Bradley Ray

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The opioid epidemic is taking an increasingly severe toll on the well-being of Hoosiers. Drug overdose deaths between 1999 and 2014 increased by 500 percent in Indiana. In 2016, more than 80% of the record-number 345 drug overdose deaths in Marion County showed signs of an opioid. Misconceptions about drug users can hinder effective dissemination and implementation of scientific findings into opioid-related prevention and treatment. Dr. Bradley Ray, with colleague Dennis P. Watson, evaluates policy and programmatic responses to the opioid crisis in Indiana.

Dr. Ray’s interdisciplinary research examines the nuances of opioid-related policies and practices to identify and implement evidence-based responses rooted in a harm reduction approach, and his findings have shaped opioid-related policy and practice. With federal support, Dr. Ray and his team recently studied the implementation of Aaron’s Law and found that fear of arrest undercuts the law that shields anyone who administers naloxone, a lifesaving emergency antidote for opioid overdose, from criminal charges. The Indiana State Department of Health uses these results to inform future efforts around naloxone access and use. Other findings have helped guide medication-assisted treatment in Porter, Starke, and Scott counties.

Dr. Brad Ray’s work to disseminate and implement scientific findings into opioid-related policy and practice in Indiana is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.


Recent Submissions

Now showing 1 - 10 of 19
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    Firearm Legislation and Fatal Police Shootings in the United States
    (American Public Health Association, 2017-07) Kivisto, Aaron J.; Ray, Bradley; Phalen, Peter L.; School of Public and Environmental Affairs
    OBJECTIVES: To examine whether stricter firearm legislation is associated with rates of fatal police shootings. METHODS: We used a cross-sectional, state-level design to evaluate the effect of state-level firearm legislation on rates of fatal police shootings from January 1, 2015, through October 31, 2016. We measured state-level variation in firearm laws with legislative scorecards from the Brady Center, and for fatal police shootings we used The Counted, an online database maintained by The Guardian. RESULTS: State-level firearm legislation was significantly associated with lower rates of fatal police shootings (incidence rate ratio = 0.961; 95% confidence interval = 0.939, 0.984). When we controlled for sociodemographic factors, states in the top quartile of legislative strength had a 51% lower incidence rate than did states in the lowest quartile. Laws aimed at strengthening background checks, promoting safe storage, and reducing gun trafficking were associated with fewer fatal police shootings. CONCLUSIONS: Legislative restrictions on firearms are associated with reductions in fatal police shootings. Public Health Implications. Although further research is necessary to determine causality and potential mechanisms, firearm legislation is a potential policy solution for reducing fatal police shootings in the United States.
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    Spatial Concentration of Opioid Overdose Deaths in Indianapolis: An Application of the Law of Crime Concentration at Place to a Public Health Epidemic
    (Sage, 2019-05) Carter, Jeremy G.; Mohler, George; Ray, Bradley; School of Public and Environmental Affairs
    The law of crime concentration at place has become a criminological axiom and the foundation for one of the strongest evidence-based policing strategies to date. Using longitudinal data from three sources, emergency medical service calls, death toxicology reports from the Marion County (Indiana) Coroner’s Office, and police crime data, we provide four unique contributions to this literature. First, this study provides the first spatial concentration estimation of opioid-related deaths. Second, our findings support the spatial concentration of opioid deaths and the feasibility of this approach for public health incidents often outside the purview of traditional policing. Third, we find that opioid overdose death hot spots spatially overlap with areas of concentrated violence. Finally, we apply a recent method, corrected Gini coefficient, to best specify low-N incident concentrations and propose a novel method for improving upon a shortcoming of this approach. Implications for research and interventions are discussed.
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    Barriers and facilitators to implementing an urban co-responding police-mental health team
    (Springer, 2018-11-22) Bailey, Katie; Paquet, Staci Rising; Ray, Bradley R.; Grommon, Eric; Lowder, Evan M.; Sightes, Emily; School of Public and Environmental Affairs
    BackgroundIn an effort to reduce the increasing number of persons with mental illness (PMI) experiencing incarceration, co-responding police-mental health teams are being utilized as a way to divert PMI from the criminal justice system. Co-response teams are typically an inter-agency collaboration between police and mental health professionals, and in some cases include emergency medical personnel. These teams are intended to facilitate emergency response by linking patients to mental health resources rather than the criminal justice system, thus reducing burdens on both the criminal justice systems as well as local healthcare systems. The current study examines the barriers and facilitators of successfully implementing the Mobile Crisis Assistance Team model, a first-responder co-response team consisting of police officers, mental health professionals, and paramedics. Through content analysis of qualitative focus groups with team members and interviews with program stakeholders, this study expands previous findings by identifying additional professional cultural barriers and facilitators to program implementation while also exploring the role of clear, systematic policies and guidelines in program success.ResultsFindings demonstrate the value of having both flexible and formal policies and procedures to help guide program implementation; ample community