Michelle Mckenzie

Michelle Mckenzie
Brown University · Department of Medicine

About

59
Publications
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1,307
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Publications

Publications (59)
Article
Background: HIV clinicians are uniquely positioned to treat their patients with opioid use disorder (OUD) using buprenorphine to prevent overdose death. The Prescribe to Save Lives (PtSL) study aimed to increase HIV clinicians' buprenorphine prescribing via an overdose prevention intervention. Methods: The quasi-experimental stepped wedge study...
Article
Full-text available
Objectives Unpredictable fluctuations in the illicit drug market increase overdose risk. Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an overdose prevention strategy with an emerging evidence base. The use of portable spectrometry devices to provide point-of-service analysis of the conten...
Article
Background People with a history of incarceration are at high risk for opioid overdose. A variety of factors contribute to this elevated risk though our understanding of these factors is deficient. Research to identify risk and protective factors for overdose is often conducted using administrative data or researcher-derived surveys and without exp...
Article
Introduction An ED visit for opioid overdose may be a person's only contact with the medical and behavioral health care systems and is an important opportunity to reduce risk of subsequent overdose and death. While ED initiatives to engage people with opioid use disorder (OUD) are being increasingly implemented, there are significant gaps in the re...
Article
Background: Evidence-based interventions that engage community-dwelling, justice-involved, people living with HIV (PLWH) in care are urgently needed. Project Bridge, an intensive case management intervention, has demonstrated efficacy for linking PLWH to care transitioning from prison to the community. We assessed whether a modified Project Bridge...
Article
The U.S. government declared the opioid epidemic as a national public health emergency in 2017, but regulatory frameworks that govern the treatment of opioid use disorder (OUD) through pharmaceutical interventions have remained inflexible. The emergence of the COVID-19 pandemic has effectively removed regulatory restrictions that experts in the fie...
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Full-text available
Background: Fentanyl has caused rapid increases in US and Canadian overdose deaths, yet its presence in illicit drugs is often unknown to consumers. This study examined the validity in identifying the presence of fentanyl of three portable devices that could be used in providing drug checking services and drug supply surveillance: fentanyl test st...
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Full-text available
Safe consumption spaces (SCS) are evidence-based interventions that reduce drug-related morbidity and mortality operating in many countries. However, SCS are yet to be widely implemented in the USA despite the escalating overdose epidemic. The aim of this multi-city study was to identify the factors associated with willingness to use a SCS among pe...
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Full-text available
Background North America is experiencing a rising trend of opioid overdose exacerbated primarily in recent years through adulteration of the heroin supply with fentanyl and its analogues. The east coast of the United States has been particularly hard hit by the epidemic. In three east coast states of Maryland, Massachusetts and Rhode Island, fentan...
Article
The publisher regrets the abstract was incorrect, the correct version is as below. Recently incarcerated individuals are at increased risk of opioid overdose. Methadone maintenance treatment (MMT) is an effective way to address opioid use disorder and prevent overdose; however, few jails and prisons in the United States initiate or continue people...
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Full-text available
Individuals on probation and parole are disproportionately at high risk for HIV infection and experience significant barriers to accessing health care. This study was a two-group randomized controlled trial conducted at a community corrections office and was designed to link HIV positive probationers/parolees to HIV treatment in the community. HIV...
Article
Recently, incarcerated individuals are at increased risk of opioid overdose. Methadone maintenance treatment (MMT) is an effective way to address opioid use disorder and prevent overdose; however, few jails and prisons in the United States initiate or continue people who are incarcerated on MMT. In the current study, the 12 month outcomes of a rand...
Article
Despite the strong correlation between HIV and corrections, testing and prevention efforts have largely been ignored among community corrections populations. The current study is a secondary analysis to compare characteristics of individuals under community corrections supervision who completed rapid HIV testing with those who refused such testing...
Article
Objectives The first 2 weeks following release from prison are associated with extraordinary risk of fatal drug overdose. However, bystanders can reverse opioid overdoses using rescue breathing and naloxone, an overdose antidote. We reviewed overdose prevention and naloxone administration training videos for incarceration-specific and behaviour cha...
Article
Background: Methadone is an effective treatment for opioid dependence. When people who are receiving methadone maintenance treatment for opioid dependence are incarcerated in prison or jail, most US correctional facilities discontinue their methadone treatment, either gradually, or more often, abruptly. This discontinuation can cause uncomfortable...
Article
The challenge of addressing the epidemic of opioid overdose in Rhode Island, and nationwide, is only possible through collaborative efforts among a wide breadth of stakeholders. This article describes the range of efforts by numerous partners that have come together to facilitate community, and treatment-related approaches to address opioid-involve...
