Thomas R. Blue

Drs. Michael Gordon and Thomas Blue Receive a two-year HEAL-JCOIN Administrative Supplement

FRI is pleased to announce that Drs. Michael Gordon, Thomas Blue, Frank Vocci and Shannon Mitchell along with Dr. Marc Fishman from Mountain Manor Treatment Center and Dr. Sean Murphy from Weill Cornell Medicine received a two-year administrative supplement to their HEAL- JCOIN grant entitled, “A comparison of sublingual and extended-release buprenorphine for individuals leaving jail.” This study consists of adding a quasi-control arm to the parent study wherein 120 incarcerated men and women receiving Sublingual buprenorphine (SL-B) in jail will be asked to participate by continuing their buprenorphine in the community and completing follow-up assessments over 12 months post-release (Monthly follow-ups during months 1-7 and a final follow-up at month 12). This quasi-control arm will be compared to participants randomized to extended-release buprenorphine (XR-B) in the parent study. Because participants will not undergo random assignment, data will be balanced to avoid biases from unequally distributed pretreatment covariates by way of propensity score weighting. HEAL JCOIN common measures will be utilized to facilitate data harmonization and cross-study analyses. We plan to conduct semi-structured interviews with correctional administrators, correctional officers; and jail health providers (N=25) to understand issues related to implementation of SL-B in jails.

The study has three specific aims: Aim 1. To determine the effectiveness of XR-B compared to SL-B in terms of (a) pharmacotherapy adherence (days in buprenorphine treatment), b) illicit opioid urine test results; (c) self-reported illicit opioid use; (d) overdose events (non-fatal and fatal); (e) quality of life (i. physical health; ii. mental health); (f) HIV risk behaviors (i. sexual behavior; ii. needle use or sharing); and (g) criminal activity (i. crime days; ii. re-arrest; iii. re-incarceration). Aim 2. Explore barriers and facilitators to SL-B implementation in jail: (1) dose induction; (2) diversion and procedures for reducing diversion; (3) continuity of care after release or transfer to another facility; (4) staffing (both custody and medical) needs for daily buprenorphine dosing; and (5) the process of verifying the dosage of an individual coming from a community maintenance program after being arrested. Aim 3. To (a) calculate the cost to the correctional health system of implementing and sustaining an SL-B or XR-B program (XR-B costs are being calculated in parent trial but will need to be estimated for new sites); and (b) determine the relative value of XR-B compared to SL-B, including the subsequent community treatment costs, from a state-policymaker and societal perspective.