DAT 18-08 Geography Variation in Opioid Addiction Treatment (GATE) Study: Multi-Level Factors Influencing MAT Use, Other Treatment, & Adverse Outcomes Among Re-entering Rural and Urban Prisoners

The United States is in the midst of an opioid crisis. While evidenced-based medications for addiction treatment (MAT) exist for persons with opioid use disorders (POUDs), they are underutilized by prisons during the re-entry period when the risk of relapse and overdose are significantly elevated. Therefore, in alignment with NIDA DAT-08-18, we propose to conduct the high-impact Geographic variation in Addiction Treatment (GATE) study. Using a mixed method approach, we will close the knowledge gap on multi-level factors influencing prison-based extended-release injectable naltrexone (XR-NTX) initiation as well as examine predictors of other MAT use and adverse outcomes post-release among both rural and urban POUDs. A social ecological framework will be used to understand individual characteristics that influence MAT initiation and adverse outcomes, as well as contexts more distal to the individual, including social networks and structural factors. The specific aims of the GATE study are: 1) to identify the individual, personal network, and structural factors associated with XR-NTX initiation in prison among rural, as compared to urban, POUDs, and 2) to examine the individual, personal network, and structural factors predicting MAT use, treatment use, and adverse outcomes in the community among re-entering rural, as compared to urban, POUDs over time. To maximize rigor and reproducibility, we will employ a concurrent triangulation strategy, whereby the qualitative and quantitative data contribute equally to the analysis and are used for cross-validation. A prospective observational longitudinal cohort study will be conducted with 500 POUDs, with survey and social network data collected in prison and at 6- and 12-months post-release to explore multi-level rural-urban variation in key outcomes. In-depth guided qualitative interviews will be conducted with POUDs, prison-based treatment staff, and social service clinicians. This proposed study is led by a qualified mutli-disciplinary team and will be the first mixed methods study examining the social influences processes that occur in rural and urban social networks as POUDs transition from prison back to geographically diverse counties. The GATE study will enhance our ability to address the opioid epidemic through the correctional context by informing process improvement efforts for prison-based MAT initiation and post-release retention in care, applying network science findings to improve the re-entry planning process, and informing future R-level intervention applications.