Parts of Connecticut have high rates of drug overdose and death. Will increasing services make a difference? – Hartford Courant
Rural sections of eastern Connecticut, especially Windham and Tolland counties, lack services for those with substance use disorder, as well as transportation to get the help available.
A new Yale School of Medicine study will help determine the best way to help inmates who have been released within 30 days and those who have been involved with the justice system because of opioid or stimulant use to establish stable, drug-free lives.
The study includes New London and Middlesex counties as well, but “we’re actually focusing on Windham and Tolland counties, where there are very few services available,” said Dr. Sandra Springer, the principal investigator and an associate professor specializing in infectious diseases.
“We have a horrible public transportation system” in Connecticut, she said. “If you live in Tolland or Windham County, how are you supposed to get to a clinic if you have no car?”
The study “also includes individuals who have been involved in other community probation, parole, other justice involvement, Springer said. Staff may begin to meet with inmates in prison within 30 days of their release as well.
“It’s kind of a broad group, but individuals could be recruited while they’re currently in prison or jail or a [Department of Correction]-controlled environment,” Springer said.
The study is being described as the ACTION study. Its full name is Addressing Risk Through Community Treatment for Infectious Disease and Opioid Use Disorder Now. It is also being carried out in Dallas and Tarrant counties (Fort Worth), Texas, by Texas Christian University.
The main purpose of the study is to see whether a mobile health van or a patient navigator, who meets individually with clients, is more effective in helping study participants get back on their feet.
“The nice thing about knowing ahead of time … is you can start doing the planning,” Springer said. “Release day is very chaotic. There’s lots of things going on.”
They also work with the discharge planner to make sure no one is missed.
“We want to get them within 30 days of their last exposure” to the criminal justice system, she said, and are even working with social workers and public defenders to include people who are released directly from court.
“The number one cause of death for people released from jail is overdose. It has been for some time,” Springer said.
They are working with two prisons, York Correctional Institution in the Niantic section of East Lyme, the state’s only women’s prison, and Brooklyn Correctional Institution; and two jails, Corrigan Correctional Center in Montville and Hartford Correctional Center.
Alliance for Living is providing community health workers and patient navigators in New London County, according to CEO Kelly Thompson.
She said the agency started as a service for people living with AIDS and expanded to testing for hepatitis C and syringe exchanges, partnering with New London and the Ledge Light Health District. The alliance’s peer navigators have “lived experience with drug use,” Thompson said.
“The reason that we are such a perfect partner for the study is we have built trust and relationships with our community in New London and beyond,” she said. She said clients don’t feel stigma because they are familiar with the agency staff.
“It’s a great collaboration because we’re going to expand services to our community, particularly to people who are exiting incarceration,” she said.
Thompson said, “We have seen high rates of overdose and death in New London County,” because cocaine and methamphetamine are almost always laced with fentanyl. The rate of HIV is stable, however, she said.
The mobile health unit will be a “one-stop shop” to test for hepatitis C, hepatitis B and sexually transmitted infections. PrEP, which prevents HIV infection, also will be available. Rapid HIV testing can be done by research staff, Springer said.
“Importantly … if they have an opioid use disorder diagnosis, that we can also prescribe them medication treatment,” such as buprenorphine and suboxone,” Springer said. They can also provide Narcan.
“Although there’s not an effective medical treatment for cocaine or methamphetamines, we can at least help … link them to mental health services they might need,” she said.
The mobile van staff and patient navigators will also be “helping them with housing, food assistance, transportation and other services,” Springer said. “A lot of people are Medicaid-eligible, so we can help them with that. They can also link people up with the Connecticut AIDS Drug Assistance Program, which helps people afford medication.
Whether those in the study are assigned to go to the mobile health unit or given a patient navigator, “who actually meets with them and brings them to all of their appointments,” all will have improved medical and social assistance, Springer said. “If you get enrolled … you’re going to get help beyond what people normally are.”
While the study is meant to see which method of delivering services is more effective, “I think it’s going to be a combination of both,” she said.
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“We have these dueling epidemics in this country,” she said: drug overdoses, HIV and mass incarceration. COVID-19 has complicated all of those issues, she said.
“They’re all kind of fueling this persistent harm to individuals,” she said.
Springer said the study is focused on determining the best way to deliver care to people. If a patient doesn’t show up for a doctor’s appointment, perhaps for lack of money for gas or food, “We have to say, Why aren’t we going to them?,” she said.
“It’s a lot more complicated. It’s a lot more energy. It’s going to take getting out and helping people who can’t get to those services,” she said.
Sandra Violette, the Department of Correction’s liaison, said, “We’re hopeful that the links to care will improve. … With ACTION, we’re able to connect people who have stimulant disorders. The continuity of care and the linking to care is often lacking.”
The $11.5 million, five-year study is supported by the National Institute on Drug Abuse, part of the National Institutes of Health. There will be 432 subjects enrolled in both Connecticut and Texas who will be compensated for participating.
Ed Stannard can be reached at firstname.lastname@example.org.