Study Protocol for Implementation of Pharmacist-Led Interventions to Increase Access to Medications for Opioid Use Disorder for Incarcerated Individuals (PLI-MOUD Study)

Abstract

Illicit opioid use and opioid use disorder (OUD) are public health crises that often lead individuals to encounter the criminal justice system. Illegally manufactured fentanyl contaminates much of the illicit drug supply, including opioids and stimulants, leading to unintentional drug overdoses. Access to evidence-based treatment with medications for opioid use disorder (MOUD) and an opioid overdose reversal agent (OORA) is paramount to preventing overdose deaths. However, few jails or prisons in the state of Arkansas currently provide access to or education about these evidence-based medications. One strategy to increase evidence-based medication utilization within a carceral setting is to engage pharmacists, who are under-utilized healthcare professionals and who have considerable expertise in MOUD and OORA. There is currently limited evidence to support pharmacists’ roles within a jail setting. With federal and state opioid response funding, we are conducting the Pharmacist-Led Interventions to Increase Access to Medications for Opioid Use Disorder (PLI-MOUD) study. This randomized controlled study evaluated the preliminary efficacy of pharmacist-led interventions to expand knowledge and access to MOUD among individuals identified with a history of symptoms suggestive of OUD. In addition, it aims to assess knowledge and confidence in OORA among individuals with a history of symptoms suggestive of stimulant use disorder alone or in combination with OUD, who are currently incarcerated and enrolled in an established Re-Entry program within a single county regional detention facility. The three aims of the study include (1) assessment of the prevalence of OUD symptoms and racial/ethnic differences within this unique study setting, (2) comparison of the effectiveness of a naloxone administration training intervention delivered by a pharmacist versus an Alcohol and Drug Counselor (ADC), and (3) compare the effectiveness of two pharmacist-delivered MOUD education interventions, Brief Intervention and Referral to Treatment versus standard medication counseling.