UB Studying Effectiveness of Opioid Intervention Courts

Now, University at Buffalo researchers have begun a scientifically rigorous study to evaluate the OIC’s strategy and compare in various ways the outcomes of OIC participants with a group of participants enrolled in traditional drug treatment court.

OIC aims to prevent overdose tragedies by offering medication-assisted treatment to nonviolent offenders with opioid-use disorder within hours of their arrest.

The purpose of the court could not be simpler: to keep people alive by getting them treatment.

It is certainly one of the reasons behind the decline in opioid-related deaths in Erie County, with 186 deaths confirmed in 2018, compared to 251 in 2017 and 301 in 2016.

The concept has attracted major national media attention and become a model for a number of similar efforts in settings like Pennsylvania’s Cumberland County Opioid Intervention Court and Arizona’s Gila County Opioid Court.

People in traditional drug treatment courts also have substance use disorders, get the opportunity to enter long-term drug treatment and agree to court supervision rather than receiving a jail sentence. However, the wait for such treatment can be weeks — or longer — which often proves fatal to people addicted to opioids.

Designed to get nonviolent users into treatment within hours of their arrest instead of weeks, the OIC model requires daily check-ins with the judge and focuses on immediate treatment with medication and other opioid-use disorder treatments. Once their condition is stable, OIC participants transfer to a traditional weekly drug court.

While the court — in which Jacobs School of Medicine and Biomedical Sciences researchers have been engaged since its inception — has clearly had an impact, policymakers and providers want evidence to show that the unique legal, social and psychological assistance the court provides contributes to positive results.

“We will deepen our understanding about OIC and traditional drug-court participants over a 12-month period,” says Linda S. Kahn, PhD, a principal investigator on the study and professor and associate vice chair for research for the Primary Care Research Institute in the Department of Family Medicine.

“This is important because people living with opioid use disorder are vulnerable to relapse, and we want to know if OIC helps them continue in their recovery,” she says.

The study is funded by the U.S. Centers for Disease Control and Prevention.

“The study ultimately addresses a leading cause of accidental death in the United States: drug overdose,” says Gregory G. Homish, PhD, professor and chair of the Department of Community Health and Health Behavior in the UB School of Public Health and Health Professions.

“The dramatic rise in opioid overdose fatalities is overwhelming communities across the country,” adds Homish, the study’s other principal investigator.

The researchers hope that study results will influence public health policy and strategies around the issue of dealing with opioid addiction.

OIC is a public health approach to the problem of opioid use disorder because it focuses on immediate medication-assisted treatment and opioid use disorder treatment with the primary aim of saving lives, Kahn explains.

“The OIC puts participants’ criminal charges on hold while getting them into treatment quickly and focusing on their recovery,” she says.

“We’re looking to improve patient outcomes and want to make sure we’re connecting people with things that make a difference,” Homish adds. “We’ll also look at whether people increase their ‘recovery capital’ through factors like connections to better housing and stable employment.”

OIC’s creation has prompted other cities to infuse this innovative public health approach into their drug court response.

UB researchers believe that if their study reveals that OIC makes a sustained positive difference in results, it “would promote the use of more programs like this nationwide,” Homish says.

The study will compare OIC and traditional drug court in four key areas:

• differences in the time needed to get people into treatment and changes in their use of substances (opioids, other illicit drugs, alcohol, tobacco) over time
• changes over time in mental health, like symptoms of depression or role limitations due to mental health, and physical health like pain or role limitations due to physical health
• changes in social and environmental factors related to recovery (housing stability, employment, social connectedness)
• impact on justice-related outcomes (people’s adherence to court appointments, drug-related arrests, non-drug related arrests, incarceration)

Co-investigators from the Jacobs School are:

• Richard D. Blondell, MD, professor emeritus of family medicine
• Gale R. Burstein, MD, MPH, Erie County Commissioner of Health and clinical professor of pediatrics

The Erie County Department of Health, on behalf of the Erie County Opioid Epidemic Task Force, is also participating in the study. Burstein is a co-director of the task force.

Evaluating the effectiveness of OIC is important because opioid addiction is a root cause of a broad range of issues that affect not just the individual but also their loved ones and the community at large, according to Burstein.

“We hope to demonstrate through an objective evaluation that OIC is an effective model to help those struggling with the chronic disease of opioid addiction. Erie County is developing some novel interventions, and we want to have evidence to show these interventions are effective,” Burstein says.