Article
Background: Overdose is a leading cause of death for former prisoners, exacting its greatest toll during the first 2 weeks post release. Protective effects have been observed with training individuals at high risk of overdose and prescribing them naloxone, an opioid antagonist that reverses the effects of the opioid-induced respiratory depression...
Article
Introduction/Background: Individuals who accidentally overdose (OD) with opioids, especially those recently released from prison, are at significant risk for death. Investigators initiated a program to assess, educate, equip and reassess at-risk, volunteering prison inmates in opiate OD prevention, recognition and naloxone administration for post-r...
Article
Many probationers and parolees do not receive HIV testing despite being at increased risk for obtaining and transmitting HIV. A two-group randomized controlled trial was conducted between April, 2011 and May, 2012 at probation/parole offices in Baltimore, Maryland and Providence/Pawtucket, Rhode Island. Male and female probationers/parolees were in...
Article
We report here on a feasibility study of initiating buprenorphine/naloxone prior to release from incarceration and linking participants to community treatment providers upon release. The study consisted of a small number of Rhode Island (RI) prisoners (N=44) diagnosed with opioid dependence. The study design is a single arm, open-label pilot study...
Conference Paper
Background: Approximately 20% of incarcerated individuals have a history of opiate use in the US. Methadone maintenance treatment (MMT) is highly effective treatment for opioid addiction and the most utilized treatment nationally. Individuals who are jailed while enrolled in community methadone treatment undergo immediate or gradual withdrawal from...
Conference Paper
Background: HIV testing, prevention, and treatment have been ignored among community corrections populations. Many of these individuals are not tested and are at increased risk for contracting and transmitting HIV. Among individuals who are HIV positive, many are not engaging in care. Through Seek, Test, and Treat (STT) grants, NIDA aims to encoura...
Conference Paper
Background: Buprenorphine/naloxone has been shown to decrease drug use, criminal activity, recidivism, and HIV risk behavior. Methods: This was a single arm pilot study. We enrolled individuals at the Rhode Island Department of Corrections (RIDOC) who screened positive for opioid dependence. Initially, study participants were enrolled pre-release a...
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Full-text available
Individuals who use heroin and illicit opioids are at high risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens, as well as incarceration. The purpose of the randomized trial reported here is to compare outcomes between participants who initiated methadone maintenance treatment (MMT) prior to release from incar...
Article
A case of heroin overdose reversed through the intravenous (IV) administration of a crushed sublingual tablet of buprenorphine/naloxone (Suboxone) by a lay responder is described. Although the sublingual administration of buprenorphine/naloxone to reverse an overdose has been reported elsewhere, this is the first report of IV administration. Health...
Article
Buprenorphine is an effective treatment for opiate dependence. Prisoners with histories of opiate dependence who are inducted on buprenorphine prior to release are at decreased risk of post-release relapse and overdose, yet many clinicians are unaware of the risks related to buprenorphine induction for non-opiate tolerant patients, especially those...
Conference Paper
Nationally, drug poisonings are the second leading cause of accidental death among adults and the leading cause of adult accidental death in Rhode Island (RI) and 15 other states. Drug-related deaths claimed the lives of 193 Rhode Islanders in 2008nearly 4 people each week. Accidental drug intoxications -overdoses- comprise the vast majority of the...
Article
More than 2.4 million people are currently incarcerated in the United States, many as a result of drug-related offenses. In addition, more than 200,000 active heroin addicts pass through the correctional system annually. New evidence suggests that both providing prisoners with referrals for community-based methadone programs and providing methadone...
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Full-text available
Death from opiate overdose is a tremendous source of mortality, with a heightened risk in the weeks following incarceration. The goal of this study is to assess overdose experience and response among long-term opiate users involved in the criminal justice system. One hundred thirty-seven subjects from a project linking opiate-dependent individuals...
Conference Paper
BACKGROUND: Twenty-three percent of state prisoners in the US have a history of opiate addiction. Methadone maintenance treatment (MMT) has been shown to be an effective treatment strategy to decrease drug use, HIV risk behaviors and criminal activity. Opiate addicted offenders re-entering the community are disproportionately affected by risk facto...
Conference Paper
BACKGROUND: Opiate overdose is the leading cause of mortality among opioid users and is preventable. Evidence suggests that pharmacological interventions like prescription naloxone may successfully prevent fatal opiate overdose, numerous such programs are currently operational. METHODS: The training occurs at a storefront located in a high drug tra...
Conference Paper
BACKGROUND: More than 20% of the incarcerated individuals have a history of opiate addiction in the US. Methadone maintenance treatment (MMT) is highly effective treatment. Re-entry is a particularly high risk time for drug relapse, overdose and disease transmission, therefore opportune for public health intervention. We are implementing a SAMHSA f...
Article
Full-text available
