Health Promotion and Public Safety: Community-based Collaborative Services to Addicted Offenders

Addiction adversely affects individual and family well-being, public health, and public safety across the state of WI. Appropriate treatment can prevent myriad physical consequences of addiction, such as HIV, viral hepatitis, endocarditis, motor vehicle accidents and other trauma. Treatment to one addicted individual prevents 63 crimes per year-not including intimate partner and child abuse, which remain under-reported. An individual's contact with the WI criminal justice system constitutes a critical point for referral into supervised treatment to promote the recovery of the user and, hence, public health and safety. This project and related future work will help optimize prevention, intervention, and policy development targeting substance use, crime and related consequences. Specifically, the proposed work will 1) examine the impact of collaborative community treatment models involving generalist physician offices, specialist treatment facilities, and criminal justice, 2) examine HIV risk behaviors and their response to study conditions, and 3) disseminate results to state and national audiences to promote collaboration between criminal justice, specialist care, and generalist health care in reducing drug-related harms to individual and population health. There is a high prevalence of opiate dependence among the criminally involved. Buprenorphine/naloxone (Suboxone) is considered a well-investigated, highly effective medication-assisted treatment for opiate dependence, but it may only be supervised through the few specialist treatment facilities in the state, or by physicians who have historically been less likely to offer this service. The effectiveness of community physician treatment supervision has not been tested for those in the criminal justice system.

The proposed project seeks to test models to expand treatment access for substance dependent individuals. The project builds logically upon previous work by the PI. Substance dependent offenders are specifically chosen for investigation due to (1) the greater severity and prevalence of substance use problems and complications when compared to the more general adult substance-dependent population, (2) the impact of drug-related criminal behavior upon victims and upon the safety and well-being of our communities, and (3) the suitability of our team and community-based collaborators to conduct research with addicted offenders in order to promote individual recovery, public health, and public safety.

To contribute to knowledge regarding potential models for the expansion of treatment and supervision for substance dependent offenders, the current project and related future work will aim to:

1. Compare models of treatment involving (1) specialist-directed treatment followed by physician-office based treatment, and (2) physician-office-based treatment alone.
2. Determine if and to what degree a period of stabilization with specialist-directed treatment improves outcomes over physician-office-based treatment alone.
3. Clarify the optimal period of time for such a period of "specialist stabilization."

In this study, "stabilization" refers to a period of time at the front end of treatment during which the addicted offender participates in a more stringent set of supervisory conditions tied to their medication dispensing. This includes daily reporting for medication dosing and more frequent urine drug testing.