Buprenorphine Facilitated Access and Supportive Treatment in Former Inmates

DESCRIPTION (provided by applicant): With the career goal of becoming an independent investigator, Dr. Aaron Fox describes a mentored research project and specific career development plan, which will prepare him to study interventions that improve treatment of opioid dependence post-incarceration. Following release from correctional facilities, opioid-dependent former inmates are at high risk of relapse to drug use, HIV-infection, and overdose-related death. Buprenorphine treatment for opioid dependence is effective, but underutilized, which makes behavioral interventions that encourage treatment critical. This proposal aims to: 1) determine the barriers to and facilitators of initiating buprenorphine treatment post-incarceration for opioid-dependent former inmates, 2) to tailor an intervention, using peer mentorship, to provide BUPrenorphine Facilitated Access and Supportive Treatment (BUP-FAST) to former inmates, and 3) to pilot test the feasibility and effectiveness of BUP-FAST at increasing initiatio of buprenorphine treatment. With guidance from a multidisciplinary team of expert mentors, Dr. Fox will conduct semi-structured interviews with opioid-dependent former inmates using Social Cognitive Theory as a theoretical framework to understand barriers to and facilitators of buprenorphine treatment. Based on these findings, he will tailor a previously developed intervention to encourage initiation of buprenorphine treatment by using peer mentors and targeting former inmates. The resulting intervention, BUP-FAST, will have specific components that are determined by applying Social Cognitive Theory to our findings, but we anticipate that peer mentors will provide: buprenorphine education, facilitated access to buprenorphine treatment, accompaniment to appointments, and supportive counseling. To pilot test BUP-FAST for feasibility and effectiveness, we will conduct a pilot randomized trial of BUP-FAST (vs. simple referral to buprenorphine treatment) collecting data on process measures to test feasibility and examining initiation of buprenorphine treatment to pilot test effectiveness. We hypothesize that compared to simple referral participants randomized to BUP-FAST will be more likely to initiate buprenorphine treatment. Subsequently, we will submit an R01 grant application to fully examine the effectiveness of BUP-FAST at improving buprenorphine treatment outcomes and reducing HIV-risk behaviors, opioid use, and re-incarceration in a multi-site randomized controlled trial. During the award period, Dr. Fox will pursue training in advanced qualitative methods, design of behavioral interventions, hierarchical modeling (for analysis of clustered data), and will gain experience in health care linkage following incarceration. With completion of these activities, along with intensive mentorship, Dr. Fox will be well prepared to fully test BUP-FAST and for his career goal of becoming an independent investigator. PUBLIC HEALTH RELEVANCE: With the high rates of relapse to substance use upon release from correctional facilities, our project seeks to link opioid-addicted former inmates to buprenorphine treatment through peer mentorship. We will tailor a previously developed intervention to target former inmates and to use peer mentors. Ultimately, this intervention has the potential to increase initiation of buprenorphine treatment, an effective treatment for opioid addiction, and reduce HIV risk behaviors, overdose-related deaths, and re-incarceration. This study's findings will be used to guide a large-scale study of our intervention.