Featured Publications
Evaluation of Changes in US Health Insurance Coverage for Individuals With Criminal Legal Involvement in Medicaid Expansion and Nonexpansion States, 2010 to 2017
Howell BA, Hawks L, Wang EA, Winkelman TNA. Evaluation of Changes in US Health Insurance Coverage for Individuals With Criminal Legal Involvement in Medicaid Expansion and Nonexpansion States, 2010 to 2017. JAMA Health Forum 2022, 3: e220493. PMID: 35977325, PMCID: PMC8994123, DOI: 10.1001/jamahealthforum.2022.0493.Peer-Reviewed Original ResearchA prospective cohort study examining exposure to incarceration and cardiovascular disease (Justice-Involved Individuals Cardiovascular Disease Epidemiology – JUSTICE study): a protocol paper
Howell BA, Puglisi LB, Aminawung J, Domingo KB, Elumn J, Gallagher C, Horton N, Kazi DS, Krumholz HM, Lin HJ, Roy B, Wang EA. A prospective cohort study examining exposure to incarceration and cardiovascular disease (Justice-Involved Individuals Cardiovascular Disease Epidemiology – JUSTICE study): a protocol paper. BMC Public Health 2022, 22: 331. PMID: 35172807, PMCID: PMC8848673, DOI: 10.1186/s12889-022-12688-x.Peer-Reviewed Original ResearchConceptsCardiovascular risk factorsProspective cohort studyRisk factorsCardiovascular diseaseCardiovascular riskCohort studyCVD riskPsychosocial factorsCVD risk factor controlRisk factor controlClinical risk factorsTraditional risk factorsHealth care useIncarceration exposureIndex releaseCVD morbidityCVD incidenceJail/prisonCare useDiscussionOur studyLeading causeClinical measuresPsychosocial stressEpidemiology studiesProtocol paperThe Stigma of Criminal Legal Involvement and Health: a Conceptual Framework
Howell BA, Earnshaw VA, Garcia M, Taylor A, Martin K, Fox AD. The Stigma of Criminal Legal Involvement and Health: a Conceptual Framework. Journal Of Urban Health 2022, 99: 92-101. PMID: 35031942, PMCID: PMC8866593, DOI: 10.1007/s11524-021-00599-y.Peer-Reviewed Original Research
2024
T50 Receipt of Prescribed Opioids and Benzodiazepines After Non-Fatal Overdose and Risk of Subsequent Overdose
Howell B, Black A, Lin H, Lauretta G, Heimer R, Hawk K, D'Onofrio G, Fiellin D, Becker W. T50 Receipt of Prescribed Opioids and Benzodiazepines After Non-Fatal Overdose and Risk of Subsequent Overdose. Drug And Alcohol Dependence 2024, 260: 110499. DOI: 10.1016/j.drugalcdep.2023.110499.Peer-Reviewed Original ResearchT42 Treatment Setting Among Individuals With Opioid Use and Criminal Legal Involvement, Housing Instability, or Medicaid Insurance, 2015-2020
Shearer R, Howell B, Khatri U, Winkelman T. T42 Treatment Setting Among Individuals With Opioid Use and Criminal Legal Involvement, Housing Instability, or Medicaid Insurance, 2015-2020. Drug And Alcohol Dependence 2024, 260: 110491. DOI: 10.1016/j.drugalcdep.2023.110491.Peer-Reviewed Original ResearchBuprenorphine-naloxone vs. extended-release naltrexone for opioid use disorder in individuals with and without criminal legal involvement: A secondary analysis of the X:BOT randomized controlled trial
Balter D, Puglisi L, Dziura J, Fiellin D, Howell B. Buprenorphine-naloxone vs. extended-release naltrexone for opioid use disorder in individuals with and without criminal legal involvement: A secondary analysis of the X:BOT randomized controlled trial. Journal Of Substance Use And Addiction Treatment 2024, 164: 209438. PMID: 38857827, PMCID: PMC11300157, DOI: 10.1016/j.josat.2024.209438.Peer-Reviewed Original ResearchXR-NTXBuprenorphine-naloxoneOpioid use disorderCriminal legal involvementUse disorderHazard of overdoseLifetime incarcerationLegal involvementOpioid use disorder treatment outcomesPer-protocol analysisExtended-release naltrexoneMOUD effectivenessTreatment outcomesEffects of medicationHazard of relapseSecondary analysisIntention-to-treat analysisIntention-to-treatRandomized controlled trialsEffects of MOUDRelapseControlled trialsDisordersOpioidPotential effect modifiersPrescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose.
