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Justice system-involved women with opioid use disorder (OUD) experience layered health risks and stigma, yet peer navigation services during reentry may support positive outcomes. This manuscript offers a program description of a women's peer navigation intervention delivered pre- and post-release from jail to remove barriers to women's access to OUD treatment, including medications for opioid use disorder (MOUD).BackgroundJustice system-involved women with opioid use disorder (OUD) experience layered health risks and stigma, yet peer navigation services during reentry may support positive outcomes. This manuscript offers a program description of a women's peer navigation intervention delivered pre- and post-release from jail to remove barriers to women's access to OUD treatment, including medications for opioid use disorder (MOUD).All data were collected as part of a NIH/NIDA-funded national cooperative, the Justice Community Opioid Innovation Network (JCOIN) project. Through the larger study's intervention, women in jail with OUD are connected via videoconference to a peer navigator, who provides an initial reentry recovery assessment and 12+ weeks of recovery support sessions post-release. Qualitative analyses examined peers' notes from initial sessions with women (N = 50) and in-depth interviews with peers (N = 3).MethodsAll data were collected as part of a NIH/NIDA-funded national cooperative, the Justice Community Opioid Innovation Network (JCOIN) project. Through the larger study's intervention, women in jail with OUD are connected via videoconference to a peer navigator, who provides an initial reentry recovery assessment and 12+ weeks of recovery support sessions post-release. Qualitative analyses examined peers' notes from initial sessions with women (N = 50) and in-depth interviews with peers (N = 3).Peers' notes from initial sessions suggest that women anticipate challenges to successful recovery and community reentry. More than half of women (51.9%) chose OUD treatment as their primary goal, while others selected more basic needs (e.g. housing, transportation). In qualitative interviews, peers described women's transitions to the community as unpredictable, creating difficulties for reentry planning, particularly for rural women. Peers also described challenges with stigma against MOUD and establishing relationships via telehealth, but ultimately believed their role was valuable in providing resource referrals, support, and hope for recovery.ResultsPeers' notes from initial sessions suggest that women anticipate challenges to successful recovery and community reentry. More than half of women (51.9%) chose OUD treatment as their primary goal, while others selected more basic needs (e.g. housing, transportation). In qualitative interviews, peers described women's transitions to the community as unpredictable, creating difficulties for reentry planning, particularly for rural women. Peers also described challenges with stigma against MOUD and establishing relationships via telehealth, but ultimately believed their role was valuable in providing resource referrals, support, and hope for recovery.For women with OUD, peer navigation can offer critical linkages to services at release from jail, in addition to hope, encouragement, and solidarity. Findings provide important insights for future peer-based interventions.ConclusionsFor women with OUD, peer navigation can offer critical linkages to services at release from jail, in addition to hope, encouragement, and solidarity. Findings provide important insights for future peer-based interventions.

Background People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80–95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender‐based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). Purpose The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. Methods This initiative is the merging of best practices in recovery and community‐based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. Findings Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests. Conclusion Considering recent policies limiting access to reproductive health, innovative community‐based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital. Clinical Relevance This is the first study to propose a methodology and context to implement a community‐based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.

Background 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). Methods 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. Results 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. Conclusions 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. Trial registration : This study was originally registered on 8/23/19, ClinicalTrials.gov, #NCT04069624.

