AMHERST — A University of Massachusetts public health researcher has received four grants totaling $17.9 million from the National Institutes of Health to launch three projects that will build on existing programs to treat and prevent opioid use disorder within the state’s incarcerated populations, and create a new program for HIV treatment and prevention within the same population.
“This is a great opportunity to bring together experts across these different institutions to learn more and hopefully improve public health and public safety,” said Elizabeth Evans, associate chair of health promotion and policy at UMass.
For the past seven years, Evans has worked with the Massachusetts hub of the Justice Community Overdose Innovation Network (JCOIN) to study and implement evidence-based opioid use disorder treatment programs in Massachusetts jails, including at jails in Hampshire and Franklin counties. The work involved offering medications for opioid use disorder (MOUD) during incarceration and facilitation continuation of treatment after release.
JCOIN is an international research effort that spun out of NIH in 2019 to expand effective recovery and support programs for people impacted by the criminal justice system.
People released from jail are 120 times more likely to overdose on opioids than the general population, and they are most at risk of an overdose within the first two weeks of release. However, Evans found in her previous research that treatment within jails can mitigate this risk. Offering a MOUD called buprenorphine within Franklin County Jail led to reduced recidivism by 32% and resulted in fewer deaths compared to Hampshire County Jail, which began offering the treatment three years after its western Massachusetts counterpart.
“It is very much an access and availability issue,” Evans said. “These medications were available, technically speaking, but they weren’t easily accessible to people who were living in jails and prisons. That’s what’s really changed, and it’s a really interesting time to do a study about this.”
While the research has shown that incarcerated individuals with access to treatment achieve better outcomes, many people do not continue the treatment when released, Evans said. With this new grant money, she will be building on previous work to see if policy and program changes can improve continuation of MOUD treatments after release.
More than half of the $17.9 million in grants, some $9.6 million, will be used to study if additional intervention within Massachusetts jails encourages participants to continue MOUD when released. Franklin and Hampshire County jails will likely continue their involvement in this work. Evans will collaborate on the study with Michael Horny, UMass assistant professor of health policy and management, and Ekaterina Pivovarova, associate professor of community health at UMass Chan Medical School.
Historically, a person’s Medicaid coverage is paused or suspended when they are incarcerated, which can limit their access to medications. But in 2024, Massachusetts received a federal wavier to provide Medicaid coverage up to 90 days before someone’s release from prison. The program will allow incarcerated people without health insurance to apply for Medicaid, and those with paused coverage to have Medicaid reinstated. Evan’s research will also look at whether this policy change can affect health and safety outcomes of incarcerated people.
“There’s a whole process to reactivate your Medicaid, etc., and so that is a barrier to continuation with health care that this new change in policy is meant to help address, while also broadening access to health care just before people get released,” Evans said.
The same team will also work on a related project that connects MOUD providers with court personnel. Using a $3.6 million NIH grant, researchers hope to build trust between the justice system employees and community health providers. By facilitating collaboration, judges and attorneys could establish effective treatment plans that reduce or negate jail times for people with substance-use disorders, Evans explains.
“There’s this idea of people can be better treated for their addiction in the community,” Evans said. “If they’re able to be treated in the community, courts are the place to sort of make that happen. And perhaps we could minimize or avoid their jail time altogether, which could ultimately be a cost savings.”
The last $4.7 million grant will initiate a new project establishing and implementing HIV testing, prevention and treatment programs in Suffolk County Jail. Evans will co-investigate the project with Dr. Alysse Wurcel at Boston Medical Center.
The Boston area experienced a major HIV outbreak in 2018, and many of the people who tested positive had recently been released from jails. Evans said the incident raised awareness of HIV rates in incarcerated populations and sparked conversation on improved testing and care of HIV within jails.
“It’s all about improving or strengthening health care that maybe is already like routine in community settings, but there was a recognized need to work on strengthening or improving that in this jail in particular,” she said.
Evans came to Massachusetts in 2019 because of the state’s acknowledgment of the high risk of overdose among those who’ve experienced incarceration. While Massachusetts pioneers this work, the goal is to create a model that other jails can apply across the nation.
“Massachusetts is on the forefront of creating these innovative programs,” she said. “I am grateful to work with leaders in in jails and courts who like want to collaborate with us, and so it’s an exciting time to do this type of research.”