Kazemitabar M, Howell B, Becker W, Lin H, Grau L, Heimer R, D'Onofrio G, Hawk K, Fiellin D, Black A. Prescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose. Journal Of Studies On Alcohol And Drugs 2024 PMID: 38775307, DOI: 10.15288/jsad.24-00026.Peer-Reviewed Original ResearchPrescribed opioidsOpioid dose changesRapid dose increaseNon-HispanicOverdose deathsToxicological resultsNon-prescription opioidsBlack non-HispanicMorphine equivalentsOpioid therapyWhite non-HispanicDose changesDaily doseMean ageDispensed opioidsPrescription opioidsPrescribing patternsOpioidDose increaseOpioid overdose crisisIncreasing dosesStudy investigated patternsEffect of timeEffects of ageSecondary analysisRacial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources—United States, 2010-2019
Shearer R, Segel J, Howell B, Jones A, Khatri U, da Silva D, Vest N, Winkelman T. Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources—United States, 2010-2019. Medical Care 2024, 62: 151-160. PMID: 38180005, PMCID: PMC10922552, DOI: 10.1097/mlr.0000000000001969.Peer-Reviewed Original ResearchOverdose deathsSubstance useTreatment admissionsCocaine useTreatment Episode Data Set-AdmissionsOverdose crisisMultiple causesMultiple substancesComprehensive surveillance dataCross-sectional analysisSubstance-related measuresPublic health officialsEthnic groupsRate of useSelf-reported useTreatment strategiesDeath filesNational data sourcesOverdose mortalityDrug useSpecific substancesMortality trendsSurveillance dataAdmissionEffective prevention
2023
Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants
Segel J, Shearer R, Jones A, Khatri U, Howell B, Crowley D, Sterner G, Vest N, da Silva D, Winkelman T. Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants. Substance Use & Misuse 2023, 59: 558-566. PMID: 38037904, PMCID: PMC10923074, DOI: 10.1080/10826084.2023.2287220.Peer-Reviewed Original ResearchOverdose mortalityHigh opioidCross-sectional observational studyOverdose mortality ratesOverdose patternsConcurrent opioidIndex percentileObservational studyOpioidsOverdose ratesUnadjusted modelsOverdose deathsMortality filesMortality rateDisease preventionPercentage point increaseSVI scoresMortalityOverdose crisisPsychostimulantsMultiple substancesTreatment planningSubstantial regional variationPoint increaseAccess centerReceipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17
Heimer R, Black A, Lin H, Grau L, Fiellin D, Howell B, Hawk K, D'Onofrio G, Becker W. Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17. Drug And Alcohol Dependence 2023, 254: 111040. PMID: 38043226, PMCID: PMC10872282, DOI: 10.1016/j.drugalcdep.2023.111040.Peer-Reviewed Original ResearchConceptsNon-medication treatmentsRelative riskOpioid overdose deathsIncidence rateMOUD treatmentOverdose deathsOpioid use disorder treatmentResults Incidence ratesRetrospective cohort studyDifferent treatment modalitiesPopulation-level effortsUse disorder treatmentFatal opioid poisoningsCohort studyOpioid poisoningTreatment modalitiesConclusion ExposurePoisoning deathsFatal overdosesTreatment exposureDisorder treatmentDeathTreatmentMethadoneRiskTreatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021
Shearer R, Howell B, Khatri U, Winkelman T. Treatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021. Drug And Alcohol Dependence Reports 2023, 8: 100179. PMID: 37502021, PMCID: PMC10368753, DOI: 10.1016/j.dadr.2023.100179.Peer-Reviewed Original ResearchMedicaid insuranceTreatment settingsDoctor's officeReceipt of MOUDHousing instabilityOpioid use disorderMultivariable logistic regressionCross-sectional studyMental health facilitiesLower ratesMOUD useOpioid useHealth facilitiesProportion of individualsMOUDUse disordersMultiple treatment settingsLogistic regressionLegal involvementHigher likelihoodTreatmentRole TreatmentSimilar ratesLow incomeVariety of settingsHealth Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion
