatment of chronic pain or severe pain after surgery. It is 100 times more potent than Morphine. Fentanyl is also illegally manufactured and found in other illicit substances such as heroin, methamphetamine, and cocaine in order to increase the potency. Not only is Fentanyl extremely potent, but it is also considered to be low cost. For these reasons, illegal drug manufacturers continue to mix Fentanyl with drugs to maximize profits, despite the extreme risk of death and overdose. For some individuals, depending on their body size and history of usage or tolerance, even 2 milligrams of Fentanyl added to illicit substances can cause a lethal overdose. <ref>https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/Fact_Sheet_Fentanyl_Testing_Approved_ADA.pdf?TSPD_101_R0=087ed344cfab20000fac25b9e57d75c2a99df36db39f7ba1100a076d3484d2c2c90ef22061f105220840f6b68b14300061fd5968947d493ea4029838e187e89116cfdff349f37e059202f8585d20f8971c5d734d886e85eed3a7676ad529528c</ref> It is very common, for people to unknowingly take a drug that has been laced with a lethal dose of Fentanyl.

As a way to reduce the risks and impacts on society of drug overdoses, many health officials, government officials, organizations, and researchers maintain that providing Fentanyl testing strips (FTS) to individuals will have positive impacts on society and those living with substance use disorders. FTS allows people to test for the presence of Fentanyl in their drugs. Testing strips are reliable and highly sensitive, making it easy to detect Fentanyl. <ref>https://www.health.state.mn.us/communities/opioids/documents/ftsforpwud.pdf</ref> The test requires only a small amount of drug residue and rapidly indicates either a positive or negative result. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> The use of FTS harm reduction strategy decreases the number of deaths due to overdose.

= Key Information =

Fentanyl contamination began to increase during the COVID-19 pandemic. Fentanyl-related deaths increased from 4% to become the leading substance involved with drug overdoses in the United States. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> Between October 2019 and October 2020, the increase in Fentanyl contamination was responsible for an almost 50% increase in overall overdose deaths. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> The Chief Medical Examiner in San Francisco, California reported more overdose deaths due to Fentanyl contamination than COVID-19 deaths from January 2020 to December 2020. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> In 2020, Fentanyl accounted for tens of thousands more deaths than COVID-19 deaths and suicide deaths combined. <ref>https://www.familiesagainstfentanyl.org/research/byage</ref> The Center for Disease Control reported a 13% increase in individuals who reported new or increased use of substances during the pandemic. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> Restrictions, loss of wages, lack of maintenance therapies (MAT treatment, clean needles) and anxiety around virus exposure may have further increased people to use with less discretion than they normally would. The total number of Fentanyl deaths nearly doubled from 2020 to 2021. Fentanyl overdose is now the leading cause of death in Americans between the ages of 18 to 45. <ref>https://www.familiesagainstfentanyl.org/research/byage</ref>

'''Fentanyl in Different Forms.''' Fentanyl is sold in pill form and is made to look like Xanax, Oxycodone, or other prescription opioids. Lethal amounts of Fentanyl in counterfeit pills can be almost impossible to distinguish from legitimate prescriptions obtained from medical providers or pharmacists. It can also be mixed with methamphetamine and cocaine, increasing the risk of overdose. <ref>https://www.health.state.mn.us/communities/opioids/basics/fentanyl.html</ref> Many people who use substances are unaware of the contents of the drug they are taking. This lack of knowledge is responsible for the impact Fentanyl has on the increasing number of drug overdoses each year in the United States. <ref>https://www.health.state.mn.us/communities/opioids/documents/ftsforpwud.pdf</ref> In 2017, Fentanyl was found in over 50% of all New York City overdose deaths. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> Fentanyl strips could provide a way for users to detect the presence of Fentanyl and give them multiple options to prevent the risk of overdose. Should someone use FTS and have a positive result, they would have the option to discard the batch, use less of the substance, use in the presence of others, or have Naloxone on hand when using with others. Although the testing strips do not provide information on the amount of Fentanyl added to a drug, it allows the user to gain insight into the trustworthiness of the dealer and this may prevent them from buying tainted drugs in the future.

'''Opposing Viewpoints and Stigma.''' Much controversy surrounds harm reduction techniques, and the FTS strategy is not immune. Stigma amplifies the false belief that people who use FTS lack a moral compass, can’t be trusted, or have a lack of concern for their wellbeing. Drug users who used FTS have reported that a positive Fentanyl test resulted in changed behavior and reduced risk of overdose. Research has shown that individuals who use Fentanyl testing strips display behaviors consistent with great concern for their wellbeing, and evidence overwhelmingly supports the idea that FTS are safe, easy, affordable (around $1 per strip), and lead to reduced overdose fatalities. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref> Substance use disorders are complex and the development of a SUD can be caused by all too common life events such as trauma, chronic pain, emotional distress, anxiety, depression, and other environmental stressors. <ref>https://medlineplus.gov/ency/article/001522.htm</ref> These events can be experienced by anyone at any point in time, not just by individuals who lack morals or self-control. <ref>https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/</ref>

= Relevant Research =

'''Johns Hopkins School of Public Health.''' In one study, researchers tested the ability of three technologies used to assess the presence of Fentanyl in street drugs. Johns Hopkins researchers reported that of the three types of technologies, Fentanyl testing strips had the lowest detection limit and the highest sensitivity and specificity for Fentanyl. <ref>https://americanhealth.jhu.edu/fentanyl</ref> Additionally, researchers gathered valuable information from people who use drugs about their overdose history, experiences with Fentanyl, and other related topics. Among the individuals who completed the interview and surveys, 84% expressed concern about Fentanyl presence in the drugs they use. <ref>https://americanhealth.jhu.edu/fentanyl</ref> Out of the 256 respondents, 85% said they wished they had known beforehand that drugs they have used in the past contained Fentanyl. <ref>https://americanhealth.jhu.edu/fentanyl</ref> The vast majority of people who use drugs are concerned about Fentanyl exposure and are interested in a product that tests for its presence. The study also found that a majority of the respondents said they would modify their drug use if their drugs tested positive for Fentanyl. <ref>https://americanhealth.jhu.edu/fentanyl</ref> This information is contrary to the stigmatized belief that drug users actively seek out Fentanyl, do not wish to change their drug habits, and are not concerned about overdose due to Fentanyl contamination. Many public health officials, family members of people who use drugs, and drug users themselves agree that the availability of Fentanyl testing strips could have a positive impact on society by reducing overdose fatalities due to Fentanyl contamination. Johns Hopkins researchers have provided valuable recommendations for implementing harm reduction techniques such as increasing the availability of FTS, increasing access to information and education about Fentanyl exposure, and providing counseling/substance use treatment where FTS are provided. <ref>https://americanhealth.jhu.edu/fentanyl</ref>.

= Impactful Federal, State, and Local Policies =

'''The CDC and SAMHSA.''' In April 2021, it was announced that federal funding can be used to purchase FTS. The strips were approved for research, distribution to the public, and clinical use. <ref>https://www.samhsa.gov/newsroom/press-announcements/202104070200</ref>

'''Minnesota''' decriminalized FTS in July 2021, and no longer considers them to be “drug paraphernalia." <ref>https://www.health.state.mn.us/communities/opioids/basics/fentanyl.html</ref>

= Available Tools and Resources =

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
**See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues.<ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>
**See the wiki titled "Improve and Expand Screening and Testing for Opioid Misuse and Dependency" for more detailed information on screening programs that can help identify interventions for people who are in the early stages of misusing opioids before they develop an addiction.<ref>https://www.yoursafesolutions.us/wiki/Improve_and_Expand_Screening_and_Testing_for_Opioid_Misuse_and_Dependency/</ref>

*'''HarmReduction.Org''' has valuable information about the use of Fentanyl Testing Strips and other harm reduction strategies. The website also has information about locating Naloxone and clean syringes. <ref>https://harmreduction.org/issues/fentanyl/</ref>

*'''DoseTest.Org''' manufactures and ships FTS in discreet boxes at $1.25 per strip. <ref>https://dosetest.com/faq-contact/</ref>

*'''PreventOverdoseRI.org''' is a website based in Rhode Island that has videos and instructions on how to properly use Fentanyl testing strips. It includes information about receiving FTS in the mail. <ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities.''' This is an online training which models a Fentanyl eduction approach. The content of this training is available for reproduction and localized implementation. <ref>https://wvdii.thinkific.com/courses/saferU</ref>

* '''Axios: Why more states are decriminalizing Fentanyl test strips.''' This quick overview provides insight into the rapidly shifting landscape around Fentanyl testing strips around the nation. A number of additional resources are linked. <ref>https://www.axios.com/2023/04/20/red-states-drug-use-fentanyl-test-strips</ref>

* '''WTFentanyl''' Physician experts in poisoning and emergency care created this site to correct Fentanyl misinformation. <ref>https://wtfentanyl.com/#about</ref>

* '''Dance Safe''' offers an improved Fentanyl test strip for the harm reduction community. <ref>https://dancesafe.org/fentanyl/</ref>

= Promising Practices =

'''Washington State''' approved over $100,000 for the distribution of Fentanyl test strips. The Washington Syringe Service Program distributed 75,000 testing strips to participants. This resulted in participants taking precautionary steps in preventing overdose if Fentanyl was detected in their drugs. <ref>https://www.axios.com/local/seattle/2023/08/15/fentanyl-test-strips-washington-state</ref>

'''Families Against Fentanyl (FAF)''' is a non-profit organization established by family members of an individual who died of a Fentanyl overdose. <ref>https://www.familiesagainstfentanyl.org/research/byage</ref> In May of 2022, FAF wrote a letter to the Biden Administration, the Department of Health and Human Services (HHS), and the Center for Disease Control (CDC) asking that the tracking of Fentanyl fatality data be published within six weeks of death opposed to the current six month time frame. This would allow experts to gather information on trends and to respond with appropriate action in a timely manner. The organization requested that the COVID-19 death tracking system be used as a framework for Fentanyl fatality reporting. More specifically, FAF requested that the department of HHS and the CDC provide weekly updates on synthetic opioid fatalities with information including state deaths, ages of deceased, and their race. <ref>https://www.foxnews.com/us/families-against-fentanyl-biden-admin-overdose-deaths-covid-19?fbclid=IwAR09SEAZxhGVDQtZZCmGqeacRaFeLM7uIx2sXzKt_nCrs9kghKkW_tQSLU8</ref>

= Sources =

Improve Access to Recovery Coaches for Parents of Newborns

2024-10-23T16:35:35Z

Charliekapinos:

=Introductory Paragraph=

New motherhood is an incredibly stressful period of life for women. They must heal from the birth, adjust to the physical and mental demands of caring for a newborn, and make peace with their new lifestyle. There are a myriad of outside factors that influence this new phase, and new life hurdles are exacerbated for mothers with a substance use disorder who are trying to get to or maintain sobriety on top of having a new baby. During the first year after their baby is born, the relapse rate for new mothers is incredibly high at 80%. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387084/</ref> Becoming sober and maintaining sobriety is no easy feat by itself, just as new motherhood is not. The combination of both circumstances is one which clinicians need to address with the utmost care, respect, and diligence. This critical time period can be profoundly improved by the addition of a recovery coach to the new mother's support team. SUDs are one of the main contributors to child removal and failed reunification of the child and parent, and the help of recovery coaches in reaching and maintaining sobriety has been shown to greatly impact the outcomes of parental-child cohabitation. <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref> <ref>https://evidencebasedprograms.org/programs/recovery-coaches/</ref> The effectiveness of the lived experience and the training of the recovery coach cannot be understated in its value to comprehensive SUD treatment for new mothers. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

=Key Information=

'''The Definition of a Recovery Coach.'''

