University of Kentucky researchers have been awarded a five-year grant, projected to total $7.2 million, from the National Institutes of Health (NIH) to test overdose prevention strategies for women transitioning from jail back into rural Kentucky communities.
The new project is supported by the NIH's National Institute on Drug Abuse as part of its Justice Community Overdose Innovation Network (JCOIN), a nationwide program that tests strategies to expand effective treatment, recovery and related services for individuals involved in the criminal legal system.
Women involved in the criminal legal system face elevated overdose risk during the vulnerable period of community re-entry due to factors including unaddressed trauma, mental health needs and relationship dynamics with substance use. Prevention approaches targeting these unique needs remain limited, especially in underserved rural areas.
The new study, co-led by Michele Staton, Ph.D., and Carrie Oser, Ph.D., aims to determine what approaches are most effective at preventing overdose and increasing treatment engagement during this high-risk reentry period.
The project is Phase II of the Kentucky Women's Justice Community Opioid Innovation Network. The first phase focused on connecting women in jail to medications for opioid use disorder through telehealth and peer navigation services.
"We are so grateful to be able to continue this research to serve some of the most vulnerable women in our state," said Staton, a professor in the UK College of Medicine Department of Behavioral Science and a faculty associate of the UK Center on Drug and Alcohol Research. "We had successes with JCOIN1 in linking women to treatment after release, but about 4% of our participants reported a nonfatal overdose after release. This project allows the opportunity to more intensively target overdose prevention efforts for women in rural communities."
"Women with substance use disorders are at an elevated risk for an overdose when released from incarceration due to reduced tolerance, and building up access to treatment and supportive networks will reduce harm and keep them safe," said Oser, Di Silvestro Endowed Professor and University Research Professor in the UK College of Arts and Sciences Department of Sociology. "Our overall goal is to prevent overdoses. We can't get someone into treatment or reunify them with their family if they've had a fatal overdose. Preventing overdoses is the critical first step."
The five-year clinical trial will enroll 300 women with opioid or stimulant use disorders from three jails in rural Appalachian Kentucky. The study will test three evidence-based interventions - recovery coaching, support person engagement and contingency management - in different combinations.
All women will receive recovery coaching, which connects them with trained mentors with lived experience with substance use recovery and criminal legal involvement, employed by Voices of Hope, a recovery community center in Lexington, Kentucky. Recovery coaches provide personalized support, helping individuals access treatment and recovery resources.
Before their release from jail, women will be randomly assigned to receive recovery coaching alone or recovery coaching combined with support person engagement, which involves identifying and involving a trusted friend or family member in the individual's overdose prevention plan. After release, some women will also receive contingency management - a behavioral therapy that provides rewards or incentives for meeting overdose prevention goals.
The team will follow participants for one year after release to measure overdose risk and treatment outcomes. The study will also assess how acceptable and practical the interventions are by gathering input from both the women and the providers working with them.
The interdisciplinary UK team includes co-investigators from the colleges of Arts and Sciences, Medicine, Nursing and Pharmacy. Study partners include the Kentucky Office of Drug Control Policy and the Kentucky Cabinet for Health and Family Services. Van Ingram, executive director of the Kentucky Office of Drug Control Policy, will serve as the justice partner, and Sarah Johnson, substance use treatment director at the Kentucky Cabinet for Health and Family Services, will serve as the treatment partner. The project will partner with Voices of Hope to provide recovery coaching services.
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number RM1DA064496. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