Howell B, Hawks L, Balasuriya L, Chang V, Wang E, Winkelman T. Health Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion. Psychiatric Services 2023, 74: 1019-1026. PMID: 37016823, PMCID: PMC10939137, DOI: 10.1176/appi.ps.20220171.Peer-Reviewed Original ResearchConceptsHealth insurance coverageMental disordersMedicaid expansionSubstance useInsurance coverageTreatment useMental health treatment useAffordable Care Act Medicaid expansionMental health treatmentSubstance use disordersFederal poverty levelUse of treatmentsLegal involvementLow health insurance coverageNSDUH respondentsUse disordersHealth treatmentDrug useMental illnessPercentage point increaseAge 18Insurance accessDisordersHealth insuranceTreatmentThe case for transitional services and programs for older adults reentering society: a narrative review of US departments of correction and recommendations
Onyeali R, Howell B, McInnes D, Emerson A, Williams M. The case for transitional services and programs for older adults reentering society: a narrative review of US departments of correction and recommendations. International Journal Of Prisoner Health 2023, 19: 4-19. PMID: 36757114, PMCID: PMC10123961, DOI: 10.1108/ijph-08-2021-0073.Peer-Reviewed Original ResearchSocial servicesIncarcerated older adultsHousing availabilityPolicy recommendationsPolicy changesSupport networksTransitional servicesComplex health needsService needsOlder adultsHealth careIncarcerationBroader perspectiveHealth needsHealth service needsNarrative literature reviewUniformity of careCommunityComplex health conditionsServicesReentryPrimary barrierUS DepartmentUSALiterature reviewConcordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis
Howell B, Black A, Grau L, Lin H, Greene C, Lee H, Heimer R, Hawk K, D'Onofrio G, Fiellin D, Becker W. Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis. Drug And Alcohol Dependence 2023, 244: 109788. PMID: 36738634, PMCID: PMC9975083, DOI: 10.1016/j.drugalcdep.2023.109788.Peer-Reviewed Original ResearchConceptsPost-mortem toxicologyOverdose deathsChief Medical ExaminerBenzodiazepine prescribingBenzodiazepine prescriptionsPrimary outcomePreventable deathsOpioid overdosesOpioidsAddiction servicesBenzodiazepinesMental healthStudy periodDeathMedical examinersConcordanceStatewide analysisSubstantial numberReceiptDaysDepartmentMedicationsToxicologyFentanylPrescribing
2022
Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model
Tsai J, Havlik J, Howell B, Johnson E, Rosenthal D. Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model. Journal Of General Internal Medicine 2022, 38: 765-783. PMID: 36443628, PMCID: PMC9971390, DOI: 10.1007/s11606-022-07970-y.Peer-Reviewed Original ResearchConceptsHomeless Patient Aligned Care TeamPrimary care medical home modelsVeterans' healthOnly original research studiesNarrative reviewPatient Aligned Care TeamsCare team modelPrimary care utilizationEmergency department utilizationMedical home modelDatabases Ovid MEDLINEPositive patient experienceVeterans Experiencing HomelessnessOriginal research studiesCare utilizationOvid EmbasePrimary careCare teamOvid MEDLINEInclusion criteriaPatient experiencePeer-reviewed studiesHome modelHealthcare outcomesVA system
2021
Peer Review of “SARS-CoV-2 Vaccination Uptake in a Correctional Setting: Cross-sectional Study”
