Opioid Overdose Deaths Among Formerly Incarcerated Persons and the General Population: North Carolina, 2000‒2018

Ranapurwala, Shabbar I.; Figgatt, Mary; Remch, Molly; Brown, Carrie; Brinkley‐Rubinstein, Lauren; Rosen, David L.; Cox, Mary E.; Proescholdbell, Scott

doi:10.2105/ajph.2021.306621

Cited by 14 publications

(9 citation statements)

References 6 publications

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“…That study also found that SMR for drug toxicity deaths in the year postrelease was 11.6 compared with others in the general population, 21 which is much smaller than the SMR in our study—31.2—though not directly comparable. Ranapurwala et al 24 similarly identified a substantial increase in opioid overdose death rates and SMRs for formerly incarcerated persons in North Carolina between 2017 and 2018, largely attributable to the rise in synthetic opioids over this period.…”

Section: Discussionmentioning

confidence: 98%

Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study

Butler

Croxford²,

Bodkin

et al. 2023

BMJ Open

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ObjectivesTo describe mortality due to opioid toxicity among people who experienced incarceration in Ontario between 2015 and 2020, during the fentanyl-dominant era.DesignIn this retrospective cohort study, we linked Ontario coronial data on opioid toxicity deaths between 2015 and 2020 with correctional data for adults incarcerated in Ontario provincial correctional facilities.SettingOntario, Canada.ParticipantsWhole population data.Main outcomes and measuresThe primary outcome was opioid toxicity death and the exposure was any incarceration in a provincial correctional facility between 2015 and 2020. We calculated crude death rates and age-standardised mortality ratios (SMR).ResultsBetween 2015 and 2020, 8460 people died from opioid toxicity in Ontario. Of those, 2207 (26.1%) were exposed to incarceration during the study period. Among those exposed to incarceration during the study period (n=1 29 152), 1.7% died from opioid toxicity during this period. Crude opioid toxicity death rates per 10 000 persons years were 43.6 (95% CI=41.8 to 45.5) for those exposed to incarceration and 0.95 (95% CI=0.93 to 0.97) for those not exposed. Compared with those not exposed, the SMR for people exposed to incarceration was 31.2 (95% CI=29.8 to 32.6), and differed by sex, at 28.1 (95% CI=26.7 to 29.5) for males and 77.7 (95% CI=69.6 to 85.9) for females. For those exposed to incarceration who died from opioid toxicity, 10.6% died within 14 days of release and the risk was highest between days 4 and 7 postrelease, at 288.1 per 10 000 person years (95% CI=227.8 to 348.1).ConclusionsThe risk of opioid toxicity death is many times higher for people who experience incarceration compared with others in Ontario. Risk is markedly elevated in the week after release, and women who experience incarceration have a substantially higher SMR than men who experience incarceration. Initiatives to prevent deaths should consider programmes and policies in correctional facilities to address high risk on release.

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Section: Discussionmentioning

confidence: 98%

Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study

Butler

Croxford²,

Bodkin

et al. 2023

BMJ Open

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“…Recently incarcerated participants had a higher prevalence of injection drug use and overdose, suggestive of greater SUD severity. The high rate of recent overdose among recently incarcerated PWUD is both expected and alarming . A qualitative study of persons recently released from prison revealed an association between overdose risk and the distress generated by the challenges of reentry, such as surviving homelessness, managing exacerbated mental illness, and struggling to access health care .…”

Section: Discussionmentioning

confidence: 99%

“…In the 2 weeks following prison release, risk of opioid overdose is extremely high, and the risk of death from synthetic opioid overdose is 50 times greater than the general population . Medications for opioid use disorder, including US Food and Drug Administration–approved formulations of methadone, buprenorphine, and injectable naltrexone, are effective and lifesaving pharmacotherapy options and have been well-studied during incarceration .…”

