Treatment Navigation for Recently Released Prisoners With Opioid Use Disorder
Phase: NA
Conditions: Opioid-use Disorder
Sponsor: University of Washington

 
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Treatment Navigation for Opioid Use Disorders 
Study Protocol 
A113229 Banta-Green (FA130694) (WA State Innovation Initiative- Medication Assisted Treatment 
upon Release from Prison) 
 
Caleb Banta-Green, 
PhD, MSW, MPH 
Principal Investigator 
Alcohol and Drug 
Abuse Institute 
206-543-0937 
Judith Tsui, MD 
Co-Investigator 
General Internal 
Medicine 
 
Theresa Hoeft, PhD 
Co-Investigator 
Psychiatry and 
Behavioral Sciences 
206 543-2167 
Jeanne Sears, PhD, RN 
Co-Investigator 
Health Services 
206-543-1360 
Anthony Floyd, PhD 
Project Director 
Alcohol and Drug 
Abuse Institute 
206-616-7382 
 
 
 
 
Abstract 
We will conduct a pilot randomized controlled trial (RCT) study. One hundred inmates with OUD 
releasing from WA State prisons to community corrections supervision in King County, WA will be 
enrolled (the county has a population of 2 million residents out of a state population of 7 million). 
Half of the subjects will receive treatment as usual, for instance outpatient drug counseling, and 
half will receive 6 months of intervention. The aims of this study are to determine: 1) whether study 
procedures can be implemented with fidelity, 2) whether offenders can be enrolled and maintained 
in the study, 3) which medications/treatment options subjects select and their experiences and 
satisfaction with the interventions, and 4) preliminary intervention effect size on outcomes of 
interest including recidivism, drug use, hospitalization, and treatment enrollment and retention.  
Introduction 
One-third of heroin users are incarcerated each year primarily due to criminal activity related to 
their drug use and “policy changes and interventions are urgently needed to reduce the negative 
consequences of opioid relapse following re-entry” (Fox et al., 2015). The number of heroin users 
and the number dying from opioid overdoses have increased significantly in recent years across the 
U.S. while pharmaceutical opioids remain a common pathway into heroin and a persistent overdose 
risk (Jones et al., 2015; Peavy et al., 2012).   
The time shortly after release from prison is a period of greatly increased risk for fatal opioid 
overdose (Binswanger et al., 2013; Merrall et al., 2010). Opioid use disorder can be readily treated 
with medication assisted treatment (MAT) reducing criminal activity, recidivism, improving 

 
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functioning, decreasing mortality and transmission of infectious diseases like HIV and HCV, and 
substantially reducing costs (Clark et al., 2011; MacArthur et al., 2012; Nolan et al., 2014; Nordlund 
et al., 2004; Tkacz et al., 2014; Tsui et al., 2014; White et al., 2014). A major challenge in breaking 
the cycle of addiction and criminality and related morbidity and mortality is seamlessly getting 
people onto MAT as they leave incarceration. This is a matter of simultaneously building interest in 
treatment among newly released inmates and increasing and facilitating access to ongoing services. 
Great interest in this topic has been expressed locally as indicated by the January 2016 release of 
Washington State’s Interagency Opioid Workplan, co-authored by Drs. Banta-Green and Fotinos, 
collaborators on this project. A main strategy in the Workplan is to “Optimize access to chemical 
dependency treatment services for offenders who have been released from prison into the 
community…”i. Numerous challenges exist to providing effective services to releasing prison 
inmates with OUD, including: 1) identification of the population at risk, 2) inmates’ often modest 
knowledge and misperceptions of MAT as well as limited  motivation and self-efficacy for accessing  
treatment, 3) lack of continuity of care between the relatively protected prison environment and 
effective services in the community and 4) maintaining ongoing utilization of MAT to support 
recovery and reduced consequences related to opioid use.  
This innovation initiative, based on evidence-based practices, will develop, implement, and assess 
the feasibility of procedures to provide effective services for offenders with OUD releasing from WA 
DOC prisons. We will aim to facilitate linkage to ongoing MAT in the community following release 
from custody beginning with an initial intervention aimed to educate inmates so they can make 
informed decisions regarding medication options. 
The Affordable Care Act (ACA) has markedly increased eligibility for health insurance coverage for 
releasing offenders, such that a very high proportion of offenders releasing from WA DOC prisons 
qualify for Medicaid coverage. Since 2014, WA DOC has launched an effort to enroll as many 
releasing offenders as possible into Medicaid coverage effective at the time of release resulting in a 
substantial majority of inmates obtaining Medicaid coverage. We are fortunate that WA HCA 
(Medicaid) has undertaken several initiatives to promote better integration of healthcare services 
including integrating medical, mental health, and substance use disorder treatment that should 
facilitate this study and support sustainability long term (see letter of support). 
The crux of this innovation initiative is building motivation and self-efficacy for and ready access to 
adequate coordinated care for releasing offenders with OUD to initiate and maintain MAT. Given 
that MAT has the best evidence base for effective treatment of OUD, facilitating access to MAT 
(accompanied by psychosocial treatment as appropriate) will be the major thrust of the initiative. 
Our intention is to make appropriate treatment (buprenorphine, methadone, and long-acting-
naltrexone) available, with the particular treatment approach selected on a case-by-case basis by 
the patient and medical provider. We will be working with community based partners who will be 
providing MAT including, but not limited to Dr. Tsui, co-investigator and Evergreen Treatment 
Services (see letter of support). These partners will be responsible for all medical and related care 

