Intermediate
Focus Session
Megan Buresh, MD
Assistant Professor
Johns Hopkins School of Medicine
Ryan Graddy, MD
Assistant Professor of Medicine
Johns Hopkins University
Deborah Agus, JD
Executive Director BHLI/Associate Professor JHSPH
Behavioral Health Leadership Institute/Johns Hopkins School of Public Health
Anika Alvanzo, MD, MS, DFASAM
Assistant Professor/ Associate Medical Director
Johns Hopkins University School of Medicine
Noa Krawczyk, B.A.
Doctoral Candidate
Johns Hopkins Bloomberg School of Public Health
Opioid use disorder (OUD) is highly prevalent among justice-involved individuals. Despite evidence that increasing access to medications for addiction treatment (MAT) decreases fatal overdoses after release from prison and jail, many barriers to expanding treatment for this population remain. Most interventions to date have focused on expanding access to MAT inside the criminal justice system, which can work well for those serving longer sentences in prisons, but the high turnover in jails and pre-trial detention centers is not always amenable to starting MAT inside jail.
In this interactive panel discussion, we will describe the development of Project Connections to Re-Entry (PCARE), a novel treatment model to expand access to buprenorphine for justice-involved individuals. Started in November 2017, PCARE is part of a network of low-threshold buprenorphine treatment site run by Behavioral Health Leadership Institute (BHLI). PCARE provides access to low threshold MAT through a mobile van parked directly outside the Baltimore City Jail in partnership with Maryland Department of Public Safety and Correctional Services. Patients are referred by jail staff or can walk in from the street. The clinical team includes an experienced primary care physician who prescribes buprenorphine, a nurse, and a peer recovery coach. Once stabilized, patients are transitioned to longer-term treatment programs or primary care for buprenorphine maintenance. Between November 2017 and July 2018, 249 people approached the van, 127 of whom began treatment with buprenorphine-naloxone. The majority of patients (94.4%) had previous criminal justice involvement, were unemployed (72.4%) and were living with family or friends (41.7%). Of those who began treatment, 67.7% returned for a second visit or more, and 29% percent were still involved in treatment after 30 days.
This focus session will begin with brief overview of current literature regarding access to MAT in criminal justice settings. The interdisciplinary panel, composed of the program director (a lawyer) and physicians, will then describe the process of developing this program, client characteristics and initial outcomes, and implications for expansion to other treatment settings. The panel will discuss successes and challenges in partnering with detention center staff and engaging vulnerable populations in care. After the panel discussion, the group will break into small groups to discuss ways of expanding access to buprenorphine in their own settings. There will be time at end for Q+A.
Proposed Timeline (in minutes):
0:00 – 0:10 Brief review of literature related to MAT in criminal justice setting and mobile treatment models
0:10 – 0:55 Panel discussion of PCARE low-threshold buprenorphine model
0:55 – 1:10 Breakout into small groups to discuss expanding treatment in their own settings
1:10 – 1:30 Questions and Answers/Session Evaluation