Researchers to study the economics of substance use disorder treatments with $4 million NIDA grant

A team led by Weill Cornell Medicine and University of Miami's Miller School of Medicine investigators has been awarded a five-year, $4 million grant from the National Institute on Drug Abuse (NIDA) for health economics research. The team will study the economics of substance use disorder treatments and overdose prevention strategies for individuals who are incarcerated or otherwise involved in the United States' criminal legal system.

Interventions for people with substance use disorders are often inadequate in the criminal-legal system. That can lead to other health and behavioral problems, including overdose when incarcerated individuals are released to their communities. Health economics researchers in this area evaluate and compare the economic value of available interventions in the many different criminal-legal settings.

The new grant will support the establishment of a health economics research facility called the Criminal-Legal Economic Analysis & Resource (CLEAR) Center, within a larger research program known as the Justice Community Overdose Innovation Network. The latter helps develop and test strategies for substance-use-disorder care within the criminal legal system. It has been supported by NIDA since 2019, and now in its second phase of funding is known as JCOIN-II.

The CLEAR Center will not only generate rigorous economic evidence regarding which care strategies deliver the greatest value, but also develop tools and resources that administrators and policymakers can use to identify strategic and sustainable investments." 

Dr. Sean Murphy, CLEAR Center co-principal investigator, professor in the department of population health sciences, Weill Cornell Medicine

The other co-principal investigator is Dr. Kathryn McCollister, professor and interim chair of the department of public health sciences at the University of Miami's Miller School of Medicine.

The U.S. criminal-legal system comprises police stations, courts, jails, prisons, halfway houses and other community supervision contexts, each of which has its own budgetary, staffing and other constraints. Traditionally, Dr. Murphy said, individuals with substance use disorder who entered this system would be deprived of the drugs they had been using-forcing untreated withdrawal-and given little or no further assistance when released. The challenge for initiatives such as JCOIN has been to find ways to integrate effective, evidence-based care at every level of this multifarious and notoriously budget-limited system.

"Ideally we want to get people on treatment as soon as they are incarcerated, and link them to evidence-based care immediately upon release-when the risk of overdose and other adverse outcomes is typically highest," Dr. Murphy said.

Drs. Murphy and McCollister and their colleagues at the CLEAR Center will provide health economics support for JCOIN-II in the form of cost-effectiveness analyses of clinical trials of substance use disorder interventions, advice on trial designs, creation of cost-benefit and budget-impact calculators for decision makers and treatment providers, and general consultation and technical assistance.

The two researchers received the new grant in part because of their extensive experience with substance use disorder-related health economics research. Drs. Murphy and McCollister are longtime collaborators through CHERISH – a large, NIDA-funded health economics center of excellence that conducts research and provides resources to inform care for the interrelated epidemics of substance use disorder and HIV and hepatitis C virus infection. Dr. Murphy is co-director of CHERISH, along with Dr. Bruce Schackman, the Saul P. Steinberg Distinguished Professor of Population Health Sciences at Weill Cornell Medicine, and Dr. McCollister is director of the CHERISH Methodology Core. CHERISH's grant was renewed in August for a total of $10.9 million over five years.