Michele Staton

The integration of trauma-informed interventions for justice-involved women into SUD treatment is a key strategy for mitigating overdose risk. Coupling the

Women who are involved with the criminal legal system face unique and well-documented barriers to substance use disorder (SUD) treatment. Less is known regarding how these barriers translate to differences in SUD treatment utilization within this population. This study aimed to identify barriers to treatment among incarcerated women with opioid use disorder and characterize women who reported these barriers and demonstrate which barriers were significantly associated with a reduction in odds of receiving SUD treatment. Women who reported barriers had worse mental and physical health and had less access to other resources. Accessibility and affordability were the most commonly endorsed, as well as a lack of motivation for treatment. These barriers were also significantly associated with lower odds of having received treatment. Recommendations include providing transportation, increasing insurance coverage for substance use treatment, incorporating peer support and other motivational strategies, and increasing linkage to treatment for individuals upon release from incarceration.

The criminal legal system (CLS) provides a critical intervention point for women at high risk for overdose, and the need continues to rise as the number of incarcerated women increases. Effective, targeted prevention interventions to reduce overdose risk for CLS-involved women are needed, such as naloxone distribution. This study describes the overdose education and naloxone distribution (OEND) procedures used in the Kentucky-hub of the Justice Community Opioid Innovation Network (JCOIN). Participants included women incarcerated in nine Kentucky jails (N = 900) who were randomly selected, screened for opioid use disorder, and consented for the study. They were followed three-months following jail release to examine naloxone utilization and overdose experiences. Study findings indicate that about three-quarters (74.4%) of women in this study reported lifetime injection and more than half (54.9%) had a lifetime history of a non-fatal overdose prior to entering jail. About 70% of women reported receiving a study naloxone unit upon jail release, and of those, 30 women reported using the unit during the three-month post-release window. About 4% of the sample reported a non-fatal overdose during this same time period. Incarcerated women in this sample reported a history of behaviors that may signal overdose risk upon release to the community such as injection drug use and non-fatal overdose. Study findings suggest targeted OEND efforts for women in general are desperately needed, and particularly among women at highest risk during community re-entry.

Opioid use disorder (OUD) remains a significant health care need for women, particularly those involved in the criminal legal system (CLS). There are no studies to date that focus on the utilization of telehealth as a platform for assessment and linkage to medications to treat opioid use disorder (MOUD) at community re-entry for women, despite the fact that women have unique risk factors that may contribute to opioid relapse in the community. The purpose of this mixed-methods study is to provide an overview of the innovative use of telehealth for linking incarcerated women to community MOUD treatment in the Kentucky-hub of the Justice Community Opioid Innovation Network (JCOIN). This study incorporates qualitative and quantitative data collection with MOUD providers, recovery staff involved in peer navigation services, and women who are incarcerated to understand perceptions of the use of telehealth prior to jail release as a linkage to community services. Findings from this study suggest overall support for the use of telehealth between community MOUD treatment providers and women who are incarcerated using videoconferencing technology. On average, there was very little variation in provider favorable feedback related to clinical engagement or in face-to-face comparability, as well as how telehealth allowed the participant to discuss personal and sensitive issues during the clinical assessment. Study findings suggest benefits associated with the use of telehealth in increasing access to treatment for women with OUD. Jails are critical venues for telehealth interventions because they provide the opportunity to reach women who have been actively using illicit substances, often have advanced-stage substance use disorders which have compromised their health and mental health, and often have not been previously identified as needing treatment. : This study was originally registered on 8/23/19, ClinicalTrials.gov, #NCT04069624.

Despite the overwhelmingly negative impacts of substance use stigma, little is known about how multiple, overlapping stigmatized identities, experiences, or characteristics (henceforth stigmas) may be related to perceived substance use stigma, especially in a sample of women who are incarcerated. The current study profiled stigmas reported by women in jail with substance use histories and investigated the relationship between the number of overlapping stigmas reported and perceptions of substance use stigma. Exploratory analyses examined the relationship between each individual stigma and substance use stigma. Findings suggest that individuals who reported more stigmas reported higher substance use stigma scores. Additionally, exploratory results suggested that rurality, transactional sex, injection drug use, methamphetamine use, being diagnosed with a mood disorder, experiencing sexual abuse or assault, and child custody loss were uniquely associated with increased substance use stigma. Results are discussed in terms of implications for stigma interventions and substance use treatment engagement.