''The NC Pregnancy and Opioid Exposure Project'' defines a recovery coach as a “paraprofessional who assists parents in obtaining needed benefits, coordinates child welfare and substance abuse treatment staff, and connects the family with treatment providers.” <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref> While they are independent of these agencies, they will often be at home visits with agents from child welfare and substance abuse treatment programs. <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref>

''The U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation (OPRE)'' describes recovery coaches who work in the child welfare system as those who work with parents who have had a child or are at risk of having a child removed from their care due to SUD. They, “increase access to and engagement in treatment and other services to support parents’ recovery, coordinate with child welfare agency staff, and ensure treatment and recovery progress is incorporated into plans to either maintain children with their families of origin or place them with other permanent families.” <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref>

The specific responsibilities of recovery coaches will vary from program to program. Some programs may require a bachelor’s degree. Many others employ peer recovery coaches who have lived experience, whether they have had success in SUD recovery and new parenting or have been directly involved with a loved one in that situation. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref> <ref>https://www.medstarhealth.org/-/media/project/mho/medstar/pdf/msh-ch-peer-recovery-coach-brochure_final.pdf</ref>

''SAMHSA'' has published ethical guidelines for peer-based recovery when the recovery coach is not a licensed clinician. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>
These guidelines provide a clear-cut picture of the competencies and responsibilities of a recovery coach and are intended to prevent any role confusion and potential unqualified treatment, because many programs presents overlapping duties between recovery coaches and other treatment players. According to these guidelines, employed peer recovery coaches are meant to provide emotional, informational, and instrumental support along with companionship in recovery. A recovery coach following these guidelines fulfills a mix of the following roles: <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

*Outreach worker
*Motivator and cheerleader
**Offers a living example of hard work/recovery success
**Encourages & celebrates recovery milestones
**Encourages & models self-advocacy and self-sufficiency
*Ally & confidant - can be trusted, cares, and listens
*Truthteller - provides honest, constructive feedback on recovery progress
*Role model & mentor
*Planner
*Problem solver
*Resource broker
*Monitor
*Tour guide
*Advocate
*Educator
*Community organizer
*Lifestyle consultant/guide
*Friend

The SAMHSA guidelines note that a recovery coach is NOT a sponsor, therapist/counselor, nurse/physician, or a member of the clergy. Tasks that fall into the wheelhouse of these professions should not be permitted and always referred out by the recovery coach. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

Substance use disorder and postpartum depression are commonly identified as having comorbidity, regardless of which condition came first. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref> It is important that the recovery coach not blur the lines in giving clinical advice regarding postpartum depression and maintain services that align to their training. However, the co-occurrence of the two conditions may indicate a greater need for the recovery coach, as they can alleviate some of the burdens of finding resources while providing social support which is critical for those with depression. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref> <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518627/</ref>

'''Role of Recovery Coaches in the Postpartum Period.'''

Sobriety during pregnancy is an important goal, and about 85% of pregnant women with a substance use disorder are able to maintain abstinence from at least one substance while they are carrying their baby. <ref>https://www.recoveryanswers.org/research-post/stopping-starting-substance-use-pregnancy/</ref> However, the first year of postpartum is very dangerous for women who struggle with SUD. Mothers who have an SUD face challenges which may propel them towards relapses, such as food insecurities, legal troubles, the threat of infant removal, and domestic turmoil. Resources to aid the new mother in her recovery need to extend beyond birth and be tailored to the unique situations these mothers face with their addiction. Mothers with an SUD are a priority for substance treatment while pregnant, as the continued use can have a major impact on the fetus. However, many women, regardless of insurance status, see their treatment options dwindle postpartum, as the shift of medical attention goes from the mother to the infant. <ref>https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/08/14/for-addicted-women-the-year-after-childbirth-is-the-deadliest</ref>

Programs implementing recovery coaching have seen success with achieving and maintaining postpartum sobriety because the coach has unique, lived experience which they provide to help navigate these struggles. With so much stigma surrounding new mothers with an SUD, a primary goal of recovery coaching is to empower the mother without judgment. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref> The coach’s lived experience can bring a sense of hope and trust to the new mother, upon seeing a peer who has gone through similar circumstances have success in maintaining sobriety. Because the recovery coach has had life experience coupled with paraprofessional training, they provide a unique and knowledgeable insight into the ins and outs of recovery and all the agencies and resources involved with recovery and child welfare.

Testimonials from mothers on the impact of their coach on their recovery document the importance of building a strong relationship with mutual understanding and unwavering support -- outside the stressors of therapies and agencies. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref> Recovery coaches play an integral role in building esteem, giving support, and providing inter-agency resources. This helps to bolster the effects of treatment for new mothers and gives them the tools to work towards sobriety.

=Relevant Research=

There is not a lot of statistical research on the effectiveness of recovery coaches postpartum. One reason is that many mothers have access to these programs while pregnant, but lose it postpartum due to insurance restrictions. Thus, some of the information provided below is not specific to postpartum recovery coaching, but on the impact of recovery coaching on aiding SUD treatment. Research is needed on the effectiveness of recovery coaches during pregnancy and could provide a springboard for advocacy in postpartum treatment.

*An evidence-based review of an Illinois program found that parents with their baby removed from care who had access to a postpartum recovery coach had a 15% increase in parent-child reunification and a 14% increase in having foster-care cases closed. It is important to note that there was no evidence of adverse impact in the increased and quicker reunifications and case-closures. <ref>https://evidencebasedprograms.org/programs/recovery-coaches/</ref>

*This article highlights the high risk of relapse (28.3%) in the first three months postpartum, especially amongst those with comorbid mental illness. <ref>https://www.sciencedirect.com/science/article/pii/S0920996418304833</ref>

*The U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation (OPRE) made a comprehensive review of nine recovery coaching interventions. OPRE evaluated the replicability, success, and readiness of the programs and documents the strengths, weaknesses, and evidence-based practice implications of each model. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref>

*This article provides a systematic review of peer recovery support services and recovery coaching. It highlights the potential of recovery coaching in SUD treatment. It recommends that more extensive research be done to empirically support the inclusion of recovery coaching and to provide a clear role definition. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585590/</ref>

*This article evaluates an intervention delivered by peer recovery coaches in a medically underserved community in Baltimore City. <ref>https://psycnet.apa.org/record/2021-20460-001</ref>

*This article examines the cyclical effects of postpartum depression, both unrelated and related to substance use. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref>

=Impactful Federal, State, and Local Policies=

'''Federal.''' Recovery support services, including recovery coaches, were included in the Comprehensive Addiction Recovery Act (CARA), but not funded. There is not a federal definition of recovery services.

'''States.''' Implementation access requirements vary from state to state.
*17 states discontinue Medicaid coverage 60 days postpartum. <ref>https://www.macpac.gov/wp-content/uploads/2019/07/Recovery-Support-Services-for-Medicaid-Beneficiaries-with-a-Substance-Use-Disorder.pdf</ref> Those people who do retain their coverage face challenges in navigating postpartum coverage changes, in finding new doctors to give them SUD treatment referrals, and in dealing with new and confusing paperwork.
*One state-level policy advance is reflected in Virginia, which provides a scholarship to help cover fees in becoming a Certified Peer Recovery Specialist. <ref>https://virginiapeerspecialistnetwork.org/getting-started/</ref>

=Available Tools and Resources=

'''SAMHSA''' provides a state-by-state directory of training and certification programs for peer recovery coaching. <ref>https://c4innovates.com/brsstacs/BRSS-TACS_State-by-State-Directory-of-Peer-Recovery-Coaching-Training-and-Certification-Programs_8_26_2020.pdf</ref> It was generated in 2018 by BRSS-TACS (Bringing Recovery Supports to Scale Technical Assistance Center Strategy).

'''SAFE Project''' has a dedicated website for Addiction and Mental Health Resources for Women that includes a number of support resources during and after pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

'''The National Center on Substance Abuse and Child Welfare''' has published a guide, “The Use of Peers and Recovery Specialists in Child Welfare Settings.” This covers models, implementation, funding, qualifications/training, supervision, and much more. It is a good tool for those wishing to implement recovery coaches and peer support. <ref>https://ncsacw.acf.hhs.gov/files/peer19_brief.pdf</ref>

'''KFF''' formerly know as the Kaiser Family Foundation, provides a breakdown of postpartum Medicaid coverage state-by-state. It addresses gaps, disparities, and needs. Medicaid coverage greatly impacts new mothers with an SUD, who are more likely to need continuity of coverage to aid in their recovery. <ref>https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/</ref>

'''The Montgomery County Office of Mental Health''' has published its recovery coaching guidelines. It is a comprehensive guide on how to effectively implement recovery coaching in the community to address a wide array of vulnerable populations. <ref>https://www.montcopa.org/DocumentCenter/View/13037/Recovery-Coaching-Practice-Guidelines?bidId=</ref>

=Promising Practices=

'''California.''' The Sobriety Treatment and Recovery Teams (START) is an intensive child welfare program for families with substance use and child abuse or neglect. START is built on cross-system collaboration and integrated service delivery. It utilizes peer recovery coaches in long-term recovery in conjunction with families, treatment providers, and court systems to provide a “system-of-care and shared decision-making approach.” This program is both child welfare and SUD treatment centered and uses trauma-informed care to help maintain safety, reduce child-removal-of-care, achieve and maintain parental sobriety, improve parenting skills, and improve inter-agency collaboration. The site includes program goals, their logic model, components, delivery, training/manuals, implementation, and published research. <ref>https://www.cebc4cw.org/program/sobriety-treatment-and-recovery-teams/detailed</ref>

'''Georgia.''' The Certified Addiction Recovery Empowerment Specialist (CARES) program was developed by the Georgia Council on Substance Abuse. CARES provides training, examination, and continuing education to maintain a strengths-based approach in peer recovery support services that builds on client’s strengths. CARES has an emergency department that provides recovery coaches to those experiencing an overdose or other substance-related incident and in need of immediate aid. They also offer a warm line -- a call line to aid those are struggling and need to talk to someone but want to remain anonymous. <ref>Link: https://gasubstanceabuse.org/cares-program/</ref>

=Sources=

Increase Access to Naloxone

2024-10-21T02:33:23Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph=

Naloxone (Narcan) has the potential to be very beneficial in communities with a high opioid problem. Increasing community awareness about the power of Narcan to reverse overdose is a benefit unlike any other. Narcan is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain and prevents breathing and heart rates to slow down to fatal levels. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help. <ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref> Narcan allows victims of substance use to be more likely to survive an overdose when first responders are rightly prepared. Many states are working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation.

Narcan can either be injected or be administered in a nasal spray. In 2023, The US Food and Drug Administration made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. <ref>https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray</ref> It can be easily administered with little or no formal training. Although the drug could potentially save more lives if it were more widely distributed, bystanders often do not summon medical assistance due to fear of possible legal prosecution. Narcan only works on opioids, and does not harm an individual in the case of a non-opioid overdose. So, if there is any question as to what a person took, use Narcan.

= Key Information =

Opioid overdose education and Naloxone distribution programs increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the Naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref> Research documents that communities which have programs aimed at training bystanders to respond to opioid overdoses have experienced a more rapid reduction in opioid overdose death rates than communities without these programs. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Those who are close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in Naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training are as adept as medical experts in the identification of an overdose and are equally able to tell when Naloxone is appropriate. Opioid users who participate in only a brief 5-minute training or who have learned about Naloxone administration through social networks are able to respond appropriately to an overdose.