 
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including counseling as indicated, we will be coordinating with them and the study participants to 
facilitate care.  
 
 
 

 
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Study Design 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NEWLY RELEASED PRISON INMATES 
Intervention
Treatment Navigation 
Standard Care
Randomization
(n=100) 
Outcomes
Interviews                Admin. Data
(1& 6 months)      (Up to 10 years) 
Screening
Eligible & Interested
Baseline Assessment 
Overdose Education
Narcan 
Potential Subjects Identified
 Consent Process

 
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Eligibility Criteria 
Inclusion criteria 
1) Meets DSM-5 criteria for opioid use disorder (at least 2 criteria) or were receiving treatment 
for opioid use disorder in the 12 months prior to incarceration. 
2) Released to community corrections, not currently incarcerated. 
3) Able to understand and provide informed consent. 
4) Has access to phone (voice or text) or email to communicate with research staff. 
Exclusion criteria 
1) Under age 18 or over age 70 at time of recruitment.  
2) Currently enrolled in an opioid treatment program using medications. 
3) Has not used opioids (prescription type or heroin) in the past 6 months prior to incarceration. 
4) Unwilling to allow access to medical or drug treatment records, criminal history or criminal 
activity records.  
5) Inability to communicate in English verbally. 
6) Inability to provide adequate contact information to assist with follow-up.  
7) Not planning on being in King County or reporting to community corrections in King County 
for 6 months. 
8)  Violent or overtly hostile/threatening towards research staff.  
9) Entering 31 days or more controlled environment in the next 6 months. 
Potential Subjects Identified 
Recruitment, baseline interviews, and some follow-up interviews (if convenient for the subject) will 
take place in community corrections offices (CCOs) throughout King County. We will concentrate 
initially on offices in Seattle and South King County. Department of Corrections (DOC) will run 
weekly reports on inmates for upcoming releases to King County CCO facilities. DOC will notify CCO 
staff that a potential subject will be released to that facility. Once released, we will approach, 
recruit and enroll them during their first visit at the community corrections office and randomize to 
treatment as usual or intervention.  
Obtain Informed Consent 
Written informed consent will be obtained from all subjects who wish to participate in the study. 
Subjects will also be asked to complete HIPAA authorization agreements for treatment and medical 
records information and other secondary data sources.  
Eligibility Screening 
Subjects will be men or women aged 18-70 released from Washington State prisons to community 
corrections supervision in King county, meeting at least mild severity for Diagnostic and Statistical 
Manual of Mental Disorders Fifth Edition (DSM-5) criteria for diagnosis for opioid use disorder (e.g. 

 
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opiate dependence).Subjects will be asked to complete an eligibility screening questionnaire. The 
items covered are general demographics, proximity to the research settings, drug use questions, 
and DSM 5 checklist.  
 
