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
Take-Home Naloxone, Release From Jail, and Opioid Overdose—A Piece of the Puzzle
Balter D, Howell B. Take-Home Naloxone, Release From Jail, and Opioid Overdose—A Piece of the Puzzle. JAMA Network Open 2024, 7: e2448667. PMID: 39656464, DOI: 10.1001/jamanetworkopen.2024.48667.Peer-Reviewed Original ResearchTreatment for Co-Occurring Stimulant and Opioid Use Disorders
Howell B, Lin L, Coughlin L. Treatment for Co-Occurring Stimulant and Opioid Use Disorders. JAMA Psychiatry 2024, 81: 853-854. PMID: 38985457, DOI: 10.1001/jamapsychiatry.2024.1775.Peer-Reviewed Original ResearchPostrelease Risk of Overdose and All-Cause Death Among Persons Released From Jail or Prison: Minnesota, March 2020-December 2021.
Hill K, Bodurtha P, Winkelman T, Howell B. Postrelease Risk of Overdose and All-Cause Death Among Persons Released From Jail or Prison: Minnesota, March 2020-December 2021. American Journal Of Public Health 2024, 114: 913-922. PMID: 39024534, PMCID: PMC11306622, DOI: 10.2105/ajph.2024.307723.Peer-Reviewed Original ResearchConceptsOverdose deathsPrison exposureJailPrisonRisk of overdoseRates of overdose deathsOverdose death ratesOpioid use disorderGeneral populationDeath recordsDrug overdosePeopleStandardized mortality ratioPersonsIncarcerationUse disorderPostreleaseMortality ratioDeath rateRisk of deathRetrospective cohort studyMortality riskCohort studyMinnesotaOverdoseT50 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 ResearchW80 Buprenorphine-Naloxone vs. Extended-Release Naltrexone for Opioid Use Disorder in People With Recent Criminal Legal Involvement: A Secondary Analysis of the X:BOT Randomized Controlled Trial
Balter D, Puglisi L, Dziura J, Fiellin D, Howell B. W80 Buprenorphine-Naloxone vs. Extended-Release Naltrexone for Opioid Use Disorder in People With Recent Criminal Legal Involvement: A Secondary Analysis of the X:BOT Randomized Controlled Trial. Drug And Alcohol Dependence 2024, 260: 110698. DOI: 10.1016/j.drugalcdep.2023.110698.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 Before 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 Before Fatal Opioid-Detected Overdose. Journal Of Studies On Alcohol And Drugs 2024, 85: 815-819. 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 analysisAccessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures
Kim J, Lee J, Thornhill T, Dennett J, Lu H, Howell B, Grau L, Fiellin D, Heimer R, Gonsalves G. Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures. JAMA Network Open 2024, 7: e240209. PMID: 38376839, PMCID: PMC10879949, DOI: 10.1001/jamanetworkopen.2024.0209.Peer-Reviewed Original ResearchConceptsTransit travel timeAccessibility metricsTravel timeTravel componentsAccessibility scoresTransportation burdenTravel burdenOut-of-vehicleComponents of travelConventional accessibility measuresSpatial regression modelsTravel time measurementsPublic transitTransit schedulesAccessibility measuresDeparture timeTravel time analysisTrip durationTravelOperating hoursTime analysisCross-sectional studyOpioid use disorderPolicy recommendationsDecision-makingRacial 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 Prison 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