Training first responders to administer Naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in Naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

'''Personal Impact of Overdose'''
Survival of an overdose has lasting physical, psychological, and personal health implications for the individual that increase in likelihood and severity of each overdose. These include<ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf</ref>:
*Opioid-Induced Respiratory Depression (OIRD) - most dangerous health consequence; acute respiratory compromise, dizziness, confusion, and ineptness.
* Brain injury - hypoxia-related brain injuries, complications caused by the OIRD
* Hypoxia injuries can contribute to:
* short-term memory loss,
* changes in cognitive and physical functioning,
* increased risk of stroke, mental disorientation,
* loss of bodily movement or lower-extremity paralysis,
*gait changes,
*incontinence,
*slow reaction time,
*reduced motor skills,
* kidney failure,
*cardiac complications,
*neurological consequences and seizures,
* nerve damage,
*fluid buildup in lungs and pneumonia, and
*temporary motor paralysis
*Increased risk of comorbid mental illness
*Interruptions in education or career goals
*Family and relationship conflicts

'''The Dangers of Dual Use'''

The extent of fatalities associated with opioids is well-documented. However, it is less understood that opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids. It is also critical to increase awareness of the need to avoid knowingly mixing opioids with other drugs. Some safety precautions are listed below:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure someone knows what drug combinations you have taken
*Have a plan in place in case something goes wrong
*Have Narcan on hand

= Relevant Research =

* '''This Massachusetts study''' found that cities which have Naloxone distribution programs have lower overdose death rates than those without a program. <ref>http://www.bmj.com/content/346/bmj.f174</ref>

*'''A University of Washington study''' evaluated the initial results of the state’s Good Samaritan policy. Drug users who were aware of the law were found to be 88 percent more likely to call 911 in the event of an overdose than before the policy took effect.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> <ref>http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf</ref>

*'''This article''' was published in the Annals of Emergency Medicine and is directed to physicians in Emergency Departments. It highlights successes that have been achieved in recent years and calls for specific patient-centered action by emergency physicians. <ref>https://www.annemergmed.com/article/S0196-0644(19)30606-7/fulltext</ref>

= Impactful Federal, State, and Local Policies =

In 2015, the White House announced a treatment-based initiative. The $2.5 million budget was allocated to a program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and to train first responders on when it is adequate to administer Naloxone. <ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> Various federal organizations have come together to encourage good faith prescription of Naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

State laws make it difficult for citizens to obtain prescriptions for ''injection'' Narcan, due to policies on third-party prescriptions and on prescriptions via standing orders. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. There are a variety of cases in which the complexity of Naloxone policies are advancing:

*The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone without a prescription in case of emergencies. <ref>https://nabp.pharmacy/news/news-releases/california-pharmacists-may-now-dispense-naloxone-without-prescription/</ref>

* In 2006, New Mexico passed a Good Samaritan Law that granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose. Within ten years, 28 states in addition to the District of Columbia had passed similar laws to overcome hesitation to seek treatment or to call medical assistance, as a result of fear of incarceration or other forms of punishment

* In 2023, in Minnesota, a Good Samaritan law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removed a potential barrier --fear of arrest -- that sometimes leads to help not being called and lives being lost to overdose. <ref>https://www.revisor.mn.gov/statutes/cite/604A.01</ref>

*The National Conference of State Legislatures has many examples of policy efforts that have been attempted or passed, including Drug Overdose Immunity and Good Samaritan Laws. <ref>http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx</ref> <ref>http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx</ref>

= Available Tools and Resources =

* '''SAMHSA''' provides an overdose prevention and response toolkit. <ref>https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf</ref>

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**'''"Keep the Seats Filled: Learn How to Save a Life with Naloxone and Take the #NoShame Pledge"''' is a SAFE Project resource that explores what Naloxone is, where it can be purchased, how to use it, the signs of an overdose, and information on the #NoShame Pledge.<ref>https://www.safeproject.us/life/</ref>
**'''SAFE Project Online Courses''' are SAFE Project original online trainings that focus on harm reduction techniques such as: Narcan administration and navigating Fentanyl use safely. <ref>https://safeproject-s-school-262f.thinkific.com/</ref>
**'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
**See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>
**See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>

*'''CDC''' provides a website titled "Reverse Overdose to Prevent Death." This has information on Naloxone and Good Samaritan laws. <ref>https://www.cdc.gov/opioids/overdoseprevention/reverse-od.html</ref>

*'''The Bureau of Justice Assistance (BJA)''' maintains an online toolkit featuring resources and information on Naloxone, including a section on liability and risk for law enforcement officers and their employers. <ref>https://bjatta.bja.ojp.gov/tools/naloxone/Liability-and-Risk</ref>

*'''The National Association of Drug Diversion Investigators, Inc. (NADDI)''' provides a resource titled "Overdose and Prevention Strategies" which has every state's strategy in an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This allows communities to identify the most effective strategies for them to implement. <ref>https://www.overdosepreventionstrategies.org/</ref>

= Promising Practices =

*'''Aetna.''' Nearly 35% people who are prescribed Narcan don’t pick it up because they can’t afford the co-pay.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref> Having insurers eliminate the co-pay is one strategy to help address that. Aetna was the first national payer to waive copays for Narcan for its fully insured commercial members. This improved access by eliminating potential financial barriers to the lifesaving drug. <ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref>

*'''Connecticut.''' Several communities have made it mandatory for first responders to receive overdose training. <ref>https://www.newstimes.com/local/article/More-responders-using-wonder-drug-Narcan-to-5925616.php</ref>

*'''New York.''' The Drug Policy Alliance printed 1 million cards and posters that explained the Good Samaritan Law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.

*'''North Carolina.''' The NC Harm Reduction Coalition has given out 52,000 Naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and Naloxone distribution, with more than 8,700 overdose reversals reported. <ref>https://www.usatoday.com/story/opinion/2017/12/01/opioid-commission-almost-got-right-their-naloxone-recommendation-megan-mclemore-corey-davis-column/899812001/</ref>

*'''The Police Executive Research Forum''' provides case examples of law enforcement Naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), and Camden County, Montgomery County, and Hagerstown (MD). They include descriptions of training, funding, administration, and support. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

= <br/> Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Increase Access to Naloxone

2024-10-21T02:33:00Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph=

Naloxone (Narcan) has the potential to be very beneficial in communities with a high opioid problem. Increasing community awareness about the power of Narcan to reverse overdose is a benefit unlike any other. Narcan is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain and prevents breathing and heart rates to slow down to fatal levels. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help. <ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref> Narcan allows victims of substance use to be more likely to survive an overdose when first responders are rightly prepared. Many states are working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation.

Narcan can either be injected or be administered in a nasal spray. In 2023, The US Food and Drug Administration made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. <ref>https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray</ref> It can be easily administered with little or no formal training. Although the drug could potentially save more lives if it were more widely distributed, bystanders often do not summon medical assistance due to fear of possible legal prosecution. Narcan only works on opioids, and does not harm an individual in the case of a non-opioid overdose. So, if there is any question as to what a person took, use Narcan.

= Key Information =

Opioid overdose education and Naloxone distribution programs increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the Naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref> Research documents that communities which have programs aimed at training bystanders to respond to opioid overdoses have experienced a more rapid reduction in opioid overdose death rates than communities without these programs. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Those who are close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in Naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training are as adept as medical experts in the identification of an overdose and are equally able to tell when Naloxone is appropriate. Opioid users who participate in only a brief 5-minute training or who have learned about Naloxone administration through social networks are able to respond appropriately to an overdose.

Training first responders to administer Naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in Naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

'''Personal Impact of Overdose'''
Survival of an overdose has lasting physical, psychological, and personal health implications for the individual that increase in likelihood and severity of each overdose. These include<ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf</ref>:
*Opioid-Induced Respiratory Depression (OIRD) - most dangerous health consequence; acute respiratory compromise, dizziness, confusion, and ineptness.
* Brain injury - hypoxia-related brain injuries, complications caused by the OIRD
* Hypoxia injuries can contribute to:
* short-term memory loss,
* changes in cognitive and physical functioning,
* increased risk of stroke, mental disorientation,
* loss of bodily movement or lower-extremity paralysis,
*gait changes,
*incontinence,
*slow reaction time,
*reduced motor skills,
* kidney failure,
*cardiac complications,
*neurological consequences and seizures,
* nerve damage,
*fluid buildup in lungs and pneumonia, and
*temporary motor paralysis
*Increased risk of comorbid mental illness
*Interruptions in education or career goals
*Family and relationship conflicts

'''The Dangers of Dual Use'''

The extent of fatalities associated with opioids is well-documented. However, it is less understood that opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids. It is also critical to increase awareness of the need to avoid knowingly mixing opioids with other drugs. Some safety precautions are listed below:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure someone knows what drug combinations you have taken
*Have a plan in place in case something goes wrong
*Have Narcan on hand

= Relevant Research =

* '''This Massachusetts study''' found that cities which have Naloxone distribution programs have lower overdose death rates than those without a program. <ref>http://www.bmj.com/content/346/bmj.f174</ref>

*'''A University of Washington study''' evaluated the initial results of the state’s Good Samaritan policy. Drug users who were aware of the law were found to be 88 percent more likely to call 911 in the event of an overdose than before the policy took effect.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> <ref>http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf</ref>

*'''This article''' was published in the Annals of Emergency Medicine and is directed to physicians in Emergency Departments. It highlights successes that have been achieved in recent years and calls for specific patient-centered action by emergency physicians. <ref>https://www.annemergmed.com/article/S0196-0644(19)30606-7/fulltext</ref>

= Impactful Federal, State, and Local Policies =

In 2015, the White House announced a treatment-based initiative. The $2.5 million budget was allocated to a program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and to train first responders on when it is adequate to administer Naloxone. <ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> Various federal organizations have come together to encourage good faith prescription of Naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

State laws make it difficult for citizens to obtain prescriptions for ''injection'' Narcan, due to policies on third-party prescriptions and on prescriptions via standing orders. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. There are a variety of cases in which the complexity of Naloxone policies are advancing:

*The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone without a prescription in case of emergencies. <ref>https://nabp.pharmacy/news/news-releases/california-pharmacists-may-now-dispense-naloxone-without-prescription/</ref>

* In 2006, New Mexico passed a Good Samaritan Law that granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose. Within ten years, 28 states in addition to the District of Columbia had passed similar laws to overcome hesitation to seek treatment or to call medical assistance, as a result of fear of incarceration or other forms of punishment

* In 2023, in Minnesota, a Good Samaritan law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removed a potential barrier --fear of arrest -- that sometimes leads to help not being called and lives being lost to overdose. <ref>https://www.revisor.mn.gov/statutes/cite/604A.01</ref>

*The National Conference of State Legislatures has many examples of policy efforts that have been attempted or passed, including Drug Overdose Immunity and Good Samaritan Laws. <ref>http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx</ref> <ref>http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx</ref>

= Available Tools and Resources =

* '''SAMHSA''' provides an overdose prevention and response toolkit. <ref>https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf</ref>

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**'''"Keep the Seats Filled: Learn How to Save a Life with Naloxone and Take the #NoShame Pledge"''' is a SAFE Project resource that explores what Naloxone is, where it can be purchased, how to use it, the signs of an overdose, and information on the #NoShame Pledge.<ref>https://www.safeproject.us/life/</ref>
**See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>
**'''SAFE Project Online Courses''' are SAFE Project original online trainings that focus on harm reduction techniques such as: Narcan administration and navigating Fentanyl use safely. <ref>https://safeproject-s-school-262f.thinkific.com/</ref>
**'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
**See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>

*'''CDC''' provides a website titled "Reverse Overdose to Prevent Death." This has information on Naloxone and Good Samaritan laws. <ref>https://www.cdc.gov/opioids/overdoseprevention/reverse-od.html</ref>

*'''The Bureau of Justice Assistance (BJA)''' maintains an online toolkit featuring resources and information on Naloxone, including a section on liability and risk for law enforcement officers and their employers. <ref>https://bjatta.bja.ojp.gov/tools/naloxone/Liability-and-Risk</ref>

*'''The National Association of Drug Diversion Investigators, Inc. (NADDI)''' provides a resource titled "Overdose and Prevention Strategies" which has every state's strategy in an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This allows communities to identify the most effective strategies for them to implement. <ref>https://www.overdosepreventionstrategies.org/</ref>

= Promising Practices =

*'''Aetna.''' Nearly 35% people who are prescribed Narcan don’t pick it up because they can’t afford the co-pay.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref> Having insurers eliminate the co-pay is one strategy to help address that. Aetna was the first national payer to waive copays for Narcan for its fully insured commercial members. This improved access by eliminating potential financial barriers to the lifesaving drug. <ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref>

*'''Connecticut.''' Several communities have made it mandatory for first responders to receive overdose training. <ref>https://www.newstimes.com/local/article/More-responders-using-wonder-drug-Narcan-to-5925616.php</ref>

*'''New York.''' The Drug Policy Alliance printed 1 million cards and posters that explained the Good Samaritan Law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.