Background In the United States, complete abstinence persists as the standard for demonstrating recovery success from substance use disorders (SUDs), apart from alcohol use disorder (AUD). Although the FDA has recently indicated openness for non-abstinence outcomes as treatment targets, the traditional benchmark of complete abstinence for new medications to treat SUDs remains a hurdle and overshadows other non-abstinent outcomes desired by people with SUDs (e.g., improved sleep, employment, family reunification). This study sought to expand the definition of recovery to include non-abstinent pathways by exploring non-abstinence-based outcomes desired by people who use methamphetamine (PWUM). Methods Participants ( n  = 100) were recruited from existing National Institute on Drug Abuse (NIDA) projects including a treatment-seeking sample of people recently released from prison (all of whom endorsed recent methamphetamine use) and a sample of people using syringe service programs. In a convergent survey design, participants responded to closed-ended questions regarding recovery outcomes, followed by open-ended items to gain a better understanding of PWUM and their conception of recovery. The importance of non-abstinent outcomes was measured in five categories (substance use, physical health, cognitive functioning, mental health, and financial/social/relationships). Results Participants were primarily White (88%), male (67%), and an average age of 40. Approximately two-thirds of participants agreed that people need to stop all mood- or mind-altering substances to be in recovery (64%). Nevertheless, participants indicated a variety of desired non-abstinent recovery outcomes, both substance-related (e.g. reductions in methamphetamine use) and non-substance-related (e.g. improved economic stability). Specific non-abstinent outcomes endorsed as “absolutely essential” by PWUM included: preventing legal trouble (92%), employment stability (82%), improved quality of life (80%), housing stability (78%), improved coping skills (78%), improved relationships (75%), economic/income stability (74%), ability to think clearly (73%), less impulsivity (73%), less depression (71%), less stress (70%), improved hopefulness (70%), and improved sleep (70%). Open-ended responses emphasized employment stability, economic/income stability, improved coping skills, improved relationships, as well as improved energy, appetite, and sleep. Conclusion Our findings indicate the importance of non-abstinent recovery outcomes among PWUM, suggesting high acceptability of non-abstinent recovery targets by people with lived experience. Further, the essential importance of non-abstinent outcomes, especially in the financial/social/relationship and mental health domains, were highlighted, providing novel targets for delivering SUD treatment/recovery.

Background Pharmacists’ role in harm reduction is expanding in many states, yet there are limited data on pharmacists’ willingness to participate in harm reduction activities. This study assessed community pharmacists’ willingness to participate in one harm reduction initiative: syringe/needle exchange. Methods In 2015, all Kentucky pharmacists with active licenses were emailed a survey that examined attitudes towards participation in syringe/needle exchange. Response frequencies were calculated for community pharmacist respondents. Ordinal logistic regression estimated the impact of community pharmacist characteristics and attitudes on willingness to provide clean needles/syringes to people who inject drugs and to dispose of used syringes/needles, where both dependent variables were defined as Likert-type questions on a scale of 1 (not at all willing) to 6 (very willing). Results Of 4699 practicing Kentucky pharmacists, 1282 pharmacists responded (response rate = 27.3%); the majority ( n  = 827) were community pharmacists. Community pharmacists were divided on willingness to provide clean needles/syringes, with 39.1% not willing (score 1 or 2 of 6) and 30% very willing (score 5 or 6 of 6). Few were willing to dispose of used needles/syringes, with only 18.7% willing. Community pharmacists who agreed that pharmacists could have significant public health impact by providing access to clean needles expressed 3.56 times more willingness to provide clean needles (95% CI 3.06–4.15), and 2.04 times more willingness to dispose of used needles (95% CI 1.77–2.35). Chain/supermarket pharmacists ( n  = 485, 58.6% of community pharmacies) were 39% less likely to express willingness to dispose of used needles (95% CI 0.43–0.87) when compared with independent community pharmacists ( n  = 342, 41.4% of community pharmacies). Independent pharmacists reported different barriers (workflow) than their chain/supermarket pharmacist colleagues (concerns of clientele). Conclusions Kentucky community pharmacists were more willing to provide clean needles than to dispose of used needles. Strategies to mitigate barriers to participation in syringe/needle exchange are warranted.

IntroductionMany rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia.Methods and analysisKyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness.Ethics and disseminationThe University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings.Trial registration numberNCT05657106.