 
Baseline Assessments 
Eligible subjects will undergo baseline assessments and provide information on personal 
information and health: 
1) Opioid Use and Treatment Experiences. This assessment captures opioid use, overdose 
history, past treatment and feelings about future treatment. 
2) Education, Employment, Income and Housing: This assessment captures other demographic 
information related to subject’s resources and social stability. 
3) Overdose Risk Assessment: This assessment is used to determine the potential for future 
overdose based on prior overdose history, current drug use practices and social context for 
current drug use. This assessment is not standardized but is compiled from individual items 
of known risk factors for overdose.  
4) World Health Organization Alcohol, Smoking and Substance Involvement Screening Test 
(WHO-ASSIST v.3). This is a multi-item tool to determine areas of substance use and misuse. 
This assessment battery screens for recent and lifetime use of a variety of substances, 
including illicit drugs, alcohol, pharmaceuticals and tobacco products. 
5) EQ-5D-3L: This validated quality of life measure asks about problems in mobility, self-care, 
usual activities, pain and discomfort, anxiety and depression and overall health. 
Locator information: 
Subjects will be asked to provide a number of sources to ensure they can be contacted for follow-up 
visits. However, because we anticipate a number of subjects to have unstable housing, subjects may 
be enrolled if they provide at least one primary source of locator information. 
Randomization 
Subjects will be randomized to receive either standard of care or the study intervention. We will 
recruit equal numbers of subjects in the intervention and control arms of the study. 
Follow-up Visits 
Follow-up visits will occur at 1and 6 months after enrollment. Interviews will be by phone or in-
person. Assessments given at the baseline interview will be repeated at each follow-up point. In 

 
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addition to the assessments subjects will be asked questions in the intervention arm about how 
well the treatment navigation process is working. 
 
 
Secondary Data Sources 
Secondary data on health care and drug treatment utilization will be obtained from Washington 
State (separate IRB action pending) using the following sources: 
 
Division of Behavioral Health and Recovery (DBHR) data for drug treatment admissions 
data (formerly TARGET) and King County Behavioral Health and Recovery Division 
 
 
The Comprehensive Hospital Abstract Reporting System (CHARS) for hospital admissions 
 
Criminal History data extracted from Administrative Office of the Courts (AOC) and 
Department of Corrections (DOC) by the Washington Institute for Public Policy (WSIPP) 
 
Emergency Department Information Exchange data for emergency department visits 
administered by Collective Medical Technologies. 
In the event of a subject death during the study we will request information on cause of death from 
the King County Medical Examiner’s Office or Vital Records from Washington Department of Health. 
If we are unable to locate a subject during the course of the study or at final follow-up we will utilize 
the King County Jail Inmate Look-up Service. At no time will subjects be contacted or study 
procedures attempted while the subject is incarcerated. 
Intervention Description 
Subjects in the intervention arm will additionally begin a discussion with the interventionist about 
whether they are interested in treatment and medication choices for opioid use disorders. The 
interventionist, called a Treatment Navigator, will use a decision tool based on the SAMSHA guide 
to medication assisted treatment in order to help make an informed decision about treatment 
choices. A treatment decision may be made during the baseline visit or at some later visit. Once a 
decision is reached, the Treatment Navigator will meet with the subject periodically to assist with 
entering treatment and help with locating other social services as needed within the community. 
The meetings are neither structured nor scripted and the subjects will determine the agenda based 
on their areas of concern. The Treatment Navigator will, however, emphasize getting into 
treatment as quickly as possible once a decision is made. The Treatment Navigator and the subject 
will determine the schedule of meetings and will continue throughout the 6 month study period, 
with more visits anticipated at the start of participation, and fewer visits anticipated at the end. See 
Appendix A for the Treatment Decision Making Guide. 