Howell B. Peer Review of “SARS-CoV-2 Vaccination Uptake in a Correctional Setting: Cross-sectional Study”. JMIRx Med 2021, 2: e31905. PMCID: PMC10414330, DOI: 10.2196/31905.Peer-Reviewed Original ResearchChanges In Health Services Use After Receipt Of Medications For Opioid Use Disorder In A Statewide Correctional System
Howell BA, Martin RA, Lebeau R, Truong AQ, Wang EA, Rich JD, Clarke JG. Changes In Health Services Use After Receipt Of Medications For Opioid Use Disorder In A Statewide Correctional System. Health Affairs 2021, 40: 1304-1311. PMID: 34339247, PMCID: PMC9036835, DOI: 10.1377/hlthaff.2020.02156.Peer-Reviewed Original ResearchConceptsOpioid use disorderReceipt of medicationHealth care useHealth service useCare useService useUse disordersTotal health care costsEmergency department visitsCorrectional settingsOpioid overdose mortalityEvidence-based treatmentsHealth care costsHealth care servicesRhode Island DepartmentUnified jailDepartment visitsPharmacy claimsInpatient admissionsMedicationsOutpatient servicesOverdose mortalityCare costsCare servicesAddiction treatmentThe Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A hybrid type-1 effectiveness trial of enhanced primary care to improve opioid use disorder treatment outcomes following release from jail
Howell BA, Puglisi L, Clark K, Albizu-Garcia C, Ashkin E, Booth T, Brinkley-Rubinstein L, Fiellin DA, Fox AD, Maurer KF, Lin HJ, McCollister K, Murphy S, Morse DS, Shavit S, Wang K, Winkelman T, Wang EA. The Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A hybrid type-1 effectiveness trial of enhanced primary care to improve opioid use disorder treatment outcomes following release from jail. Journal Of Substance Use And Addiction Treatment 2021, 128: 108315. PMID: 33583610, PMCID: PMC8319218, DOI: 10.1016/j.jsat.2021.108315.Peer-Reviewed Original ResearchConceptsTransitions Clinic NetworkOpioid use disorderPrimary careTreatment cascadeClinic networkOpioid Use Disorder Treatment OutcomesMedical needData Safety Monitoring BoardStandard primary careCommunity health centersCommunity health workersPrimary care teamsSafety monitoring boardCause of deathDisorder treatment outcomesPatient's medical needsHistory of incarcerationPolicy-level barriersOUD treatmentCare teamEffectiveness trialHealth centersTreatment outcomesCommon causeOpioid overdose
2019
Health, Social Reform, and Medical Schools - The Training of American Physicians and the Dissenting Tradition.
Chowkwanyun M, Howell B. Health, Social Reform, and Medical Schools - The Training of American Physicians and the Dissenting Tradition. The New England Journal Of Medicine 2019, 381: 1870-1875. PMID: 31693812, DOI: 10.1056/NEJMms1907237.Peer-Reviewed Original ResearchMental Health Treatment Among Individuals Involved in the Criminal Justice System After Implementation of the Affordable Care Act
Howell BA, Wang EA, Winkelman TNA. Mental Health Treatment Among Individuals Involved in the Criminal Justice System After Implementation of the Affordable Care Act. Psychiatric Services 2019, 70: 765-771. PMID: 31138056, DOI: 10.1176/appi.ps.201800559.Peer-Reviewed Original ResearchConceptsMental health treatmentHealth insurance coverageCriminal justice involvementHealth treatmentAffordable Care ActInsurance coveragePast-year criminal justice involvementJustice involvementMultivariable logistic regressionCare ActSerious psychological distressGeneral populationDrug useLogistic regressionAdjusted estimatesPsychological distressTreatmentNational surveyInvolvementStudy yearsPercentage pointsIndividualsPast yearYears