Non-fatal drug overdose after release from prison: A prospective data linkage study

Keen, Claire; Young, Jesse T; Borschmann, Rohan; Kinner, Stuart A

doi:10.1016/j.drugalcdep.2019.107707

Cited by 31 publications

(38 citation statements)

References 69 publications

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“…Given that the 4-week period after release from prison has been associated with an increased risk in both fatal and non-fatal overdose events, 16,23 it is essential to ensure that people have access to MOUD, alcohol treatment, and other drug treatments while in prison, and that this care continues uninterrupted after release from prison, to reduce the occurrence of overdose during this period. Our study also found an increased risk of non-fatal overdose on the day of incarceration.…”

Section: Discussionmentioning

confidence: 99%

“…22 However, individual studies have identified an increased risk of non-fatal overdose following release from incarceration. 5,23 The inconsistency between study findings could be due to the reliance on self-reported nonfatal overdose in many studies, thus reducing the ability to accurately determine the time-dependent nature of the association between exposure and the non-fatal overdose.…”

Section: Introductionmentioning

confidence: 99%

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Periods of altered risk for non-fatal drug overdose: a self-controlled case series

Keen

Kinner

Young

et al. 2021

The Lancet Public Health

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Background Being recently released from prison or discharged from hospital, or being dispensed opioids, benzodiazepines, or antipsychotics have been associated with an increased risk of fatal drug overdose. This study aimed to examine the association between these periods and non-fatal drug overdose using a within-person design.Methods In this self-controlled case series, we used data from the provincial health insurance client roster to identify a 20% random sample of residents (aged ≥10 years) in British Columbia, Canada between Jan 1, 2015, and Dec 31, 2017 (n=921 346). Individuals aged younger than 10 years as of Jan 1, 2015, or who did not have their sex recorded in the client roster were excluded. We used linked provincial health and correctional records to identify a cohort of individuals who had a non-fatal overdose resulting in medical care during this time period, and key exposures, including periods of incarceration, admission to hospital, emergency department care, and supply of medications for opioid use disorder (MOUD), opioids for pain (unrelated to MOUD), benzodiazepines, and antipsychotics. Using a self-controlled case series, we examined the association between the time periods during and after each of these exposures and the incidence of non-fatal overdose with case-only, conditional Poisson regression analysis. Sensitivity analyses included recurrent overdoses and pre-exposure risk periods. FindingsWe identified 4149 individuals who had a non-fatal overdose in 2015-17. Compared with unexposed periods (ie, all follow-up time that was not part of a designated risk period for each exposure), the incidence of non-fatal overdose was higher on the day of admission to prison (adjusted incidence rate ratio [aIRR] 2•76 [95% CI 1•51-5•04]), at 1-2 weeks (2•92 [2•37-3•61]), and 3-4 weeks (1•34 [1•01-1•78]) after release from prison, 1-2 weeks after discharge from hospital (1•35 [1•11-1•63]), when being dispensed opioids for pain (after ≥4 weeks) or benzodiazepines (entire use period), and from 3 weeks after discontinuing antipsychotics. The incidence of non-fatal overdose was reduced during use of MOUD (aIRRs ranging from 0•33 [0•26-0•42] to 0•41 [0•25-0•67]) and when in prison (0•12 [0•08-0•19]).Interpretation Expanding access to and increasing support for stable and long-term medication for the management of opioid use disorder, improving continuity of care when transitioning between service systems, and ensuring safe prescribing and medication monitoring processes for medications that reduce respiratory function (eg, benzodiazepines) could decrease the incidence of non-fatal overdose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Periods of altered risk for non-fatal drug overdose: a self-controlled case series

Keen

Kinner

Young

et al. 2021

The Lancet Public Health

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“…This is especially important among people with co-occurring serious mental illness and substance use; 18 a particularly vulnerable population who experience high levels of poor health and social outcomes post release from prison. [19][20][21] Preventing imprisonment among people with co-occurring mental illness and substance use may also be achieved through diversion to appropriate mental health services at various points prior to, and when moving through the criminal justice system. 22,23 Holistically addressing pertinent social factors via mental health services, such as housing instability, 24,25 may also reduce offending and prevent entry into secure custodial settings.…”

Section: Discussionmentioning

confidence: 99%

Mental Health Contact Episodes in the Year Prior to First Adult Imprisonment Among Men Who Inject Drugs in Victoria, Australia

Stewart¹,

Cossar²,

Al³

et al. 2021

Preprint

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Background: People in prison experience higher rates of mental illness than the general community, and commonly have cooccurring histories of drug dependence. While patterns of mental health service contacts following prison release have been extensively described, limited research has explored histories of service contacts prior to adult imprisonment. We describe public mental health contacts in the 12 months prior to first adult imprisonment among a cohort of men recruited in prison in Victoria, Australia, with recent histories of injecting drug use (IDU).Methods: Retrospective data from two administrative databases — public mental health service contacts from the Victorian state-wide public mental health database and imprisonment episodes from Corrections Victoria — were linked to primary data from the Prison and Transition Health (PATH) cohort study. We describe patterns of mental health contact episodes (contact days) and contact types, including continuing community care (categorised as non-urgent care) and crisis/emergency contacts (categorised as urgent) in the 12 months prior to participants’ first adult imprisonment.Results: Among 400 participants, 60 (15%) had contact with a mental health service in the year prior to their first adult imprisonment, accounting for 861 contact episodes [median 5; interquartile range (IQR) 2–11]. The median days between last contact and imprisonment was 52 (IQR 7–116) and the median days between contacts was three (IQR 1–7). Of the total contacts, 52% (n=450/861) were for continuing community care and 27% (n=234/861) involved crisis assessment treatment; 42 (70%) participants with mental health service contacts had at least one crisis/emergency contact within one year of their first adult imprisonment. Conclusion: We found that 15% of a cohort of men with histories of IDU had mental health service contacts in the 12 months prior to their first adult imprisonment. These contacts were typically frequent and more than one in four involved crisis/emergency care. These findings highlight significant vulnerabilities and potential missed opportunities for intervention early in offending trajectories. Further research is required to understand how these vulnerabilities can be better identified and more appropriately addressed in-community to reduce pathways into prison.

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“…In addition to this relationship, the high risk of overdose following incarceration demands attention. Even after years of incarceration, people with OUD are at high risk of opioid relapse and overdose, as well as recidivism upon community re-entry (Binswanger, Nguyen, Morenoff, Xu, & Harding, 2020 ; Bukten et al, 2017 ; Keen, Young, Borschmann, & Kinner, 2020 ; Winter et al, 2015 ). The risk of death from opioid overdose is particularly high in the immediate period following release from prison, with one study showing a 40-fold increase in risk of opioid overdose fatality among individuals in the two weeks following their release from prison, compared with the general population (Ranapurwala et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of the opioid crisis on U.S. state prison systems

et al. 2021

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Background Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). Methods A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. Results MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. Conclusion Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.

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Non-fatal drug overdose after release from prison: A prospective data linkage study

Cited by 31 publications

References 69 publications

Periods of altered risk for non-fatal drug overdose: a self-controlled case series

Periods of altered risk for non-fatal drug overdose: a self-controlled case series

Mental Health Contact Episodes in the Year Prior to First Adult Imprisonment Among Men Who Inject Drugs in Victoria, Australia

The impact of the opioid crisis on U.S. state prison systems

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