Background The Stay Safe Study is the first observational prospective cohort study investigating fentanyl test strip (FTS) use by people who use drugs (PWUD) and distribution by community organizations that provide harm reduction services (e.g., naloxone distribution) in three states (Kentucky, New York, and Ohio). The purpose of this paper is to describe the study design, along with implementation successes and challenges. A related goal is to provide recommendations and encourage researchers to undertake multi-state and multilevel studies of FTS use and distribution. Methods The Stay Safe Study has one primary, five secondary, and three exploratory objectives. From May-December 2023, we collected survey, interview, and oral fluid drug test data with the primary population of PWUD attending service locations of partner organizations that distribute FTS. We collected survey and interview data with a population of community organizations providing harm reduction services that have a distribution relationship to FTS. There was no intervention, and the study did not distribute FTS. Results A total of 1,156 PWUD participants were enrolled in the study and were invited to complete four weekly survey assessments. Of these, 732 PWUD participants (97.6% of the target) completed at least two of the four weekly surveys and reported drug use at least once during the 28-day observation period. A subset of enrolled participants completed a one-time oral fluid data collection visit (48-hour self-report survey and oral fluid specimen collection) ( n  = 267) and one-on-one semi-structured interviews ( n  = 120). From the population of 36 organizations providing harm reduction services, employees of 28 (78%) in 22 counties across 3 states completed a web-based survey and employees of 24 (66.7%) completed an interview. Study findings will be presented in subsequent publications [ 1 , 2 ]. Conclusion The research team successfully enrolled a large sample of PWUD participants and organizations that provide harm reduction services in three states, followed a cohort of PWUD participants, and generated rich data using three types of instruments. Factors contributing to implementation success include drawing on the community expertise of the parent HEALing Communities Study, selecting incentive amounts that acknowledged the time and expertise of PWUD participants, centralizing survey data collection, and tracking implementation challenges and solutions. Areas of implementation complexity included conducting research on site at the service locations of 14 partner organizations, facilitating timely incentive payments, overseeing research staff, and returning oral fluid results to PWUD participants.

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

Background This study uses the Practical, Robust, Implementation, and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to describe how features of jail contexts are associated with the number of people linked to medication for opioid use disorder (MOUD) and sustainment of jail linkage programs implemented in Wave 1 of the HEALing Communities Study in Kentucky (HCS-KY) from 2021 to 22. The HCS-KY is part of a parallel-group, cluster-randomized wait-list controlled trial examining the effects of supporting wide-scale implementation of evidence-based practices to reduce opioid overdose deaths. One strategy involved implementation of MOUD linkage programs within five Kentucky county jails. Minutes from program planning and maintenance meetings led by HCS-KY implementation facilitators with linkage staff/supervisors and jail liaisons/partners (average of five participants/meeting) were coded following PRISM-RE-AIM using template analysis to understand variations in participation across sites as well as barriers to and facilitators of MOUD linkage implementation. Results Across the five jails, 277 participants met with linkage staff during and/or post-incarceration for 1,119 visits conducted in-person or via phone/video conference. Twenty-six participants linked to community-based MOUD treatment during the implementation period. Participation differed across sites based on jail and linkage staff utilization of implementation support strategies but did not affect program sustainment, which all jails pursued in some form. Qualitative analysis yielded four overarching themes characterizing jail linkage program implementation. First, program integration into jail infrastructure entailed navigation of jail facilities and technologies as well as legal factors surrounding linkage staff backgrounds and information-sharing. Second, adapting the intervention to site-specific needs required providing training and implementation support to jail and linkage staff tailored to each jail context. Third, facilitating inter-organizational and cross-system coordination was related to collaboration successes and challenges among the HCS-KY team, linkage staff, the courts, and other provider partners. Finally, staffing and legal factors influenced sustainment. Conclusions Only ~ 10% of participants linked to community-based MOUD despite intensive implementation support, yet jails highly valued the program and planned for sustainment. Given the complexities in postponing treatment initiation until reentry, we call for simultaneous efforts to integrate MOUD screening and treatment into jail booking processes.