In the United States, vigorous enforcement of drug laws and stricter sentencing guidelines over the past 20 years have contributed to an expanded incarcerated population with a high rate of drug use. One in five state prisoners reports a history of injection drug use, and many are opiate dependent. For over 35 years, methadone maintenance therapy h...
Article
Approximately 7 million people in the United States are in jail, in prison, or on probation or parole, many as a result of drug-related offenses. Individuals who use opiates account for a significant minority of this population. Methadone maintenance treatment (MMT) of opiate addiction is highly effective in reducing drug use, drug-related criminal...
Article
Injection drug users (IDUs) are at increased risk for HIV, viral hepatitis, and tuberculosis, and making up more than a quarter of the incarcerated population in the United States. Methadone maintenance treatment of opiate addiction is highly effective at reducing drug use, drug-related criminal activity, and risk of HIV transmission. Recently rele...
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Full-text available
Highly active antiretroviral therapy (HAART) can dramatically decrease human immunodeficiency virus (HIV) load in plasma, increase CD4+ cell counts, and prolong life for HIV-seropositive persons. However, the need for optimal adherence has been recognized. We implemented a pilot community-based program of directly observed therapy (DOT) with HAART...
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Full-text available
Injection drug users (IDUs) are at increased risk for many health problems, including acquisition of human immunodeficiency virus (HIV) and hepatitis B and C. These risks are compounded by barriers in obtaining legal, sterile syringes and in accessing necessary medical care. In 1999, we established the first-ever syringe prescription program in Pro...
Article
Prior to the year 2000, strict laws regulated the purchase and possession of syringes in Rhode Island, USA. More than 50% of the state’s AIDS cases were related to injection drug use, and injecting drug users (IDUs) in Rhode Island reused each syringe, on average, over 20 times. Rhode Island’s syringe exchange programme began in 1995, and has serve...
Article
Efforts to prevent the spread of HIV and hepatitis among injection drug users (IDUs) by improving access to sterile syringes can raise questions about syringe disposal. This study sought to evaluate the acceptability and utility of the Voyager, a newly approved, hand-held syringe disposal device for active injection drug users (IDUs). We offered th...
Article
In order to assess attitudes and practices of physicians regarding prescribing syringes to injection drug users (IDUs) to prevent disease transmission, a survey was conducted at the 2000 ASAM Conference. Of 497 physicians, 104 responded, representing 30 states and 3 countries. Seventy-eight percent provided care for IDUs. Only 2% had prescribed syr...
Article
Based on the model of directly observed therapy (DOT) for tuberculosis, we implemented an uncontrolled pilot program of modified DOT to increase adherence to HAART. Participants met every weekday with an outreach worker who observed them taking the morning dose of HAART. Thirty-seven patients with a history of poor adherence were enrolled and follo...
Article
Full-text available
Injection drug users (IDUs) are a population at high risk for many diseases, including AIDS, and are clearly in need of medical and substance abuse treatment. Access to sterile syringes is critical for lowering the risk of transmission of HIV and other blood-borne pathogens among IDUs. Previously tried strategies include needle exchange programs an...
Article
This article describes the assessment of physicians' attitudes and practices regarding prescribing syringes to injection drug users (IDUs). A brief, anonymous, self-administered questionnaire was sent to all Infectious Disease and Addiction Medicine specialists in Rhode Island. Of 49 eligible physicians, 39 responded (response rate 80%). Most (95%)...
Article
The current epidemic of injection drug use in the United States and abroad has precipitated an increase in transmission of infectious diseases, including human immunodeficiency virus (HIV), hepatitis B, hepatitis C, and human T-lymphotrophic virus II (HTLV-II) in injection drug users (IDUs) who share syringes and other injection equipment. Sharing...
Article
Maintaining study cohorts is a key element of longitudinal research. Participant attrition introduces the possibility of bias and limits the generalizability of a study's findings, but with appropriate planning it is possible to sustain contact with even the most transient participants. This paper reviews the essential elements of tracking and foll...
Article
To the Editor: Highly active antiretroviral therapy (HAART) has been shown to decrease mortality and morbidity in persons infected with human immunodeficiency virus, but adherence to the regimen is essential to a successful outcome.1- 2 With the widespread use of protease inhibitors, directly observed therapy (DOT) with these medications has been p...
Article
A significant number of people are currently misusing and abusing anabolic steroids. Hepatitis B, C, and HIV have all been documented to occur among anabolic steroid injectors (ASIs), most likely from the sharing of injection equipment. A survey was administered to 42 needle exchange programs (NEPs) from 17 states in the US to determine ASI partici...
Article
This study explores obstacles to participation in needle exchange programs (NEPs) among injection drug users (IDUs) in the state of Rhode Island, U.S.A. A written questionnaire was administered at two Rhode Island drug detoxification sites in 1998. 488 self-administered surveys were completed, 226 (46.3%) respondents had injected drugs in the past...
Article
Objective: This study explores obstacles to participation in needle exchange programs (NEPs) among injection drug users (IDUs) in the state of Rhode Island, U.S.A. Methods: A written questionnaire was administered at two Rhode Island drug detoxification sites in 1998. Results: 488 self-administered surveys were completed, 226 (46.3%) respondents ha...

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