JCOIN phase II innovation hub - PROJECT SUMMARY/ABSTRACT Access to substance use disorder (SUD) treatment remains inadequate for many groups, particularly those in Southern jails. Black individuals and people experiencing homelessness are disproportionately represented in carceral populations, yet they lack equitable access to medications for opioid use disorder (MOUD), including methadone and buprenorphine (3-8). Further, these populations are rarely prescribed MOUD upon release from incarceration, when the risk for death from overdose is highest.(8) MOUD can be lifesaving, yet represents one part of the recovery ecosystem; medications with a similar effect size are not yet available for individuals with a non-opioid SUD including stimulants.(9-11) An individualized yet scalable approach matched to individual needs and substance use, is required.(12-14) Peer recovery coach (PRC) models which engage individuals with lived experience to conduct motivational interviewing and a warm handoff to medical, behavioral, and community-based services, are associated with improved SUD-related outcomes and can be delivered via telehealth.(15-19) Nonetheless, there is less research assessing the implementation and effectiveness of PRCs in jails, except for linking persons with HIV to community care upon release, despite the heightened vulnerabilities individuals with SUD face as they transition from carceral settings.(20-22) The proposed JCOIN II Innovation Hub will implement and rigorously evaluate a PRC program at three high- throughput jails in the Atlanta, Georgia area. The Innovation Hub will adapt and evaluate an established SUD virtual peer recovery (telehealth) model (LINCS UP) to the jail setting. Project implementation will be guided by the EPIS framework and developed in collaboration with an established community advisory board including individuals with a history of SUD and justice involvement. Outcomes will be measured across the RE-AIM framework.(23) PRC effectiveness will be evaluated through a stepped wedge cluster randomized clinical trial. Primary outcomes will include engagement in addiction care while in jail and successful linkage to community- based care upon release. Secondary outcomes will include, but are not limited to ongoing substance use, recovery capital, overdose events, mortality, and recidivism. Finally, the Innovation Hub will conduct a cost effectiveness analysis of the jail PRC program. Following consensus recommendations, this analysis will include cost considerations from both healthcare and societal perspectives.