*'''North Carolina.''' The NC Harm Reduction Coalition has given out 52,000 Naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and Naloxone distribution, with more than 8,700 overdose reversals reported. <ref>https://www.usatoday.com/story/opinion/2017/12/01/opioid-commission-almost-got-right-their-naloxone-recommendation-megan-mclemore-corey-davis-column/899812001/</ref>

*'''The Police Executive Research Forum''' provides case examples of law enforcement Naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), and Camden County, Montgomery County, and Hagerstown (MD). They include descriptions of training, funding, administration, and support. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

= <br/> Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Increase Access to Naloxone

2024-10-21T02:21:17Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph=

Naloxone (Narcan) has the potential to be very beneficial in communities with a high opioid problem. Increasing community awareness about the power of Narcan to reverse overdose is a benefit unlike any other. Narcan is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain and prevents breathing and heart rates to slow down to fatal levels. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help. <ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref> Narcan allows victims of substance use to be more likely to survive an overdose when first responders are rightly prepared. Many states are working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation.

Narcan can either be injected or be administered in a nasal spray. In 2023, The US Food and Drug Administration made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. <ref>https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray</ref> It can be easily administered with little or no formal training. Although the drug could potentially save more lives if it were more widely distributed, bystanders often do not summon medical assistance due to fear of possible legal prosecution. Narcan only works on opioids, and does not harm an individual in the case of a non-opioid overdose. So, if there is any question as to what a person took, use Narcan.

= Key Information =

Opioid overdose education and Naloxone distribution programs increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the Naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref> Research documents that communities which have programs aimed at training bystanders to respond to opioid overdoses have experienced a more rapid reduction in opioid overdose death rates than communities without these programs. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Those who are close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in Naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training are as adept as medical experts in the identification of an overdose and are equally able to tell when Naloxone is appropriate. Opioid users who participate in only a brief 5-minute training or who have learned about Naloxone administration through social networks are able to respond appropriately to an overdose.

Training first responders to administer Naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in Naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

'''Personal Impact of Overdose'''
Survival of an overdose has lasting physical, psychological, and personal health implications for the individual that increase in likelihood and severity of each overdose. These include<ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf</ref>:
*Opioid-Induced Respiratory Depression (OIRD) - most dangerous health consequence; acute respiratory compromise, dizziness, confusion, and ineptness.
* Brain injury - hypoxia-related brain injuries, complications caused by the OIRD
* Hypoxia injuries can contribute to:
* short-term memory loss,
* changes in cognitive and physical functioning,
* increased risk of stroke, mental disorientation,
* loss of bodily movement or lower-extremity paralysis,
*gait changes,
*incontinence,
*slow reaction time,
*reduced motor skills,
* kidney failure,
*cardiac complications,
*neurological consequences and seizures,
* nerve damage,
*fluid buildup in lungs and pneumonia, and
*temporary motor paralysis
*Increased risk of comorbid mental illness
*Interruptions in education or career goals
*Family and relationship conflicts

'''The Dangers of Dual Use'''

The extent of fatalities associated with opioids is well-documented. However, it is less understood that opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids. It is also critical to increase awareness of the need to avoid knowingly mixing opioids with other drugs. Some safety precautions are listed below:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure someone knows what drug combinations you have taken
*Have a plan in place in case something goes wrong
*Have Narcan on hand

= Relevant Research =

* '''This Massachusetts study''' found that cities which have Naloxone distribution programs have lower overdose death rates than those without a program. <ref>http://www.bmj.com/content/346/bmj.f174</ref>

*'''A University of Washington study''' evaluated the initial results of the state’s Good Samaritan policy. Drug users who were aware of the law were found to be 88 percent more likely to call 911 in the event of an overdose than before the policy took effect.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> <ref>http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf</ref>

*'''This article''' was published in the Annals of Emergency Medicine and is directed to physicians in Emergency Departments. It highlights successes that have been achieved in recent years and calls for specific patient-centered action by emergency physicians. <ref>https://www.annemergmed.com/article/S0196-0644(19)30606-7/fulltext</ref>

= Impactful Federal, State, and Local Policies =

In 2015, the White House announced a treatment-based initiative. The $2.5 million budget was allocated to a program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and to train first responders on when it is adequate to administer Naloxone. <ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> Various federal organizations have come together to encourage good faith prescription of Naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

State laws make it difficult for citizens to obtain prescriptions for ''injection'' Narcan, due to policies on third-party prescriptions and on prescriptions via standing orders. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. There are a variety of cases in which the complexity of Naloxone policies are advancing:

*The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone without a prescription in case of emergencies. <ref>https://nabp.pharmacy/news/news-releases/california-pharmacists-may-now-dispense-naloxone-without-prescription/</ref>

* In 2006, New Mexico passed a Good Samaritan Law that granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose. Within ten years, 28 states in addition to the District of Columbia had passed similar laws to overcome hesitation to seek treatment or to call medical assistance, as a result of fear of incarceration or other forms of punishment

* In 2023, in Minnesota, a Good Samaritan law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removed a potential barrier --fear of arrest -- that sometimes leads to help not being called and lives being lost to overdose. <ref>https://www.revisor.mn.gov/statutes/cite/604A.01</ref>

*The National Conference of State Legislatures has many examples of policy efforts that have been attempted or passed, including Drug Overdose Immunity and Good Samaritan Laws. <ref>http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx</ref> <ref>http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx</ref>

= Available Tools and Resources =

* '''SAMHSA''' provides an overdose prevention and response toolkit. <ref>https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf</ref>

*'''SAFE Project:'''
**See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>
**See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>

*'''CDC''' provides a website titled "Reverse Overdose to Prevent Death." This has information on Naloxone and Good Samaritan laws. <ref>https://www.cdc.gov/opioids/overdoseprevention/reverse-od.html</ref>

*'''The Bureau of Justice Assistance (BJA)''' maintains an online toolkit featuring resources and information on Naloxone, including a section on liability and risk for law enforcement officers and their employers. <ref>https://bjatta.bja.ojp.gov/tools/naloxone/Liability-and-Risk</ref>

*'''The National Association of Drug Diversion Investigators, Inc. (NADDI)''' provides a resource titled "Overdose and Prevention Strategies" which has every state's strategy in an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This allows communities to identify the most effective strategies for them to implement. <ref>https://www.overdosepreventionstrategies.org/</ref>

= Promising Practices =

*'''Aetna.''' Nearly 35% people who are prescribed Narcan don’t pick it up because they can’t afford the co-pay.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref> Having insurers eliminate the co-pay is one strategy to help address that. Aetna was the first national payer to waive copays for Narcan for its fully insured commercial members. This improved access by eliminating potential financial barriers to the lifesaving drug. <ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref>

*'''Connecticut.''' Several communities have made it mandatory for first responders to receive overdose training. <ref>https://www.newstimes.com/local/article/More-responders-using-wonder-drug-Narcan-to-5925616.php</ref>

*'''New York.''' The Drug Policy Alliance printed 1 million cards and posters that explained the Good Samaritan Law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.

*'''North Carolina.''' The NC Harm Reduction Coalition has given out 52,000 Naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and Naloxone distribution, with more than 8,700 overdose reversals reported. <ref>https://www.usatoday.com/story/opinion/2017/12/01/opioid-commission-almost-got-right-their-naloxone-recommendation-megan-mclemore-corey-davis-column/899812001/</ref>

*'''The Police Executive Research Forum''' provides case examples of law enforcement Naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), and Camden County, Montgomery County, and Hagerstown (MD). They include descriptions of training, funding, administration, and support. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

= <br/> Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Expand Harm Reduction Practices

2024-10-21T02:14:17Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Harm reduction supports interventions which are aimed at reducing negative effects without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover.

The term harm reduction involves addressing all types of harm, including:
* Preventing death through reversing overdose
* Preventing overdose through the use of testing strips
* Preventing infection and disease transmission through needle exchange programs
* Supporting public awareness campaigns

An additional category of harm reduction is MAT (medically-assisted treatment). This a complex topic which warrants a detailed focus under the treatment domain. See the SAFE Solution article titled "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medicated_Assisted_Treatment/Recovery_(MAT/MAR)</ref>

=Key Information=

The Harm Reduction Journal defines harm reduction as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The Harm Reduction Coalition defines harm reduction as "a range of widely accepted public health policies, practices, and programs that seek to reduce morbidity and mortality associated with drug use and sexual activity, while respecting the autonomy, rights, and dignity of people who use drugs or engage in sex work.” <ref>https://www.prisonpolicy.org/scans/vera/public-health-and-policing.pdf</ref> The Coalition has developed the following eight principles to guide to communities and agencies in effective harm reduction policies and programs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref>

*Accept, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

*Do not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.

*Affirm people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower them to share information and support each other in strategies that meet their actual conditions of use.

*Establish quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies.

*Understand drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

*Ensure that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

*Call for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

*Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Four of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Increase Distribution of Fentanyl Testing Strips.''' This provides a way for users to detect the presence of Fentanyl and to prevent the risk of overdose. Likewise, access to testing strips opens additional options for users to reduce harm or learn about treatment opportunities.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

* '''International Journal of Drug Policy.''' This study examined evidence from 44 US states and found that Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use. “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on the purchase of Fentanyl testing strips

= Available Tools and Resources =

* '''SAMHSA: Harm Reduction Framework''' This is the first document to comprehensively outline harm reduction and its role within the Department of Health and Human Services (HHS). The Framework was developed and written in partnership with the Harm Reduction Steering Committee, composed of harm reduction leaders from around the country. This group represents a broad array of backgrounds and experience, with most having lived experience of drug use. This document includes a definition of harm reduction, pillars and principles supporting that definition, and core practices that SAMHSA can support. <ref>https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf</ref>
*'''SAFE Project:'''
**'''"Opioid Overdose on Campus: Key Steps to Expand Harm Reduction Efforts"''' is a SAFE Project written article that equips students, staff, and faculty with the knowledge and tools to intervene effectively in an opioid emergency.<ref>https://www.safeproject.us/campuses/opioid-overdose-harm-reduction/</ref>
**'''"Lessons Learned: The Truth About Harm Reduction"''' is a SAFE Project written article that explores the concept of harm reduction and offers resources on how to better implement harm reduction practices into substance use treatment programs.<ref>https://www.safeproject.us/resource/the-truth-about-harm-reduction/#:~:text=Lessons%20Learned%3A%20The%20Truth%20About%20Harm%20Reduction&text=Harm%20reduction%20treats%20individuals%20with,be%20considered%20%E2%80%9Charm%20reduction%E2%80%9D%3F</ref>
**'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>

* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on Fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
* '''Harm Reduction International''' uses data and advocacy to promote harm reduction and drug policy reform. It promotes rights-based and evidence-informed responses to drug use in order to contribute to healthier and safer societies. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities.''' This is an online training which models a Fentanyl eduction approach. The content of this training is available for reproduction and localized implementation. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''Never Use Alone (NUA)''' is a peer-led nonprofit. Their staff and volunteers have lived experience with substance use and have been impacted by the drug overdose crisis. They provide compassionate phone support regarding personal use or use by a loved one. <ref>https://neverusealone.com/</ref>
* '''Next Distro''' is an online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs. <ref>https://nextdistro.org/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides an account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. The level of vulnerability is rare, making this a valuable resource, especially in on-campus work. <ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>
*'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-10-21T02:13:50Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Harm reduction supports interventions which are aimed at reducing negative effects without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover.

The term harm reduction involves addressing all types of harm, including:
* Preventing death through reversing overdose
* Preventing overdose through the use of testing strips
* Preventing infection and disease transmission through needle exchange programs
* Supporting public awareness campaigns

An additional category of harm reduction is MAT (medically-assisted treatment). This a complex topic which warrants a detailed focus under the treatment domain. See the SAFE Solution article titled "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medicated_Assisted_Treatment/Recovery_(MAT/MAR)</ref>

=Key Information=

The Harm Reduction Journal defines harm reduction as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The Harm Reduction Coalition defines harm reduction as "a range of widely accepted public health policies, practices, and programs that seek to reduce morbidity and mortality associated with drug use and sexual activity, while respecting the autonomy, rights, and dignity of people who use drugs or engage in sex work.” <ref>https://www.prisonpolicy.org/scans/vera/public-health-and-policing.pdf</ref> The Coalition has developed the following eight principles to guide to communities and agencies in effective harm reduction policies and programs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref>

*Accept, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

*Do not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.

