A newly awarded federal grant provides a boost for the Bloomington-based nonprofit Chestnut Health Systems for continued research into the intersections of drug addiction and the criminal justice system.
Chestnut’s research arm called the Lighthouse Institute received a $1.1 million grant from the U.S. Department of Health and Human Services to develop evidence-based strategies for safe and effective treatment and recovery services at various points in the legal system.
“About one in four people with an opioid use disorder are involved with the legal system during any give 12-month period,” said Lighthouse Institute Chief Research Officer Michael Dennis. “So, it’s one of the easiest ways to find out-of-treatment opioid users.”
Dennis said the institute’s research seeks to reduce overdose risk at any access point, aiming to intervene earlier and more often.
“Can we find them in the community and keep them out of the legal system? Can we find them close to arrest? Can we find them in jail? Can we find them in courts and work with them in courts? Can we deal with them on probation, parole or in prison?”
Previous research showed one of the highest risk periods for overdose and overdose-related death in when a person is released from jail or prison. Dennis said jail is a particularly high risk due to the short length of stay.
“They are addicted, they came in, they may or may not have gotten services because of such a high turnover rate—then they go back out into the community,” Dennis said. “That first 90 days when they come out, if they’re not linked to treatment, if they’re not getting help, they often continue to use and will have a very high risk of overdose.”
The critical trigger is stress.
“If you’re involved in the legal system, it is stressful,” he said. “If you’re involved in a controlled environment in which you may have come into that because you overdosed or were arrested, you’re removed from your supply, the level of narcotics in your system is going down and you’re needing to use—you’re approaching a panic attack. You’re in pain.”
In a previous Lighthouse Institute Study, about half the people with opioid use disorders funneling through Cook County Jail had already overdosed at least once. A third had overdosed multiple times, some as many as six times. Typically a longer stay, Dennis said a prison sentence can create a stable environment for a person to detox fully and establish medical interventions curbing substance use. Risk of overdose leaving prison remains high, but for different reasons.
“You may have gone in with a four-bag-a-day heroin habit, but you’ve been abstinent for years,” Dennis said. “You go out and you get some heroin, and you think you’ve got a four-bag-a-day habit, but you don’t anymore because your body’s adjusted to being abstinent.”
The composition of drugs also changes over time, so a person who has been off the street might not be aware of heroin being cut with fentanyl, for example, a cheaper, stronger drug than heroin, or laced with tranquilizers, increasing overdose risk.
Scalable and sustainable
Chestnut’s HHS grant funds a 5-year study and is aimed at facilitating conversation and collaboration between researchers and providers to ensure what Chestnut proposing is both scalable and sustainable.
“Scalability means we have to make it more portable so other agencies can do it,” Dennis said. “And that is literally the focus of the trial.”
Sustainability refers to working with Medicaid or other funding sources to help pay for interventions in the long-term.
“The research grant is five years, then it’ll be over,” he said. “Our goal is not just to teach them how to do it, show they can do it well and that it’s cost effective—but also to work with them to get the funding codes set up necessary to sustain it once we’re gone.”
The initiative has been expanded to include justice-involved individuals struggling with substance use beyond opioids like heroin and fentanyl. Chestnut also explores how abuse of alcohol and stimulants like cocaine and methamphetamine intersect with the justice system.
But whether jails, prisons, court services or community partners apply Chestnut's recommendations is another question. Dennis says most don't, but McLean County is better than most.
Chestnut and the McLean County Health Department invested in vending machines which freely dispense the overdose reversal drug Narcan. Bloomington-Normal’s three college campuses have overdose prevention tools. And last year, the county approved funding to add an opioid prevention coordinator within the Health Department.
“They collaborate with a lot of local providers,” he said. “Chestnut for substance abuse, the Community Health Care Clinic for mental health, and others. They’ll try to connect you with various services.”