resources and treatment services in order to successfully refer clients to needed services; and streamlined communication among participating agencies and the local healthcare community. A significant barrier to successful program implementation is that of role conflict and stigma. Indeed, members of the co-response teams experienced difficulty transitioning into their new roles and reported negative feedback from other first responders as well as from within their own agency. Initial agency collaboration, information sharing between agencies, and team building were also identified as facilitators to program implementation.ConclusionThe current study provides a critical foundation for the implementation of first-responder police-mental health co-response teams. Cultural and systematic barriers to co-response team success should be understood prior to program creation and used to guide implementation. Furthermore, attention must be directed to cultivating community and professional support for co-response teams. Findings from this study can be used to guide future efforts to implement first-response co-response teams in order to positively engage PMI and divert PMI from the criminal justice system.
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    Emergency department-based peer support for opioid use disorder: Emergent functions and forms
    (Elsevier, 2019) McGuire, Alan B.; Gilmore Powell, Kristen; Treitler, Peter C.; Wagner, Karla D.; Smith, Krysti P.; Cooperman, Nina; Robinson, Lisa; Carter, Jessica; Ray, Bradley; Watson, Dennis P.; School of Public and Environmental Affairs
    Emergency department (ED)-based peer support programs aimed at linking persons with opioid use disorder (OUD) to medication for addiction treatment and other recovery services are a promising approach to addressing the opioid crisis. This brief report draws on experiences from three states' experience with such programs funded by the SAMHSA Opioid State Targeted Repose (STR) grants. Core functions of such programs include: Integration of peer supports in EDs; Alerting peers of eligible patients and making the patient aware of peer services; and connecting patients with recovery services. Qualitative data were analyzed using a general inductive approach conducted in 3 steps in order to identify forms utilized to fulfill these functions. Peer integration differed in terms of peer's physical location and who hired and supervised peers. Peers often depend on ED staff to alert them to potential patients while people other than the peers often first introduce potential patients to programming. Programs generally schedule initial appointments for recovery services for patients, but some programs provide a range of other services aimed at supporting participation in recovery services. Future effectiveness evaluations of ED-based peer support programs for OUD should consistently report on forms used to fulfill core functions.
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    Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties
    (BioMed Central, 2018-04-06) Watson, Dennis P.; Ray, Bradley; Robison, Lisa; Huynh, Philip; Sightes, Emily; Walker, La Shea; Brucker, Krista; Duwve, Joan; Social and Behavioral Sciences, School of Public Health
    BACKGROUND: To reduce fatal drug overdoses, two approaches many states have followed is to pass laws expanding naloxone access and Good Samaritan protections for lay persons with high likelihood to respond to an opioid overdose. Most prior research has examined attitudes and knowledge among lay responders in large metropolitan areas who actively use illicit substances. The present study addresses current gaps in knowledge related to this issue through an analysis of data collected from a broader group of lay responders who received naloxone kits from 20 local health departments across Indiana. METHODS: Postcard surveys were included inside naloxone kits distributed in 20 Indiana counties, for which 217 returned cards indicated the person completing it was a lay responder. The survey captured demographic information and experiences with overdose, including the use of 911 and knowledge about Good Samaritan protections. RESULTS: Few respondents had administered naloxone before, but approximately one third had witnessed a prior overdose and the majority knew someone who had died from one. Those who knew someone who had overdosed were more likely to have obtained naloxone for someone other than themselves. Also, persons with knowledge of Good Samaritan protections or who had previously used naloxone were significantly more likely to have indicated calling 911 at the scene of a previously witnessed overdose. Primary reasons for not calling 911 included fear of the police and the person who overdosed waking up on their own. CONCLUSIONS: Knowing someone who has had a fatal or non-fatal overdose appears to be a strong motivating factor for obtaining naloxone. Clarifying and strengthening Good Samaritan protections, educating lay persons about these protections, and working to improve police interactions with the public when they are called to an overdose scene are likely to improve implementation and outcomes of naloxone distribution and opioid-related Good Samaritan laws.
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    Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial
    (BMC, 2017-12-15) Watson, Dennis P.; Ray, Bradley; Robison, Lisa; Xu, Huiping; Edwards, Rhiannon; Salyers, Michelle P.; Hill, James; Shue, Sarah; Social and Behavioral Sciences, School of Public Health