 
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Study Medication 
The medication, naloxone, is being used for an indicated condition, opioid overdose. The specific 
formulation of Naloxone we will use is Narcan® nasal spray, 4mg naloxone hydrochloride from 
ADAPT Pharma. 
At usual doses, naloxone is relatively free of adverse effects. Because the duration of action of 
naloxone may be shorter than that of the narcotic being reversed, patients being treated for opioid 
intoxication with symptoms of respiratory depression should be closely monitored as additional 
doses of naloxone may be required.   
Administration of naloxone to opioid-dependent patients may provoke an acute withdrawal 
syndrome (including body aches, diarrhea, tachycardia, fever, runny nose, sneezing, piloerection, 
sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or 
trembling, abdominal cramps, weakness, and increased blood pressure). Withdrawal reaction are 
not life threatening. Agitation and paresthesia have been infrequently reported with the 
postoperative use of naloxone hydrochloride injection. 
Hypersensitivity reactions, such as allergic reactions, are theoretically possible, but have never been 
documented with naloxone.  We will ask about allergic reactions to naloxone during the baseline 
interview and at each of the three follow up interviews. Any allergic reactions will be reported to 
the University of Washington’s human subjects division.  
Subjects will be educated about withdrawal reactions. The overdose intervention training and all 
education materials will clearly and strongly encourage calling 911 during any suspected overdoses.  
Emergency medical services are well equipped to handle any withdrawal reactions.  
Regulatory Compliance and Safety 
Regulatory binder 
The regulatory files should contain all required documents, study-specific documents, and all 
important communications. Regulatory files will be checked for compliance prior to study initiation, 
throughout the study, as well as at study closure. 
Study documentation includes all case report forms, data collection forms, workbooks, source 
documents, monitoring logs and appointment schedules, sponsor-investigator correspondence, and 
signed protocol and amendments, or Institutional Review Board correspondence and approved 
current and previous consent forms and signed participant consent forms.  
Source documents include all reports and records necessary for the evaluation and reconstruction 
of the clinical research study. The original recording of an observation should be retained as the 
source document. Because direct data entry through the REDCap electronic data capture system 
will be employed relatively few source documents are anticipated for the collection of primary data. 
 
Data Safety Monitoring Oversight Committee 

 
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The Data Safety Monitoring Oversight Committee will have 2-4 representatives who have clinical 
and research expertise relevant to the study.  They are not directly involved in study procedures. 
They will meet during the period of study planning, one month and 4 months after the study is 
initiated.  The committee will receive reports on the progress of the study prior to the meeting, 
including the number and characteristics of subjects and those who declined to participate.  Any 
serious adverse events (SAE) will be discussed with the committee to determine if the risks of SAE 
could be modified by any changes in study procedures.  Other reports will be provided as the 
committee requests. Committee membership will be determined prior to study initiation. 
Drug accountability 
Study medication will be ordered and prescribed by Kelly-Ross Pharmacy in Seattle. Upon receipt, 
the investigator is responsible for taking inventory of the investigational agent. A record of this 
inventory will be kept and usage will be documented. Any unused or expired investigational agent 
shall be accounted for. 
Adverse event reporting 
 
The risks expected from trials employing behavioral interventions are presumed minimal and the 
medication being prescribed for possible future use is designed to be used to prevent a fatal 
overdose with side effects being rare. However, given the nature of ongoing drug and/or 
medication use the population studied in this trial is possibly at risk for an overdose.  Adverse 
events (AEs) will be categorized as serious or non-serious, as related or not related to the study, and 
as expected or unexpected. An AE is defined as any reaction, side effect, or untoward event that 
occurs during the course of the clinical trial. Stable chronic conditions, such as substance abuse, 
which are present prior to clinical trial entry and do not worsen, are not considered AEs. Common, 
minor ailments and complaints will be excluded from any type of documentation. These may 
include: colds, flu’s, cuts, scrapes, coughs, headaches, stomach complaints, and general fatigue.  
Serious adverse events (SAEs) are defined as any fatal event, any immediately life threatening 
event, any permanent or substantially disabling event, any event that requires or prolongs inpatient 
hospitalization, congenital anomaly or birth defect, or any event requiring intervention to prevent 
any of the previously listed serious events. Hospital visits that do not result in admittance are not 
considered SAE’s (e.g. emergency room visit for a non- study-related injury that does not result in 
admittance). Normal childbirth and pre-planned elective procedures are not considered SAEs. 
AE/SAE’s will be elicited by interventionists/research interviewers at each assessment visit by asking 
the participants if they have noticed any new problems or existing problems that have gotten worse 
(using the Adverse Events Worksheet).  
Disclosure of an AE/SAE may also occur in an unsolicited manner to a research or clinical staff 
member. The interviewers should be focused on gathering data to aid in determining study 
relatedness. Study-relatedness will be determined by the interviewers in consultation with one of 