*Affirm people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower them to share information and support each other in strategies that meet their actual conditions of use.

*Establish quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies.

*Understand drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

*Ensure that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

*Call for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

*Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Four of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Increase Distribution of Fentanyl Testing Strips.''' This provides a way for users to detect the presence of Fentanyl and to prevent the risk of overdose. Likewise, access to testing strips opens additional options for users to reduce harm or learn about treatment opportunities.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

* '''International Journal of Drug Policy.''' This study examined evidence from 44 US states and found that Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use. “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on the purchase of Fentanyl testing strips

= Available Tools and Resources =

* '''SAMHSA: Harm Reduction Framework''' This is the first document to comprehensively outline harm reduction and its role within the Department of Health and Human Services (HHS). The Framework was developed and written in partnership with the Harm Reduction Steering Committee, composed of harm reduction leaders from around the country. This group represents a broad array of backgrounds and experience, with most having lived experience of drug use. This document includes a definition of harm reduction, pillars and principles supporting that definition, and core practices that SAMHSA can support. <ref>https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf</ref>
*'''SAFE Project:'''
**'''"Opioid Overdose on Campus: Key Steps to Expand Harm Reduction Efforts"''' is a SAFE Project written article that equips students, staff, and faculty with the knowledge and tools to intervene effectively in an opioid emergency.<ref>https://www.safeproject.us/campuses/opioid-overdose-harm-reduction/</ref>
**'''"Lessons Learned: The Truth About Harm Reduction"''' is a SAFE Project written article that explores the concept of harm reduction and offers resources on how to better implement harm reduction practices into substance use treatment programs.<ref>https://www.safeproject.us/resource/the-truth-about-harm-reduction/#:~:text=Lessons%20Learned%3A%20The%20Truth%20About%20Harm%20Reduction&text=Harm%20reduction%20treats%20individuals%20with,be%20considered%20%E2%80%9Charm%20reduction%E2%80%9D%3F</ref>
**'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>

* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on Fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
* '''Harm Reduction International''' uses data and advocacy to promote harm reduction and drug policy reform. It promotes rights-based and evidence-informed responses to drug use in order to contribute to healthier and safer societies. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities.''' This is an online training which models a Fentanyl eduction approach. The content of this training is available for reproduction and localized implementation. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''Never Use Alone (NUA)''' is a peer-led nonprofit. Their staff and volunteers have lived experience with substance use and have been impacted by the drug overdose crisis. They provide compassionate phone support regarding personal use or use by a loved one. <ref>https://neverusealone.com/</ref>
* '''Next Distro''' is an online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs. <ref>https://nextdistro.org/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides an account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. The level of vulnerability is rare, making this a valuable resource, especially in on-campus work. <ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>
*'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-10-21T02:13:30Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Harm reduction supports interventions which are aimed at reducing negative effects without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover.

The term harm reduction involves addressing all types of harm, including:
* Preventing death through reversing overdose
* Preventing overdose through the use of testing strips
* Preventing infection and disease transmission through needle exchange programs
* Supporting public awareness campaigns

An additional category of harm reduction is MAT (medically-assisted treatment). This a complex topic which warrants a detailed focus under the treatment domain. See the SAFE Solution article titled "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medicated_Assisted_Treatment/Recovery_(MAT/MAR)</ref>

=Key Information=

The Harm Reduction Journal defines harm reduction as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The Harm Reduction Coalition defines harm reduction as "a range of widely accepted public health policies, practices, and programs that seek to reduce morbidity and mortality associated with drug use and sexual activity, while respecting the autonomy, rights, and dignity of people who use drugs or engage in sex work.” <ref>https://www.prisonpolicy.org/scans/vera/public-health-and-policing.pdf</ref> The Coalition has developed the following eight principles to guide to communities and agencies in effective harm reduction policies and programs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref>

*Accept, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

*Do not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.

*Affirm people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower them to share information and support each other in strategies that meet their actual conditions of use.

*Establish quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies.

*Understand drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

*Ensure that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

*Call for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

*Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Four of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Increase Distribution of Fentanyl Testing Strips.''' This provides a way for users to detect the presence of Fentanyl and to prevent the risk of overdose. Likewise, access to testing strips opens additional options for users to reduce harm or learn about treatment opportunities.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

* '''International Journal of Drug Policy.''' This study examined evidence from 44 US states and found that Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use. “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on the purchase of Fentanyl testing strips

= Available Tools and Resources =

* '''SAMHSA: Harm Reduction Framework''' This is the first document to comprehensively outline harm reduction and its role within the Department of Health and Human Services (HHS). The Framework was developed and written in partnership with the Harm Reduction Steering Committee, composed of harm reduction leaders from around the country. This group represents a broad array of backgrounds and experience, with most having lived experience of drug use. This document includes a definition of harm reduction, pillars and principles supporting that definition, and core practices that SAMHSA can support. <ref>https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf</ref>
*'''SAFE Project:'''
*'''"Opioid Overdose on Campus: Key Steps to Expand Harm Reduction Efforts"''' is a SAFE Project written article that equips students, staff, and faculty with the knowledge and tools to intervene effectively in an opioid emergency.<ref>https://www.safeproject.us/campuses/opioid-overdose-harm-reduction/</ref>
*'''"Lessons Learned: The Truth About Harm Reduction"''' is a SAFE Project written article that explores the concept of harm reduction and offers resources on how to better implement harm reduction practices into substance use treatment programs.<ref>https://www.safeproject.us/resource/the-truth-about-harm-reduction/#:~:text=Lessons%20Learned%3A%20The%20Truth%20About%20Harm%20Reduction&text=Harm%20reduction%20treats%20individuals%20with,be%20considered%20%E2%80%9Charm%20reduction%E2%80%9D%3F</ref>
*'''"SAFE Community Playbook"''' is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.<https://www.safeproject.us/safe-community-playbook-and-safe-solutions/download/</ref>

* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on Fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
* '''Harm Reduction International''' uses data and advocacy to promote harm reduction and drug policy reform. It promotes rights-based and evidence-informed responses to drug use in order to contribute to healthier and safer societies. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities.''' This is an online training which models a Fentanyl eduction approach. The content of this training is available for reproduction and localized implementation. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''Never Use Alone (NUA)''' is a peer-led nonprofit. Their staff and volunteers have lived experience with substance use and have been impacted by the drug overdose crisis. They provide compassionate phone support regarding personal use or use by a loved one. <ref>https://neverusealone.com/</ref>
* '''Next Distro''' is an online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs. <ref>https://nextdistro.org/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides an account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. The level of vulnerability is rare, making this a valuable resource, especially in on-campus work. <ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>
*'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-10-21T02:07:23Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Harm reduction supports interventions which are aimed at reducing negative effects without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover.

The term harm reduction involves addressing all types of harm, including:
* Preventing death through reversing overdose
* Preventing overdose through the use of testing strips
* Preventing infection and disease transmission through needle exchange programs
* Supporting public awareness campaigns

An additional category of harm reduction is MAT (medically-assisted treatment). This a complex topic which warrants a detailed focus under the treatment domain. See the SAFE Solution article titled "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medicated_Assisted_Treatment/Recovery_(MAT/MAR)</ref>

=Key Information=

The Harm Reduction Journal defines harm reduction as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The Harm Reduction Coalition defines harm reduction as "a range of widely accepted public health policies, practices, and programs that seek to reduce morbidity and mortality associated with drug use and sexual activity, while respecting the autonomy, rights, and dignity of people who use drugs or engage in sex work.” <ref>https://www.prisonpolicy.org/scans/vera/public-health-and-policing.pdf</ref> The Coalition has developed the following eight principles to guide to communities and agencies in effective harm reduction policies and programs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref>

*Accept, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

*Do not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.

*Affirm people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower them to share information and support each other in strategies that meet their actual conditions of use.

*Establish quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies.

*Understand drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

*Ensure that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

*Call for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

*Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Four of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Increase Distribution of Fentanyl Testing Strips.''' This provides a way for users to detect the presence of Fentanyl and to prevent the risk of overdose. Likewise, access to testing strips opens additional options for users to reduce harm or learn about treatment opportunities.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

* '''International Journal of Drug Policy.''' This study examined evidence from 44 US states and found that Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use. “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on the purchase of Fentanyl testing strips

= Available Tools and Resources =

* '''SAMHSA: Harm Reduction Framework''' This is the first document to comprehensively outline harm reduction and its role within the Department of Health and Human Services (HHS). The Framework was developed and written in partnership with the Harm Reduction Steering Committee, composed of harm reduction leaders from around the country. This group represents a broad array of backgrounds and experience, with most having lived experience of drug use. This document includes a definition of harm reduction, pillars and principles supporting that definition, and core practices that SAMHSA can support. <ref>https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on Fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
* '''Harm Reduction International''' uses data and advocacy to promote harm reduction and drug policy reform. It promotes rights-based and evidence-informed responses to drug use in order to contribute to healthier and safer societies. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities.''' This is an online training which models a Fentanyl eduction approach. The content of this training is available for reproduction and localized implementation. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''Never Use Alone (NUA)''' is a peer-led nonprofit. Their staff and volunteers have lived experience with substance use and have been impacted by the drug overdose crisis. They provide compassionate phone support regarding personal use or use by a loved one. <ref>https://neverusealone.com/</ref>
* '''Next Distro''' is an online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs. <ref>https://nextdistro.org/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides an account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. The level of vulnerability is rare, making this a valuable resource, especially in on-campus work. <ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>
*'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Early Intervention Strategies

2024-10-21T02:06:34Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

Early intervention may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use. For individuals with more serious substance misuse, intervention can serve as a mechanism to engage them into treatment. <ref>"Facing Addiction in America: The Surgeon General's Spotlight on Opioids" at https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

Early intervention can occur when a person is not seeking treatment for a substance use disorder. For example, intervention services can be provided when an individual presents for another condition within a medical or social services context. Community intervention can involve multi-sector partnerships and community leaders and members. Intervention services may be initiated in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/</ref>

=Key Information=

'''At-Risk Populations Who Should Receive Early Intervention'''

Early intervention differs from prevention efforts. Prevention targets the general population with a universal need to understand the risks of substance use disorder. Early intervention strategies focus on those who have just started experimenting or using substances. Likewise, certain individuals, age groups, or families have more risk factors. While the entire community can benefit from early intervention resources, there are populations which have been identified at a higher risk for substance use.

* Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
* Individuals who have suffered childhood trauma. <ref>https://www.acesconnection.com/</ref>
* Binge drinkers: In 2018, about 67.1 million Americans aged 12 or older were binge drinking in the past month, and about 1.2 million adolescents aged 12 to 17 reported binge drinking in the previous month. <ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>
* People who use substances while driving.
* Expectant mothers who use substances while pregnant.
* Senior citizens.
* Ethnic minorities who may not be receiving culturally relevant care.
* Individuals with co-occurring substance use and mental disorders.
* Homeless population.

'''Components of Early Intervention'''

* Screening, Brief Intervention and Referral to Treatment, or SBIRT. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
* Screen for risk factors for substance use such as childhood trauma and ACEs. </span><ref>https://www.acesconnection.com/</ref>
* Reduce Stigma in Community. <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>
* Pre-Arrest Diversion Programs. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>
* “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain. <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
* Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

=Relevant Research=

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

=Impactful Federal, State, and Local Policies=

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Available Tools and Resources =

'''SAFE Project''':
*'''SAFE Campuses''' provides developmental assistance to support the needs of students in recovery and collegiate recovery communities. The program offers program-specific sessions tailored to various professional degree programs.<ref>https://www.safeproject.us/campuses/</ref>
*'''SAFE Choices''' is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.<ref>https://www.safeproject.us/safe-choices/</ref>
*'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>
*See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance misuse in the general population.<ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
*See the wiki titled "Reduce Stigma" for more detailed information on what stigma is and resources to overcome stigma as it relates to substance use disorders.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>

'''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"''' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

'''Facing Addiction in America: The Surgeon General’s Spotlight on Opioids.''' The following is taken from the section titled ''Importance of Prevention, Screening, Early Intervention, and Treatment:'' “Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

'''HHS Office of the Assistant Secretary for Planning and Evaluation''' published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." It includes information on screening and early intervention. <ref>https://www.aspe.hhs.gov/sites/default/files/migrated_legacy_files//187391/BestSUD.pdf?_ga=2.175262753.2025544468.1693431443-868347927.1691445109</ref>

'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''' <ref>https://communitycatalyst.org/resource/training-resources-for-the-implementation-of-sbirt-with-young-people/</ref> This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention. It describes a set of tools for early intervention and strategies to implement and fund early intervention in schools and clinics.