    Background There is a lack of evidence-based substance use disorder treatment and services targeting returning inmates. Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT) is a community-driven, recovery-oriented approach to substance abuse care which has the potential to address this service gap. SUPPORT is modeled after Indiana’s Access to Recovery program, which was closed due to lack of federal support despite positive improvements in clients’ recovery outcomes. SUPPORT builds on noted limitations of Indiana's Access to Recovery program. The ultimate goal of this project is to establish SUPPORT as an effective and scalable recovery-oriented system of care. A necessary step we must take before launching a large clinical trial is pilot testing the SUPPORT intervention. Methods The pilot will take place at Public Advocates in Community Re-Entry (PACE), nonprofit serving individuals with felony convictions who are located in Marion County, Indiana (Indianapolis). The pilot will follow a basic parallel randomized design to compare clients receiving SUPPORT with clients receiving standard services. A total of 80 clients within 3 months of prison release will be recruited to participate and randomly assigned to one of the two intervention arms. Quantitative measures will be collected at multiple time points to understand SUPPORT’s impact on recovery capital and outcomes. We will also collect qualitative data from SUPPORT clients to better understand their program and post-discharge experiences. Discussion Successful completion of this pilot will prepare us to conduct a multi-site clinical trial. The ultimate goal of this future work is to develop an evidence-based and scalable approach to treating substance use disorder among persons returning to society after incarceration. Trial registration (Clinical Trials ID: NCT03132753 and Protocol Number: 1511731907). Registered 28 April 2017.
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    Fentanyl related overdose in Indianapolis: Estimating trends using multilevel Bayesian models
    (Addictive Behaviors, 2018-03-20) Phalen, Peter; Ray, Bradley; Watson, Dennis P.; Huynh, Phillip; Green, Marion S.
    Introduction: The opioid epidemic has been largely attributed to changes in prescribing practices over the past 20 years. Although current overdose trends appear driven by the opioid fentanyl, heroin has remained the focus of overdose fatality assessments. We obtained full toxicology screens on lethal overdose cases in a major US city, allowing more accurate assessment of the time-course of fentanyl-related deaths. Methods: We used coroner data from Marion County, Indiana comprising 1583 overdose deaths recorded between January 1, 2010 and April 30, 2017. Bayesian multilevel models were fitted to predict likelihood of lethal fentanyl-related overdose using information about the victim's age, race, sex, zip code, and date of death. Results: Three hundred and seventy-seven (23.8%) overdose deaths contained fentanyl across the seven-year period. Rates rose exponentially over time, beginning well below 15% from 2010 through 2013 before rising to approximately 50% by 2017. At the beginning of the study period, rates of fentanyl overdose were lowest among Black persons but increased more rapidly, eventually surpassing Whites. Currently, White females may be at particularly low risk of fentanyl overdose and Black females at high risk. Rates were highest for younger and middle-aged groups. Over time, fentanyl was more likely detected without the presence of other opioids. Conclusions: Fentanyl has increasingly been detected in fatal overdose deaths in Marion County. Policy and program responses must focus on education for those at highest risk of fentanyl exposure and death. These responses should also be tailored to meet the unique needs of high-risk demographics.
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    Developing a Culturally Proficient Intervention for Young African American Men in Drug Court: Examining Feasibility and Estimating an Effect Size for Habilitation Empowerment Accountability Therapy (HEAT)
    (2018) Marlowe, Douglas B.; Shannon, Lisa M.; Ray, Bradley; Turpin, Darryl P.; Wheeler, Guy A.; Newell, Jennifer; Lawson, Spencer G.
    African American males between 18 and 29 years of age are substantially less likely than many other participants to graduate successfully from drug court. Unsuccessful termination from drug court can have serious repercussions for these young men, including possible incarceration and negative collateral consequences associated with having a criminal record. This article reports preliminary results from two pilot studies that examined the feasibility of implementing a culturally proficient intervention for young African American men in drug court, and estimated an effect size for the intervention in improving treatment retention and reducing termination rates. Results confirmed that participants with serious criminal and substance use histories were willing and able to complete the lengthy 9-month curriculum, were satisfied with the intervention, and graduated from drug court at substantially higher rates than are commonly observed in this at-risk population. A sufficient basis has been established to justify the effort and expense of examining this intervention — Habilitation Empowerment Accountability Therapy (HEAT) — in fully powered randomized controlled trials.
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    Traumatic Brain Injury and Recidivism among Returning Inmates
    (Sage, 2017-03) Ray, Bradley; Richardson, Nicholas J.; School of Public and Environmental Affairs
    In recent years, there has been a surge in research that examines the relationship between traumatic brain injury (TBI) and involvement in the criminal justice system. However, the bulk of this research has been largely retrospective and descriptive, comparing rates of TBI in the offending population with the rates of TBI in the general population. Although findings from these studies indicate a higher prevalence of TBI in the offending population, virtually no studies have examined whether those with TBI are more likely to recidivate. To address this gap, the present study examined rearrest post release from prison among a cohort sample of Indiana inmates who were screened using the Ohio State University Traumatic Brain Injury Identification (OSU-TBI-ID) instrument. Findings indicate that, net of control variables, those with TBI were more likely to recidivate sooner than those without TBI. Policy implications and directions for future research are discussed.
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    Erratum to: Examining Fatal Opioid Overdoses in Marion County, Indiana
    (Springer-Verlag, 2017-04) Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena; School of Public and Environmental Affairs