Implementing a public health intervention to reduce fatal overdose upon release from incarceration: descriptions and lessons learned

Type: Oral Presentation
Date: March 2024

Citation

K Smith, N Chaudhuri, T Taforo, C Bisceglia-Kane, C Burns, G Gattuso, S Ladner, J Kron, J Desmarais, S Jalbert. “Implementing a public health intervention to reduce fatal overdose upon release from incarceration: descriptions and lessons learned“, Grayken Center for Addiction Together for Hope: Boston Addiction Conference 2024 (oral presentation)

Abstract

Intro and Background- Recognizing the high prevalence of opioid use disorder (OUD) among incarcerated, homeless individuals and their dramatically elevated risk of fatal overdose upon release, Boston Health Care for the Homeless Program (BHCHP) collaborated with two county jails to implement a comprehensive, public health approach to reducing fatal overdoses upon release. 

Objective- BHCHP’s Reentry Initiatives for Support and Empowerment (RISE) team aims to prevent fatal overdoses upon release from incarceration by providing recovery support and overdose prevention services to individuals without stable housing in the immediate pre and post release period, including Medication for Opioid Use Disorder (MOUD), case management, therapy, psychiatry, and recovery coaching.

Description of Innovative Clinical or Education Program- Over the last five years, BHCHP’s RISE team has developed and adapted a multidisciplinary health care model to support homeless individuals at risk for overdose upon release and has served close to 400 individuals incarcerated in two correctional facilities. We offer MOUD, therapy, recovery coaching, intensive case management including legal case management, rapid access to psychiatric care, and linkage to HCV treatment to individuals exiting incarceration. These services are provided in a variety of ways, including both in person at the correctional facilities and via telehealth, two behavioral health groups are offered weekly for both men and women, and all services are offered in both English and Spanish. We have established several referral pathways to expand our reach and developed a screening process to help equitably offer services in the context of such overwhelming demand. The RISE team is made up of a physician, several case managers including a legal case manager, a therapist, a recovery coach, two psychiatric nurse practitioners, as well as close partnerships with BHCHP’s OBAT, HIV, and HCV teams. No release is the same and the process is difficult to accommodate through predictable workflows. The Covid-19 pandemic added layers of complexity as the RISE team and jail partners developed unique and innovate ways to support this population.

Conclusion & Discussion- This presentation will describe BHCHP’s reentry model of care, populations served, changes observed in outcomes over time, and challenges with implementing a public health and harm reduction-focused approach to overdose prevention within a correctional setting; highlighting barriers, lessons learned, and programmatic successes. We will discuss how the model has been expanded and adapted based on staff and patient feedback, as well as different analyses we’ve conducted to identify and understand any inequities in care.