 
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the investigators. All AEs and SAEs will be recorded in the AE/SAE log and entered into the secured 
project database. AEs that are not study related do not require any further paperwork 
documentation besides the AE Log. In this study, potential AEs that may be related to the study 
would be an increase in emotional distress in relation to discussion of past or current drug use 
behaviors or side effects of naloxone.  
University of Washington Adverse Events reporting requirements 
The term adverse event is generally used to refer to any untoward or unfavorable medical 
occurrence in a human subject, including any abnormal sign (for example, abnormal physical exam 
or laboratory finding), symptom, or disease, temporally associated with the subject's participation 
in the research, whether or not considered related to the subject's participation in the research. 
Adverse events encompass both physical and psychological harms. They occur most commonly in 
the context of biomedical research although, on occasion, they can occur in the context of social 
and behavioral research. 
Unanticipated problems, in general, include any incident, experience, or outcome that meets all of 
the following criteria: 
1. unexpected (in terms of nature, severity, or frequency) given (a) the research procedures 
that are described in the protocol-related documents, such as the IRB-approved research 
protocol and informed consent document; and (b) the characteristics of the subject 
population being studied; 
2. related or there is a reasonable possibility that the incident, experience, or outcome may 
have been caused by the procedures involved in the research; and 
3. suggests that the research places subjects or others at a greater risk of harm (including 
physical, psychological, economic, or social harm) than was previously known or recognized. 
The adverse event report form is to be used to report an adverse event where there is a reasonable 
probability that the event was attributable to a study procedure. The UW IRB defines reasonable 
probability as "more likely than not" - that is, there is a greater than 50% likelihood of the event 
having been caused or partially caused by the research or arising from the circumstances of the 
research. 
Per HSD policy the form is required to be submitted as soon as possible but no later than 10 
business days after becoming aware of the event. 
Data security  
Data will be uploaded to ADAI servers weekly. Only authorized individuals are permitted access to 
the project database. Data are backed up nightly so there is minimal risk of data loss. Any edits to 
previously saved data are fully tracked in an electronic audit table and include the date/time stamp 

 
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and user ID of the person making the edit. Ongoing data monitoring will be the responsibility of the 
research coordinator. 
Confidentiality 
We will obtain a federal Certificate of Confidentiality (CoC), protecting participants against 
disclosure of sensitive information (e.g., drug use). The Department of Health and Human Services 
(HHS) office that issues the CoC will be advised of any changes in the CoC application information.  
Participant records will be kept confidential by the use of study codes for identifying participants on 
data collection forms, secure separate storage of any documents that have participant identifiers, 
and secure computing procedures for entering and transferring electronic data. 
Study monitoring 
The monitoring of study records will be conducted on a regular basis by the research coordinator. 
The purpose of these visits is to encourage and assess regulatory compliance and to document the 
integrity of the trial progress. Monitoring activity will assure that submitted data are accurate and in 
agreement with source documentation and will also review regulatory/essential documents such as 
correspondence with the IRB. Areas of particular concern will be participant informed consent, 
protocol adherence, safety monitoring, IRB reviews and approvals, regulatory documents, participant 
records, study drug accountability, and principal investigator supervision and involvement in the trial. 
The research coordinator will ensure that staff are trained and able to conduct the protocol 
appropriately and that study procedures are properly followed. If additional training of study 
personnel is needed, project staff will undertake or arrange for that training.  
Data monitoring 
Study data will be entered by interventionists directly into password protected, study specific 
laptop computers.  Data will be captured using the REDCap electronic data capture system which 
uses a secure connection to local REDCap servers located at ITHS. Only authorized users will be 
allowed access to the data entry system and no identifiable data will be entered into REDCap. 
Research staff will use password protected UW works for data entry.  
Data completion will be verified when study interviews are completed. Baseline data and study arm 
assignment will be captured by secure data servers at ITHS as data are collected in REDCap.  Data 
will be managed by the principal investigator and research coordinator, who will access study data 
from desktop computers connected via local area network to computer servers that are in a locked 
room in a locked office suite at the Alcohol and Drug Abuse Institute (ADAI). Similarly, follow-up 
interview data will be entered directly into password protected, study specific laptop computers 
using REDCap, with data uploaded to servers at ADAI weekly.   
Health services and cost data will be obtained, cleaned and made into analytic data sets by Dr. 
Sears. Data will be transferred securely and stored on ADAI servers which are backed up nightly. 
The research coordinator will be responsible for the integrity of all study data and will prepare 

