Browsing by Author "Tillson, Martha"

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    Impacts of COVID-19 at the intersection of substance use disorder treatment and criminal justice systems: findings from three states
    (BMC, 2022-08-04) Dir, Allyson L.; Tillson, Martha; Aalsma, Matthew C.; Staton, Michele; Staton, Monte; Watson, Dennis; Psychiatry, School of Medicine
    Background: Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD), who are criminal justice-involved are a particularly vulnerable population that has been adversely affected by COVID-19 due to impacts of the pandemic on both the criminal justice and treatment systems. The manuscript presents qualitative data and findings exploring issues related to SUD/OUD treatment among individuals involved in the justice system and the impacts of COVID-19 on these service systems. Qualitative data were collected separately by teams from three different research hubs/sites in Illinois, Indiana, and Kentucky; at each hub, data were collected from justice system personnel (n = 17) and community-level SUD/OUD providers (n = 21). Codes from two hubs were reviewed and merged to develop the cross-hub coding list. The combined codes were used deductively to analyze the third hub's data, and higher-level themes were then developed across all the hubs' data. Results: Themes reflected the justice and treatment systems' responses to COVID-19, the intersection of systems and COVID-19's impact on providing OUD treatment for such individuals, and the use of telehealth and telejustice. Conclusions: Results highlight that despite rapid adaptations made by systems during the pandemic, additional work is needed to better support individuals with OUD who are involved in the justice system. Such work can inform longer-term public health crisis planning to improve community OUD treatment access and linkage for those who are criminal justice-involved.
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    Response to a peer telehealth intervention for emergency department patients presenting with opioid use disorder or unintentional overdose: a stratified interrupted time series analysis
    (Springer Nature, 2025-05-17) Tillson, Martha; Xu, Huiping; McGuire, Alan; Medcalf, Spencer; Beaudoin, Francesca L.; Watson, Dennis P.; Psychology, School of Science
    Background: People in the United States who use opioids frequently use emergency department (ED) services. Some hospitals have begun placing peer recovery support specialists (PRSS) in EDs to support and advocate for patients and provide linkages to services, in an effort to reduce future presentations for opioid-related and other health problems related to substance use. However, evidence supporting the impact of PRSS services on reducing future ED presentations is limited, and even less is known about ED-based PRSS services delivered via telehealth. Methods: Using records from a large Indiana-based hospital system, we conducted an interrupted time series (ITS) analysis of ED patients presenting for unintentional opioid overdose or other opioid-related issues. Over a five-year period, 2,542 unique ED visits were included across 12 hospitals. The primary outcome assessed was the impact of PRSS telehealth service implementation (comparing pre- and post-periods) on 30-day all-cause ED revisits. Analyses were also stratified by appropriate demographics. Results: There was no significant change in 30-day ED revisits between pre- and post-implementation of the PRSS telehealth program. Results of sex-stratified ITS indicated a significant change for females only, with decreasing log-odds of ED revisits post-program implementation (post-implementation slope OR = 0.911, p = 0.031; slope change OR = 0.874, p = 0.017). Conclusions: Although there was no detectable difference in overall ED revisits following program implementation, outcomes of stratified analyses suggested that the program may have been more impactful for females vs. males. Future research should examine the underlying mechanism of the observed sex differences to target behavioral change more effectively for all participants of telehealth PRSS services in ED settings.
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    Results from the POINT pragmatic randomized trial: An emergency department-based peer recovery coach intervention to increase opioid use disorder treatment linkage and reduce recurrent overdose
    (Sage, 2024) Watson, Dennis P.; Tillson, Martha; Taylor, Lisa; Xu, Huiping; Ouyang, Fangqian; Beaudoin, Francesca; O’Donnell, Daniel; McGuire, Alan B.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Background: People with opioid use disorder (OUD) frequently present at the emergency department (ED), a potentially critical point for intervention and treatment linkage. Peer recovery support specialist (PRSS) interventions have expanded in US-based EDs, although evidence supporting such interventions has not been firmly established. Methods: Researchers conducted a pragmatic trial of POINT (Project Planned Outreach, Intervention, Naloxone, and Treatment), an ED-initiated intervention for harm reduction and recovery coaching/treatment linkage in 2 Indiana EDs. Cluster randomization allocated patients to the POINT intervention (n = 157) versus a control condition (n = 86). Participants completed a structured interview, and all outcomes were assessed using administrative data from an extensive state health exchange and state systems. Target patients (n = 243) presented to the ED for a possible opioid-related reason. The primary outcome was overdose-related ED re-presentation. Key secondary outcomes included OUD medication treatment linkage, duration of medication in days, all-cause ED re-presentation, all-cause inpatient re-presentation, and Medicaid enrollment. All outcomes were assessed at 3-, 6-, and 12-months post-enrollment. Ad hoc analyses were performed to assess treatment motivation and readiness. Results: POINT and standard care participants did not differ significantly on any outcomes measured. Participants who presented to the ED for overdose had significantly lower scores (3.5 vs 4.2, P < .01) regarding readiness to begin treatment compared to those presenting for other opioid-related issues. Conclusions: This is the first randomized trial investigating overdose outcomes for an ED peer recovery support specialist intervention. Though underpowered, results suggest no benefit of PRSS services over standard care. Given the scope of PRSS, future work in this area should assess more recovery- and harm reduction-oriented outcomes, as well as the potential benefits of integrating PRSS within multimodal ED-based interventions for OUD.