'SAMHSA''' provides a chart for screening and assessment tools for substance use disorders. <ref>https://www.samhsa.gov/resource/dbhis/screening-assessment-tools-chart</ref>

= Promising Practices =

'''OhioSTART (Sobriety, Treatment, and Reducing Trauma) <ref>https://ohiostart.org/</ref>

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. The goal is to reunify and stabilize families with parents who have lost custody of their children to foster care or another government-approved living arrangement. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists parents of those children with mentors who have firsthand experience with substance use disorder.

'''Project Engage - Delaware''' <ref>https://christianacare.org/services/behavioralhealth/project-engage/</ref>

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

'''Project IMPACT''' <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref>

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

* Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers who understand addiction.

* Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.

= Sources =

----

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Early Intervention Strategies

2024-10-21T02:06:16Z

Charliekapinos: /* Available Tools and Resources */

=Introductory Paragraph=

Early intervention may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use. For individuals with more serious substance misuse, intervention can serve as a mechanism to engage them into treatment. <ref>"Facing Addiction in America: The Surgeon General's Spotlight on Opioids" at https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

Early intervention can occur when a person is not seeking treatment for a substance use disorder. For example, intervention services can be provided when an individual presents for another condition within a medical or social services context. Community intervention can involve multi-sector partnerships and community leaders and members. Intervention services may be initiated in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/</ref>

=Key Information=

'''At-Risk Populations Who Should Receive Early Intervention'''

Early intervention differs from prevention efforts. Prevention targets the general population with a universal need to understand the risks of substance use disorder. Early intervention strategies focus on those who have just started experimenting or using substances. Likewise, certain individuals, age groups, or families have more risk factors. While the entire community can benefit from early intervention resources, there are populations which have been identified at a higher risk for substance use.

* Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
* Individuals who have suffered childhood trauma. <ref>https://www.acesconnection.com/</ref>
* Binge drinkers: In 2018, about 67.1 million Americans aged 12 or older were binge drinking in the past month, and about 1.2 million adolescents aged 12 to 17 reported binge drinking in the previous month. <ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>
* People who use substances while driving.
* Expectant mothers who use substances while pregnant.
* Senior citizens.
* Ethnic minorities who may not be receiving culturally relevant care.
* Individuals with co-occurring substance use and mental disorders.
* Homeless population.

'''Components of Early Intervention'''

* Screening, Brief Intervention and Referral to Treatment, or SBIRT. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
* Screen for risk factors for substance use such as childhood trauma and ACEs. </span><ref>https://www.acesconnection.com/</ref>
* Reduce Stigma in Community. <ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>
* Pre-Arrest Diversion Programs. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>
* “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain. <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
* Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

=Relevant Research=

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

=Impactful Federal, State, and Local Policies=

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Available Tools and Resources =

'''SAFE Project''':
*'''SAFE Campuses''' provides developmental assistance to support the needs of students in recovery and collegiate recovery communities. The program offers program-specific sessions tailored to various professional degree programs.<ref>https://www.safeproject.us/campuses/</ref>
*'''SAFE Choices''' is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.<ref>https://www.safeproject.us/safe-choices/</ref>
*'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
*'''SAFE Veterans''' provides services to connect veterans, active-duty service members, and their families — all military-connected individuals — to the resources they need to address mental health challenges and substance use disorders. <ref>https://www.safeproject.us/veterans/</ref>
*See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse. <ref>https://www.yoursafesolutions.us/wiki/Expand_School-Based_Prevention_Programs</ref>
*See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance misuse in the general population.<ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
*See the wiki titled "Reduce Stigma" for more detailed information on what stigma is and resources to overcome stigma as it relates to substance use disorders.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Stigma</ref>

''The Network for Public Health Law "Policies in Schools to Reduce Overdose and Other Drug-related Harm"'' Webinar explores substance abuse policy issues in schools.<ref>https://www.networkforphl.org/resources/policies-in-schools-to-reduce-overdose-and-other-drug-related-harm/</ref>

'''Facing Addiction in America: The Surgeon General’s Spotlight on Opioids.''' The following is taken from the section titled ''Importance of Prevention, Screening, Early Intervention, and Treatment:'' “Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

'''HHS Office of the Assistant Secretary for Planning and Evaluation''' published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." It includes information on screening and early intervention. <ref>https://www.aspe.hhs.gov/sites/default/files/migrated_legacy_files//187391/BestSUD.pdf?_ga=2.175262753.2025544468.1693431443-868347927.1691445109</ref>

'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''' <ref>https://communitycatalyst.org/resource/training-resources-for-the-implementation-of-sbirt-with-young-people/</ref> This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention. It describes a set of tools for early intervention and strategies to implement and fund early intervention in schools and clinics.

'SAMHSA''' provides a chart for screening and assessment tools for substance use disorders. <ref>https://www.samhsa.gov/resource/dbhis/screening-assessment-tools-chart</ref>

= Promising Practices =

'''OhioSTART (Sobriety, Treatment, and Reducing Trauma) <ref>https://ohiostart.org/</ref>

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. The goal is to reunify and stabilize families with parents who have lost custody of their children to foster care or another government-approved living arrangement. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists parents of those children with mentors who have firsthand experience with substance use disorder.

'''Project Engage - Delaware''' <ref>https://christianacare.org/services/behavioralhealth/project-engage/</ref>

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

'''Project IMPACT''' <ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref>

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

* Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers who understand addiction.

* Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.

= Sources =

----

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]

Reduce Non-Medical Access to Prescription Drugs

2024-10-21T02:04:45Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

It is essential that people who have prescription medications in their homes store them safely. When people begin to misuse prescription drugs, they often acquire them by stealing them from family, relatives, friends or from homes which they enter for other reasons (work, open houses, breaking and entering). If prescription drugs are safely stored, misuse can be stopped earlier, because people who have not yet developed a dependence on opioids usually do not go directly to illegal opioids like heroin or Fentanyl. Prescription drugs that are not safely stored can also be accidentally taken by young children or by curious pre-teens.

= Key Information =

Safe storage of prescription drugs within the home has been prioritized as a key strategy by many organizations and coalitions. <ref>https://end-overdose-epidemic.org/task-force-recommendations/</ref> Even if a community does an excellent job of reducing prescriptions and taking back or disposing of unused opioids, there will still be a lot of opioids in communities. Thirty-two percent of American adults received a prescription for opioids in the two years preceding 2018. <ref>https://www.norc.org/NewsEventsPublications/PressReleases/Pages/one-third-of-americans-have-received-an-opioid-prescription-in-the-past-two-years.aspx#:~:text=Nearly%20one%20in%20five%20adults,the%20prescription%20at%20least%20once.</ref> In 2019, 22% of U.S. adults with chronic pain used a prescription opioid in the previous 3 months. <ref>https://www.cdc.gov/nchs/data/nhsr/nhsr162-508.pdf</ref> Many people are legitimately being prescribed opioids for short-term pain management. These can be misused, stolen or accidentally consumed by children. Failure to securely store prescription drugs contributes to the opioid epidemic and other health hazards in several ways.

* Easy access to prescription drugs can lead to initial experimentation, especially by teens.

* Stealing prescription drugs, which is much easier when they are commonly available in unlocked medicine cabinets, is often a step toward more destructive misuse.

* Easy access to unsecured opioids or other prescription drugs contributes to theft by people who sell them or give them away.

* Children who access unsecured drugs sometimes take them, thinking they are candy.

'''Staggering Statistics'''

* Only 2 in 10 who have dangerous medications—such as opioid pain pills, stimulants used to treat ADHD, and sedatives—lock them up. <ref> https://www.jhsph.edu/news/news-releases/2017/majority-of-opioid-medications-not-safely-stored-in-home-with-children-survey-finds.html</ref>

* A recent study of adults living in households with children found that prescription opioids were stored in a locked or latched place in only 32.6% of households with young children and 11.7% with older children. <ref> https://pediatrics.aappublications.org/content/139/3/e20162161</ref>

* More than 1,600 teens begin abusing prescription drugs each day. <ref>https://www.ridgefieldrecovery.com/drugs/prescription-drugs/related/commonly-abused-prescription-drugs/</ref>

* 1 in every 4 teens in America say they have misused or abused a prescription drug at least once. <ref> https://drugfree.org/newsroom/news-item/national-study-teen-misuse-and-abuse-of-prescription-drugs-up-33-percent-since-2008-stimulants-contributing-to-sustained-rx-epidemic/</ref>

* 60,000 kids under the age of 5 accidentally ingest these dangerous drugs every year and wind up in emergency rooms. <ref>http://www.consumerreports.org/drugs/best-ways-to-protect-kids-accidental-drug-poisoning-/</ref>

* 12-17 year olds abuse prescription drugs more than ecstasy, heroin, crack/cocaine and methamphetamines combined.

* In one study, only 8.6% of the respondents reported locking up their opioid medication and only 20.9% reported using a latched location. <ref>Kennedy-Hendricks A, et al. “Medication sharing, storage and disposal practices for opioid medications among US adults.” JAMA Intern Med 2016; 176:1027-29.</ref>

* The National Drug Intelligence Center notes that older people are especially vulnerable to theft of prescription drugs. They also indicate that over half of teens, ages 12 and up, obtained prescription drugs from a friend or family member "for free." <ref>https://www.nnw.org/publication/medication-theft-protecting-our-most-vulnerable-neighbors</ref>

'''Succesful Strategies'''

There are four primary successful strategies for communities to consider. The four strategies are conducive for implementation in conjunction with each other, but are covered separately below:

*'''Campaigns''' - An information campaign enables a variety of sectors in the community to collaborate. For example, an awareness campaign could engage law enforcement in drug take-backs. When law enforcement hosts drop-off locations, it promotes the overall campaign. Health department staff could disseminate information. Schools could provide an avenue for reaching parents and informing them about the location of take-back events. Pharmacies and the businesses could be engaged in sponsoring the campaign. A few models of national campaigns are provided in the “Promising Practices” section below.

*'''Proper Disposal''' — In addition to take-backs and promotion of drop-off locations, there are medication neutralization kits that are available. These provide an appealing way to engage people to take action in a one-off event that increases their readiness to take more routine medication safety actions.

*'''Safe Storage''' — Increasing awareness about the importance of safe storage often goes hand-in-hand with providing members of the community free or affordable storage options. A variety of vendors associated with both safe storage and disposal products are listed in the “Available Tools and Resources” section below.

*'''Education'''— Families are generally more receptive to tips for medication safety than they might be for information about other forms of prevention. While any of the statistics above can be used in an education campaigns, some basic ideas can get people thinking about their own practices in a new way. For example, most people have not considered that it makes sense to keep a medication log or an inventory of all their medication types and amounts. Updating their inventory every six to twelve months keeps medication safety in their awareness. <ref>http://www.youthconnectionscoalition.org/content/wp-content/uploads/2015/04/safe_storage.pdf</ref> Likewise, people are ready to recall that the medicine cabinet in a bathroom is often not the best place to store prescriptions, since they should be stored in a cool, dry place. Humidity, heat, and the change in temperatures in the bathroom can alter the potency of some medications, and some storage devices can help protect medications from humidity, even if they are stored in bathrooms. <ref>http://www.youthconnectionscoalition.org/content/reduce-rx-abuse-2/the-proper-storage-of-prescription-drugs/</ref> This is a good lead-in to building a desire to obtain a lock-box.