 
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regular reports for the 3-person data and safety monitoring oversight committee which will review 
any adverse events as well as monitor study progress to ensure that study results are scientifically 
valid. 
The research coordinator for the study will conduct software programming and data management 
activities. Data will be stored on computer servers at ADAI that are fully HIPAA-compliant in 
accordance with the University of Washington School of Medicine. The senior computer specialist 
at ADAI maintains nightly tape backups and active disaster recovery protection and procedures. The 
research coordinator will develop data collection forms used by research staff.  These forms will 
also have a companion data dictionary which comprehensively defines each data element. The data 
dictionary specifies missing, illogical, out of range, and inconsistent value checks for each data 
element, in addition to logic checks and assists the project data analysis. 
Intervention fidelity monitoring 
The primary threat to the integrity of the intervention is that the intervention may not be delivered 
as intended. This potential problem is minimized because the intervention is highly structured and 
intervention fidelity will be regularly monitored by co-investigators who will monitor audio 
recordings of intervention sessions after the interventionist has initially been approved to conduct 
interventions without supervision. 
Data Analysis Plan 
Analyses will allow us to evaluate the aims of this study: 1) whether study procedures can be 
implemented with fidelity, 2) whether offenders can be enrolled and maintained in the study, 3) 
which medications/treatment options subjects select and their experiences and satisfaction with 
the interventions and 4) preliminary intervention effect size on outcomes of interest including 
recidivism, drug use, hospitalization, and treatment enrollment and retention. The number of 
subjects is not intended to be adequate to test the impact of the intervention, but rather to provide 
sufficient numbers of subjects to assess the feasibility of both research study procedures and 
intervention components.  
The number and proportion of subjects retained at each step of the study will be documented and 
reported in a CONSRT diagram similar to the one in the Appendix for our current RCT. Baseline 
characteristics will be compared for each study arm to ensure randomization was properly 
implemented. Bi-variate test statistics of differences in outcomes of interest will be compared by 
study arm and reported for all outcomes. Study analyses will begin prior to study completion due to 
the fact that this is a pilot-feasibility trial and data will be used to determine if a full randomized 
trial is appropriate and what modifications to the study design are needed, this is different than 
procedures for a full RCT where analyses would await and complete, closed dataset. Data will be 
used to determine the possible treatment effect sizes which will allow sample size estimates to be 
calculated for a future full scale randomized controlled trial.   

 
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Equitable access to care and outcomes will be examined (Beletsky et al., 2015) by comparing the 
characteristics of the eligible pool of offenders with those screened, enrolled, and maintained 
throughout the study.  
 
 

 
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Appendix A: Treatment Decision Making Aid: Semi-Structured Intervention Guide 
Helping you decide what works best for you 
Treatment Decision Making 
Introduction 
 I’d like to share with you some information about treatment options and support you in making a 
decision about what types of treatments you would like to try. This will involve: 
1. describing what opiate use disorder is  
2. compare treatment options 
3. asking you some questions about your preferences for treatment  
4. providing you feedback about the tradeoffs, pluses and minuses, of treatment options you are 
interested in  
5. if you are interested in treatment we’ll work on a plan to get you started including finding a 
treatment provider if you are interested in a medication  
After today, I will continue to be available to work with you for six months to talk through how 
treatment is going, if you’d like to try a different type of treatment, and help you get back on treatment 
if you stop. 
Treating opiate use disorder is like treating other health conditions. Often different treatments need to 
be tried until the one that works best if found. 
 
 

 
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1. What is opiate use disorder? 
To understand opiate use disorder, it is helpful to look at the difference between physical dependence 
on opiates and opiate use disorder: 
Opiate dependence: A physical condition in which the body gets used to the amount of opiates taken. 
This happens whether a person take pain pills like Vicodin, Percocet or OxyContin or heroin. The body 
adapts by needing more opiates to feel the same effect (tolerance) and feeling terrible (withdrawal) 
when opiates are reduced or removed. This is normal and happens to anyone who takes opiates for 
awhile. 
Opiate use disorder is the current medical term used to describe what has been commonly known as 
addiction. Opiate use disorder involves being 1) physically dependent on opiates as well as negative 
impacts on a 2) person’s thinking, and 3) relationships and ability to function. Opiate use disorder is 
considered to be a chronic, relapsing medical condition, meaning it lasts a long time and can keep 
coming back, much like diabetes and high blood pressure. It can also be managed very well with 
medication and supportive services. A person can be on treatment medications and be in recovery. 
Why might opiate use disorder be relevant to you? 
People releasing from prison or jail are at very high risk for using opiates again as well as fatal overdose. 
If not treated opiate use disorder can cause great physical, social and psychological harm- both to the 
person with the disorder and others in their life. People with opiate use disorder are at increased risk for 
HIV, hepatitis, other serious health problems, and dying from an overdose. 

