A University of Massachusetts Amherst public health researcher has received four grants totaling $17.9 million from the National Institutes of Health (NIH) to continue groundbreaking research that implemented and assessed medical treatment programs for incarcerated people with opioid use disorder, as well as develop a new program for HIV prevention and treatment.
The research-initiated by the NIH in 2019 and dubbed JCOIN (Justice Community Overdose Innovation Network)-serves as the first evidence-based model for jail-based treatment for a vulnerable group of people in a nation still grappling with a costly and deadly opioid epidemic.
In phase one of the Massachusetts JCOIN Hub research, Elizabeth Evans, professor of community health education and associate chair of health promotion and policy in the UMass Amherst School of Public Health and Health Sciences, and team worked with partners at seven rural and urban jails to assess the outcomes, implementation and costs of a pilot program designed to offer medications for opioid use disorder (MOUD) during incarceration and facilitate continuation of MOUD treatment after release. Evans will receive a $1.4 million grant to fund the final year of Phase 1 and a five-year, $8.2 million grant for Phase 2.
We found that the people in jail getting MOUD treatment for opioid use disorder have better outcomes later than people who don't get that treatment. But we also found that when they leave jail and go back to the community, quite a few people are not continuing with the treatment they were receiving in jail."
Elizabeth Evans, professor of community health education and associate chair of health promotion and policy, UMass Amherst School of Public Health and Health Sciences
Evans' new research will develop an intervention with incarcerated people at four jails in Massachusetts to address the challenge of engaging with MOUD treatment after release.
The research will begin by addressing a traditional barrier to healthcare for many incarcerated individuals. "Historically, when people get incarcerated, their access to Medicaid can get paused or suspended," Evans explains. "And Massachusetts recognized that as a real challenge, especially for incarcerated people with addiction."
In 2024, Massachusetts received federal approval for a Section 1115 waiver to provide Medicaid benefits to incarcerated individuals up to 90 days before their release, with the aim of improving access to healthcare, especially for substance use disorders, and support services for people transitioning back into the community. This will allow incarcerated people without health insurance to apply for Medicaid, and those with paused coverage to have Medicaid reinstated.
"In the first year of our study, we are going to look at that-does this waiver expand access to healthcare for incarcerated people and lead to better outcomes," says Evans, who will collaborate with UMass Amherst colleague Michal Horný, assistant professor of health policy and management, and Ekaterina "Kate" Pivovarova, associate professor of family medicine and community health at UMass Chan Medical School. "At the same time, we'll be developing an intervention that we want to test in the jails to support the continuation of MOUD once people transition back to the community-with the idea that if it is promising it also could be sustained with supports from Medicaid."
As with the first phase of JCOIN, Massachusetts is a testing ground. "If this works in Massachusetts, then other states can learn from this very innovative program and try to do something similar in their state," Evans says.
Several of the jails that were the test sites for JCOIN's first phase-in Western Massachusetts and in the Boston area-will also be the pilot sites for the new research.
In a related project with $3.6 million in NIH funding, Pivovarova, Evans and team will work to develop an alliance between the courts and MOUD treatment providers to better route people with opioid use disorder into treatment rather than jail.
In the another new NIH project, funded with a $4.7 million grant, Evans and Dr. Alysse Wurcel, a physician-scientist at Boston Medical Center, will develop an HIV testing, prevention and treatment program for people incarcerated in a Boston-area jail that experienced an HIV outbreak a few years ago.
"Jail settings offer opportunities for testing, prevention and treatment of both infectious disease and also opioid and other substance use disorders," Evans says, "making jails a critical part of our public health system."
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