= Relevant Research =

This report highlights survey results that reveal the disconnect between parent knowledge and behavior regarding safe storage of medicine.<ref>https://www.safekids.org/node/25758</ref>

= Impactful Federal, State, and Local Policies =

'''HHS 5-Point Plan.''' HHS developed a comprehensive strategy to improve access to prevention, treatment, and recovery support services. The strategy aims to support individuals to achieve long-term recovery and to prevent the health, social, and economic consequences associated with opioid misuse and addiction: <ref>https://www.ahrq.gov/sites/default/files/wysiwyg/topics/impact-opioid-final.pdf</ref>

* '''Better Addiction Prevention, Treatment, and Recovery Services.''' <ref> https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref> This involves working across the continuum of care. It has evolved to explicitly include harm reduction.

* '''Better Data''' strengthens public health reporting to improve the timeliness and specificity of data and to inform a real-time public health response.

* '''Better Pain Management''' advances the practice of pain management to enable access to high-quality, evidence-based pain care which reduces the burden of pain for individuals, families, and society while reducing the inappropriate use of opioids. <ref>https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

* '''Better Targeting of Overdose Reversing Drugs.''' This has a particular focus on high-risk populations. Increasing the availability and distribution of overdose-reversing medications ensures broader provision of these drugs to people most likely to experience or respond to an overdose.

* '''Better Research.''' Supporting cutting-edge research advances our understanding of pain, overdose and addiction. This leads to the development of new treatment and identifies effective public health interventions to reduce opioid-related health harms.

= Available Tools and Resources =

*'''SAFE Project:'''
*'''"At-Home Drug Disposal"''' is a SAFE Project written article that discusses the importance of proper disposal for opioid/prescription medications at home and how to do so safely.<ref>https://www.safeproject.us/disposal/</ref>
*See the wiki titled "Reduce Criminal Diversion of Prescription Drugs" for more detailed information on the illegal distribution and misuse of prescription drugs, encompassing activities like selling medications, doctor shopping, and theft or forgery of prescriptions.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Criminal_Diversion_of_Prescription_Drugs</ref>
*See the wiki titled "Expand Prescription Drug Take-Back and Disposal Programs" for more detailed information on prescription drug take-back and disposal programs that enhance safety by reducing accidental exposure, protect the environment by preventing medications from contaminating water sources, and decrease drug diversion, limiting the misuse of prescription drugs that are often obtained from family or friends.

Here is a small sample of products which can either be distributed or advertised by community coalitions for families to purchase. Some of these are low-cost items, useful as give-ways at community events. Some of the items could have logos of local business sponsors or coalition branding added:

* '''IKeyp''' provides a safe that offers storage for personal items that need to be securely stored yet regularly accessed. It is linked to an app on a smart phone. <ref>https://www.ikeyp.com/</ref>

* '''Pack4U''' equips pharmacies with single-dose packaging. Using blister packs instead of having an entire bottle filled with prescription pills has been shown to help prevent accident poisonings in children. <ref>http://www.livescience.com/58351-kids-opioids-ingestion.html</ref>

*'''Safer Lock''' provides 4-digit combination lock boxes and locking caps. <ref>https://rxguardian.com/</ref>

* '''TimerCaps''' have a built-in LCD stopwatch timer which displays how long it has been since the cap was last replaced. Timer caps come in different sizes, and they can replace an existing medicine bottle cap (or you can get a cap and bottle combination). TimerCaps are easy to use and don't require a change in patient behavior. They are also useful to track the timing since the last dosage -- reducing accidental overdoses and emergency room visits. <ref>https://www.timercap.com/</ref>

= Promising Practices =

Many communities have engaged in education and awareness efforts to increase prescription drug disposal and safe storage. There is potential to reach significantly more people by reaching a more diverse group of cross-sector partners in a campaign. The CDC promotes three different national campaigns: <ref>https://www.cdc.gov/medicationsafety/campaign_initiatives.html</ref>

* '''The National Action Plan for Adverse Drug Event Prevention (ADE Action Plan)''' identifies common, preventable, and measurable adverse drug events and aligns the efforts of federal health agencies to reduce patient harms from these ADEs nationwide. <ref>https://health.gov/our-work/national-health-initiatives/health-care-quality/adverse-drug-events</ref>

* '''The PROTECT Initiative''' is an innovative collaboration led by CDC. PROTECT unites public health agencies, private sector companies, professional organizations, consumer/patient advocates, and academic experts to keep children safe from unintended medication overdoses. <ref>https://www.cdc.gov/medicationsafety/protect/protect_initiative.html</ref>

* '''Up and Away Campaign.''' "Put your medicines up and away and out of sight." This campaign is designed to remind families about the importance of safe medicine storage. <ref>https://www.cdc.gov/medicationsafety/protect/campaign.html</ref>

There are numerous examples of campaigns that were started by local communities. One example in Rhode Island is the partnership between
the South Kingstown Partnership for Prevention and Rebels Inspiring Positive Lifestyles. Their medication safety campaign held community awareness events and garnered local news publicity for their cause and were able to raise funds to send youth leaders to CADCA training. <ref>https://www.cadca.org/resources/coalitions-action-south-kingstown-partnership-prevention-launches-med-safety-campaign</ref>

= Sources =

Reduce Non-Medical Access to Prescription Drugs

2024-10-21T02:04:31Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

It is essential that people who have prescription medications in their homes store them safely. When people begin to misuse prescription drugs, they often acquire them by stealing them from family, relatives, friends or from homes which they enter for other reasons (work, open houses, breaking and entering). If prescription drugs are safely stored, misuse can be stopped earlier, because people who have not yet developed a dependence on opioids usually do not go directly to illegal opioids like heroin or Fentanyl. Prescription drugs that are not safely stored can also be accidentally taken by young children or by curious pre-teens.

= Key Information =

Safe storage of prescription drugs within the home has been prioritized as a key strategy by many organizations and coalitions. <ref>https://end-overdose-epidemic.org/task-force-recommendations/</ref> Even if a community does an excellent job of reducing prescriptions and taking back or disposing of unused opioids, there will still be a lot of opioids in communities. Thirty-two percent of American adults received a prescription for opioids in the two years preceding 2018. <ref>https://www.norc.org/NewsEventsPublications/PressReleases/Pages/one-third-of-americans-have-received-an-opioid-prescription-in-the-past-two-years.aspx#:~:text=Nearly%20one%20in%20five%20adults,the%20prescription%20at%20least%20once.</ref> In 2019, 22% of U.S. adults with chronic pain used a prescription opioid in the previous 3 months. <ref>https://www.cdc.gov/nchs/data/nhsr/nhsr162-508.pdf</ref> Many people are legitimately being prescribed opioids for short-term pain management. These can be misused, stolen or accidentally consumed by children. Failure to securely store prescription drugs contributes to the opioid epidemic and other health hazards in several ways.

* Easy access to prescription drugs can lead to initial experimentation, especially by teens.

* Stealing prescription drugs, which is much easier when they are commonly available in unlocked medicine cabinets, is often a step toward more destructive misuse.

* Easy access to unsecured opioids or other prescription drugs contributes to theft by people who sell them or give them away.

* Children who access unsecured drugs sometimes take them, thinking they are candy.

'''Staggering Statistics'''

* Only 2 in 10 who have dangerous medications—such as opioid pain pills, stimulants used to treat ADHD, and sedatives—lock them up. <ref> https://www.jhsph.edu/news/news-releases/2017/majority-of-opioid-medications-not-safely-stored-in-home-with-children-survey-finds.html</ref>

* A recent study of adults living in households with children found that prescription opioids were stored in a locked or latched place in only 32.6% of households with young children and 11.7% with older children. <ref> https://pediatrics.aappublications.org/content/139/3/e20162161</ref>

* More than 1,600 teens begin abusing prescription drugs each day. <ref>https://www.ridgefieldrecovery.com/drugs/prescription-drugs/related/commonly-abused-prescription-drugs/</ref>

* 1 in every 4 teens in America say they have misused or abused a prescription drug at least once. <ref> https://drugfree.org/newsroom/news-item/national-study-teen-misuse-and-abuse-of-prescription-drugs-up-33-percent-since-2008-stimulants-contributing-to-sustained-rx-epidemic/</ref>

* 60,000 kids under the age of 5 accidentally ingest these dangerous drugs every year and wind up in emergency rooms. <ref>http://www.consumerreports.org/drugs/best-ways-to-protect-kids-accidental-drug-poisoning-/</ref>

* 12-17 year olds abuse prescription drugs more than ecstasy, heroin, crack/cocaine and methamphetamines combined.

* In one study, only 8.6% of the respondents reported locking up their opioid medication and only 20.9% reported using a latched location. <ref>Kennedy-Hendricks A, et al. “Medication sharing, storage and disposal practices for opioid medications among US adults.” JAMA Intern Med 2016; 176:1027-29.</ref>

* The National Drug Intelligence Center notes that older people are especially vulnerable to theft of prescription drugs. They also indicate that over half of teens, ages 12 and up, obtained prescription drugs from a friend or family member "for free." <ref>https://www.nnw.org/publication/medication-theft-protecting-our-most-vulnerable-neighbors</ref>

'''Succesful Strategies'''

There are four primary successful strategies for communities to consider. The four strategies are conducive for implementation in conjunction with each other, but are covered separately below:

*'''Campaigns''' - An information campaign enables a variety of sectors in the community to collaborate. For example, an awareness campaign could engage law enforcement in drug take-backs. When law enforcement hosts drop-off locations, it promotes the overall campaign. Health department staff could disseminate information. Schools could provide an avenue for reaching parents and informing them about the location of take-back events. Pharmacies and the businesses could be engaged in sponsoring the campaign. A few models of national campaigns are provided in the “Promising Practices” section below.

*'''Proper Disposal''' — In addition to take-backs and promotion of drop-off locations, there are medication neutralization kits that are available. These provide an appealing way to engage people to take action in a one-off event that increases their readiness to take more routine medication safety actions.

*'''Safe Storage''' — Increasing awareness about the importance of safe storage often goes hand-in-hand with providing members of the community free or affordable storage options. A variety of vendors associated with both safe storage and disposal products are listed in the “Available Tools and Resources” section below.

*'''Education'''— Families are generally more receptive to tips for medication safety than they might be for information about other forms of prevention. While any of the statistics above can be used in an education campaigns, some basic ideas can get people thinking about their own practices in a new way. For example, most people have not considered that it makes sense to keep a medication log or an inventory of all their medication types and amounts. Updating their inventory every six to twelve months keeps medication safety in their awareness. <ref>http://www.youthconnectionscoalition.org/content/wp-content/uploads/2015/04/safe_storage.pdf</ref> Likewise, people are ready to recall that the medicine cabinet in a bathroom is often not the best place to store prescriptions, since they should be stored in a cool, dry place. Humidity, heat, and the change in temperatures in the bathroom can alter the potency of some medications, and some storage devices can help protect medications from humidity, even if they are stored in bathrooms. <ref>http://www.youthconnectionscoalition.org/content/reduce-rx-abuse-2/the-proper-storage-of-prescription-drugs/</ref> This is a good lead-in to building a desire to obtain a lock-box.

= Relevant Research =

This report highlights survey results that reveal the disconnect between parent knowledge and behavior regarding safe storage of medicine.<ref>https://www.safekids.org/node/25758</ref>

= Impactful Federal, State, and Local Policies =

'''HHS 5-Point Plan.''' HHS developed a comprehensive strategy to improve access to prevention, treatment, and recovery support services. The strategy aims to support individuals to achieve long-term recovery and to prevent the health, social, and economic consequences associated with opioid misuse and addiction: <ref>https://www.ahrq.gov/sites/default/files/wysiwyg/topics/impact-opioid-final.pdf</ref>

* '''Better Addiction Prevention, Treatment, and Recovery Services.''' <ref> https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref> This involves working across the continuum of care. It has evolved to explicitly include harm reduction.

* '''Better Data''' strengthens public health reporting to improve the timeliness and specificity of data and to inform a real-time public health response.

* '''Better Pain Management''' advances the practice of pain management to enable access to high-quality, evidence-based pain care which reduces the burden of pain for individuals, families, and society while reducing the inappropriate use of opioids. <ref>https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

* '''Better Targeting of Overdose Reversing Drugs.''' This has a particular focus on high-risk populations. Increasing the availability and distribution of overdose-reversing medications ensures broader provision of these drugs to people most likely to experience or respond to an overdose.