 
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2.What are treatments for opiate use disorder? 
Three types of treatments may be combined, or you may choose to do nothing at this point. 
 
Watchful waiting, do nothing right now, but observe how you are feeling and what you are doing. 
Notice if you are having cravings or start using opiates or other drugs or alcohol. 
1. Social support such as organized groups like narcotics anonymous or smart recovery. Joining 
another social support group run by peers for other things impacting your life like chronic pain. 
2. Professional counseling. Getting one on one counseling from a social worker, therapist, or chemical 
dependency professional. 
3. Treatment medications including methadone, buprenorphine/Suboxone, or long-acting-
naltrexone/Vivitrol. 
o Methadone is an opiate medication that lasts approximately 24 hours and that is taken by 
mouth. It is dispensed at a methadone clinic (also called an opiate treatment program). At 
these programs most days you will be observed while you take your dose. You will also have 
regular urine drug testing as well as counseling. Methadone is a full opiate meaning that the 
more you take the more you will feel it. 
o Buprenorphine is an opiate medication that you take orally that lasts approximately 24 
hours. It has a partial opiate effect. You can get is at different settings. A common brand 
name is Suboxone. 
 
You could get it at an opiate treatment program where most days you will be 
observed while you take your dose. You will also have regular urine drug testing as 
well as counseling. 
 
You could get it prescribed to you by a doctor and pick it up at a pharmacy. Typically 
you would start with a prescription for a few days, then you might get weekly 
prescriptions for a while, and eventually you could get a 30 day prescription. Most 
will do some urine drug testing and some also 
include counseling supports as part of their care. 
o Naltrexone is an opiate blocker. It is typically given as a 
shot/injection that lasts 30 days and this form of the drug is 
called Vivitrol. It is not an opiate. It has to be prescribed by 
a medical provider who may offer other services as well 
including counseling and may require urine drug testing. 

 
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What is the evidence for the medications? 
Methadone and buprenorphine have been shown to cut peoples’ chances of dying by 50%. They have 
been very well studied and are very effective when taken as directed, they are opiate medications.  
Naltrexone is a newer medication and we don’t have good data on how it impacts the risk for fatal 
overdoses; however it is protective against overdose during the 30 days the medication is active in the 
body. After it wears off a person’s overdose risk if very high because the body has a lower tolerance to 
opiates. 
While some people with opiate use disorders are able to abstain from problem opiate use on their own 
or by entering a treatment program that does not include treatment medications, the scientific data 
overwhelmingly supports medications as the most effective way of avoiding relapse and supporting long 
term recovery for most people. 
 
3. Which treatment is right for me? 
It is important that a person with opiate use disorder understand the pros and cons of different 
treatment options, including the role of medications.  
**** Now I’m going to ask you a few questions about what you prefer related to treatment. 
 
 
 
 
 
 
 

 
Treatment Navigation for Opioid Use Disorders  
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4. Compare Options 
The right choice for people may change over time. This decision aid aims to help you make the right 
choice for right now, but you may want to change their mind as your use, cravings, or life changes. The 
ultimate decision about what treatment options you will be able to use, and exactly how, will be made 
between you and the treatment providers.  What options are you interested in? 
 
Watchful 
waiting 
Social 
support 
Counseling Vivitrol 
Naltrexone 
Methadone 
Suboxone 
Buprenorphine 
How will I feel
 
 
 
 
Blocks 
opiates. May 
not feel 
anything. 
 
 
 
Helps with 
cravings & 
withdrawal 
 
 
Helps with 
cravings & 
withdrawal 
How I will take it 
 
 
 
Injection  
Mouth 
Mouth 
Overdose risk 
 
 
 
 
 
 
How often I have to go 
to clinic/pharmacy 
 
 
 
Monthly 
6x week OTP 
6x week OTP 
 
~Weekly @ 
pharmacy 
How often do I take it 
 
 
 
Monthly 
Daily 
Daily 
Convenience 
Transportation 
Time 
 
 
 
 
 
 
Cost/Medicaid? 
 
 
 
 
 
 
Housing  
Relationships 
Supportive of choice? 
 
 
 
 
 
 
 
5. Make a decision 
What treatment options sound good for you? 

 
Treatment Navigation for Opioid Use Disorders  
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Let’s make a plan to help you get you started. 
 
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