* '''Better Research.''' Supporting cutting-edge research advances our understanding of pain, overdose and addiction. This leads to the development of new treatment and identifies effective public health interventions to reduce opioid-related health harms.

= Available Tools and Resources =

*'''SAFE Project:'''
**'''"At-Home Drug Disposal"''' is a SAFE Project written article that discusses the importance of proper disposal for opioid/prescription medications at home and how to do so safely.<ref>https://www.safeproject.us/disposal/</ref>
*See the wiki titled "Reduce Criminal Diversion of Prescription Drugs" for more detailed information on the illegal distribution and misuse of prescription drugs, encompassing activities like selling medications, doctor shopping, and theft or forgery of prescriptions.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Criminal_Diversion_of_Prescription_Drugs</ref>
*See the wiki titled "Expand Prescription Drug Take-Back and Disposal Programs" for more detailed information on prescription drug take-back and disposal programs that enhance safety by reducing accidental exposure, protect the environment by preventing medications from contaminating water sources, and decrease drug diversion, limiting the misuse of prescription drugs that are often obtained from family or friends.

Here is a small sample of products which can either be distributed or advertised by community coalitions for families to purchase. Some of these are low-cost items, useful as give-ways at community events. Some of the items could have logos of local business sponsors or coalition branding added:

* '''IKeyp''' provides a safe that offers storage for personal items that need to be securely stored yet regularly accessed. It is linked to an app on a smart phone. <ref>https://www.ikeyp.com/</ref>

* '''Pack4U''' equips pharmacies with single-dose packaging. Using blister packs instead of having an entire bottle filled with prescription pills has been shown to help prevent accident poisonings in children. <ref>http://www.livescience.com/58351-kids-opioids-ingestion.html</ref>

*'''Safer Lock''' provides 4-digit combination lock boxes and locking caps. <ref>https://rxguardian.com/</ref>

* '''TimerCaps''' have a built-in LCD stopwatch timer which displays how long it has been since the cap was last replaced. Timer caps come in different sizes, and they can replace an existing medicine bottle cap (or you can get a cap and bottle combination). TimerCaps are easy to use and don't require a change in patient behavior. They are also useful to track the timing since the last dosage -- reducing accidental overdoses and emergency room visits. <ref>https://www.timercap.com/</ref>

= Promising Practices =

Many communities have engaged in education and awareness efforts to increase prescription drug disposal and safe storage. There is potential to reach significantly more people by reaching a more diverse group of cross-sector partners in a campaign. The CDC promotes three different national campaigns: <ref>https://www.cdc.gov/medicationsafety/campaign_initiatives.html</ref>

* '''The National Action Plan for Adverse Drug Event Prevention (ADE Action Plan)''' identifies common, preventable, and measurable adverse drug events and aligns the efforts of federal health agencies to reduce patient harms from these ADEs nationwide. <ref>https://health.gov/our-work/national-health-initiatives/health-care-quality/adverse-drug-events</ref>

* '''The PROTECT Initiative''' is an innovative collaboration led by CDC. PROTECT unites public health agencies, private sector companies, professional organizations, consumer/patient advocates, and academic experts to keep children safe from unintended medication overdoses. <ref>https://www.cdc.gov/medicationsafety/protect/protect_initiative.html</ref>

* '''Up and Away Campaign.''' "Put your medicines up and away and out of sight." This campaign is designed to remind families about the importance of safe medicine storage. <ref>https://www.cdc.gov/medicationsafety/protect/campaign.html</ref>

There are numerous examples of campaigns that were started by local communities. One example in Rhode Island is the partnership between
the South Kingstown Partnership for Prevention and Rebels Inspiring Positive Lifestyles. Their medication safety campaign held community awareness events and garnered local news publicity for their cause and were able to raise funds to send youth leaders to CADCA training. <ref>https://www.cadca.org/resources/coalitions-action-south-kingstown-partnership-prevention-launches-med-safety-campaign</ref>

= Sources =

Reduce Criminal Diversion of Prescription Drugs

2024-10-21T02:01:39Z

Charliekapinos: /* Available Tools and Resources */

= Introductory Paragraph =

Drug diversion is the illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber.<ref>https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrityProgram/downloads/drugdiversion.pdf </ref> Inciardi et al. (2006), defines prescription drug diversion as the illegal way of acquiring or distributing controlled medicinal drugs for any use.<ref>Inciardi JA, Surratt HL, Kurtz SP, Burke JJ. The diversion of prescription drugs by health care workers in Cincinnati, Ohio. Subst Use Misuse. 2006;41(2):255–264.</ref> According to the US Department of Health and Human Services the most common types of drug diversion include: <ref>https://www.ncbi.nlm.ni.gov/pmc/articles/PMC2879025/</ref>
* Selling prescription drugs
* Doctor shopping
* Illegal internet pharmacies
* Drug theft
* Prescription pad theft and forgery
* Illicit prescribing

= Key Information =

The potential for misuse of opioids and other medications used to treat pain by patients suffering from chronic ongoing pain is high. Patients may abuse their own medication and may divert by obtaining medications under false pretenses or by reselling medications prescribed to them. <ref>https://www.aafp.org/fpm/2001/1000/p37.html</ref> Physicians are in the forefront of managing chronic pain for their patients and play a key role in drug diversion. It is estimated that this may affect 15 percent to 30 percent of the general population of the United States – as many as 70 million individuals. <ref>Krames ES, Olson K. Clinical realities and economic considerations: patient selection in intrathecal therapy. J Pain Symptom Manage. September1997;14(suppl 3):S3–S13</ref> Prevention strategies include training to identify points of diversion, improve drug monitoring, and recognition of signs of drug diversion. The American Academy of Family Physicians (AAFP) provides tips on recognizing signs of diversion. These include:

* '''Strange stories. '''Be wary of new patients with stories that don’t seem quite right. Diverters often claim to be traveling through town on business or visiting relatives. Occasionally, they’ll pose as government officials or pharmaceutical company representatives. They may be excessively complimentary about the office facilities or your appearance or medical reputation in the community. They may deliberately request appointments toward the end of the day or may show up just after regular office hours. One common ploy diverters use is to ask to be seen immediately or to be given a prescription right away because they have to “catch a plane” or “get to an important appointment.” They may claim that they have lost a paper prescription, forgotten to pack their medication or had their medication stolen.

* '''Reluctance to cooperate.''' Diverters often refuse a physical exam and are unwilling to give permission to access past medical records or allow contact with previous providers. If pressed, they may claim they cannot precisely remember where they were last treated or that the previous clinic, hospital or provider has gone out of business. In many cases, these patients leave the office suddenly if things are not going their way.

* '''Unusually high (or low) understanding of medications'''. Be alert when patients appear to be extremely well-informed about specific medications. While it is true that people who have been sick for a long time often learn much about their disease process and know the medications that work best for them, this is also true of diverters. They often appear to have a familiarity with diseases that comes straight from textbooks rather than real life. Some diverters may feign naiveté by deliberately mispronouncing medication names or seeming to be uninformed about their underlying medical condition.

* '''Strange symptoms.''' Diverters may exaggerate or feign symptoms. Certain complaints are typical, such as back pain, kidney stones, migraine headaches, toothaches or post-herpetic neuralgia. Some diverters may even attempt to alter urine samples by pricking a finger and putting a drop of blood in the specimen to corroborate their story of renal colic.

* '''Specific drug requests.''' Because many diverters are very knowledgeable about controlled substances, they may request specific medication brands and resist any of your attempts to prescribe generic forms and substitutes, stating that they are “allergic” or that a particular alternative has never provided relief for them in the past.

= Relevant Research =

*The Department of Justice has funded a research summary on diversion titled "Illegal Prescription Drug Market Interventions." <ref>https://www.ojp.gov/pdffiles1/nij/grants/248905.pdf</ref>

*The Mayo Clinic has documented steps that have been taken to reduce drug diversion by its healthcare workers in a report titled "Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention." <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538481/</ref>

= Impactful Federal, State, and Local Policies =

'''The Affordable Care Act''' The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, has published an issue brief titled "Continuing Progress on the Opioid Epidemic: The Role of the Affordable Care Act." <ref>https://aspe.hhs.gov/pdf-report/continuing-progress-opioid-epidemic-role-affordable-care-act</ref>

'''The Controlled Substances Act (CSA)''' is a federal drug law regulating the manufacture and distribution of controlled substances. <ref>https://www.dea.gov/drug-information/csa</ref> Since the 1970s, every person who orders, handles, stores or distributes controlled substances is required to register with the Drug Enforcement Agency (DEA). "Registrants must maintain accurate inventories and records, and must have specific security controls and operating procedures in place to guard against theft and diversion." In addition, the CSA requires all prescriptions for controlled substances to be issued for a medical purpose by an individual practitioner acting in the usual course of medical practice. <ref>https://cdn.ymaws.com/www.iahss.org/resource/collection/48907176-3B11-4B24-A7C0-FF756143C7DE/2018_Methods,_Trends_and_Solutions_for_Drug_Diversion.pdf</ref> The CSA categorizes drugs into one of five schedules based on each drug’s medical use and its potential for abuse or dependency. The DEA and the Food and Drug Administration (FDA) have authority to add or remove drugs from the different schedules.The most harmful substances are placed in Schedule I, and the rest appear in descending order as follows: <ref>https://www.deadiversion.usdoj.gov/schedules/</ref>

*Schedule I: heroin, ecstasy, LSD, marijuana
*Schedule II: morphine, cocaine, methamphetamine
*Schedule III: Vicodin, anabolic steroids
*Schedule IV: Ambien, Soma, Valium
*Schedule V: Lyrica, cough suppressants

= Available Tools and Resources =

'''SAFE Project:'''
*'''The Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training''' by SAFE Project is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.<ref>https://www.safeproject.us/ifprs-training/</ref>
*See the wiki titled "Disrupt the Supply of Illegal Drugs" for more detailed information on how all levels of government are working together to stop the supply of illegal drugs reaching communities across the country and the world.<ref>https://www.yoursafesolutions.us/wiki/Disrupt_the_Supply_of_Illegal_Drugs#Available_Tools_and_Resources</ref>

'''The Office of Diversion Control''' within DEA provides a website with current information on drug diversion. <ref>https://www.deadiversion.usdoj.gov/</ref> It has published an informational outline of the CSA fpr pharmacists. <ref>https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-046R1)(EO-DEA154R1)_Pharmacist's_Manual_DEA.pdf</ref>

'''The US Department of Health and Human Services''' has a fact sheet for the prescriber's role in drug diversion. <ref>https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/DrugDiversionFS022316.pdf</ref>

'''The Center for Medicare and Medicaid Services (CMS)''' provides detailed information on how prescribers can prevent drug diversion. <ref>https://www.cms.gov/files/document/drugdiversion022316pdf</ref> The Center for Program Integrity within CMS promotes a variety of strategies for states to reduce drug diversion in Medicaid. <ref>https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaidintegrityprogram/downloads/drugdiversion.pdf</ref>

'''American Society of Health-System Pharmacists (ASHP)''' provides a website with multiple resources for pharmacy technicians on controlled substances diversion. <ref>https://www.ashp.org/pharmacy-technician/about-pharmacy-technicians/advanced-pharmacy-technician-roles-toolkits/controlled-substances-drug-diversion-pharmacy-technician-toolkit?loginreturnUrl=SSOCheckOnly</ref>

'''The Real Reporting Foundation''' is a nonprofit which maintains a website titled "Drug Policy Facts." It covers numerous topics, and one extensive chapter of their website is devoted to the diversion of prescription drugs. <ref>https://www.drugpolicyfacts.org/chapter/diversion</ref>

= Promising Practices =

'''The Bureau of Justice Assistance (BJA)''' has published a call to action and issue brief. It details the justice system use of prescription drug monitoring programs (PDMPs). <ref>https://www.ojp.gov/ncjrs/virtual-library/abstracts/call-action-and-issue-brief-justice-system-use-prescription-drug</ref>

= Sources =