Section: Introductionmentioning

confidence: 99%

Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities

Hoover,

Korthuis,

Waddell

et al. 2023

JAMA Netw Open

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ImportanceDrug use and incarceration have a substantial impact on rural communities, but factors associated with the incarceration of rural people who use drugs (PWUD) have not been thoroughly investigated.ObjectiveTo characterize associations between recent incarceration, overdose, and substance use disorder (SUD) treatment access among rural PWUD.Design, Setting, and ParticipantsFor this cross-sectional study, the Rural Opioid Initiative research consortium conducted a survey in geographically diverse rural counties with high rates of overdose across 10 US states (Illinois, Wisconsin, North Carolina, Oregon, Kentucky, West Virginia, Ohio, Massachusetts, New Hampshire, and Vermont) between January 25, 2018, and March 17, 2020, asking PWUD about their substance use, substance use treatment, and interactions with the criminal legal system. Participants were recruited through respondent-driven sampling in 8 rural US regions. Respondents who were willing to recruit additional respondents from their personal networks were enrolled at syringe service programs, community support organizations, and through direct community outreach; these so-called seed respondents then recruited others. Of 3044 respondents, 2935 included participants who resided in rural communities and reported past-30-day injection of any drug or use of opioids nonmedically via any route. Data were analyzed from February 8, 2022, to September 15, 2023.ExposureRecent incarceration was the exposure of interest, defined as a report of incarceration in jail or prison for at least 1 day in the past 6 months.Main Outcomes and MeasuresThe associations between PWUD who were recently incarcerated and main outcomes of treatment use and overdose were examined using logistic regression.ResultsOf 2935 participants, 1662 (56.6%) were male, 2496 (85.0%) were White; the mean (SD) age was 36 (10) years; and in the past 30 days, 2507 (85.4%) reported opioid use and 1663 (56.7%) reported injecting drugs daily. A total of 1224 participants (41.7%) reported recent incarceration, with a median (IQR) incarceration of 15 (3-60) days in the past 6 months. Recent incarceration was associated with past-6-month overdose (adjusted odds ratio [AOR], 1.38; 95% CI, 1.12-1.70) and recent SUD treatment (AOR, 1.62; 95% CI, 1.36-1.93) but not recent medication for opioid use disorder (MOUD; AOR, 1.03; 95% CI, 0.82-1.28) or currently carrying naloxone (AOR, 1.02; 95% CI, 0.86-1.21).Conclusions and RelevanceIn this cross-sectional study of PWUD in rural areas, participants commonly experienced recent incarceration, which was not associated with MOUD, an effective and lifesaving treatment. The criminal legal system should implement effective SUD treatment in rural areas, including MOUD and provision of naloxone, to fully align with evidence-based SUD health care policies.

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“…Dep Var: Overdose Death Rate (1) (2) (3) (4) (5) Fentanyl seizures per capita (asinh) Washington's unique policy trajectory also influences our interpretation of results. There may be carryover effects of the Blake decision that continue to shape police and consumer behavior after the state recriminalized drugs.…”

Section: Supplemental Materials Etable 1: Fentanyl Saturation (Per Ca...mentioning

confidence: 99%

“…Amid an overdose mortality crisis that has yielded historic reductions in US life expectancy, evidence has emerged that a punitive response to drug possession exacerbates overdose mortality risk, especially among people with opioid use disorder: release from incarceration is associated with a substantially elevated risk of fatal overdose, 1,2 and police drug seizures were spatiotemporally associated with increased fatal overdose in a large US city. 3 Moreover, fear of arrest for drugs, drug paraphernalia, or outstanding warrants has been shown to deter timely calls to 911 during overdose events.…”

Section: Introductionmentioning

confidence: 99%

Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon

Zoorob,

Park,

Kral

et al. 2024

Preprint

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Importance: With the implementation of Measure 110 (M110), Oregon became the first state in the United States to decriminalize personal possession of all drugs. No analysis of the effect of this law on overdose mortality has fully accounted for the introduction of fentanyl to Oregon's unregulated drug market, a substance known to drive fatal overdose rates. Objective: To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the timing and spread of fentanyl through Oregon's unregulated drug market. Design, Setting, and Participants: The association between fatal drug overdose and enactment of M110 in Oregon was analyzed using a matrix completion synthetic control method. The synthetic control unit was imputed from the 48 US states and Washington DC that did not decriminalize drugs. The rapid escalation of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogs. A changepoint analysis was used to determine when each state experienced a rapid escalation of fentanyl in its unregulated drug market. Mortality data were obtained from the Centers for Disease Control and Prevention from 2008-2022. Exposures: M110 took effect on February 1, 2021. Main Outcome: Fatal drug overdose rates per half-year. Results: Analysis indicated a rapid escalation of fentanyl in Oregon's unregulated drug supply occurred in the first half of 2021, contemporaneous with the enactment of M110. The crude association between decriminalization and fatal overdose rate per 100,000 per half-year was significant (Tau = 1.83; SE = 0.39; p < 0.001); however, adjusting for the rapid escalation of fentanyl as a confounder, the effect of drug decriminalization on overdose mortality in Oregon was null (Tau = -0.51; SE = 0.36). Sensitivity analyses were consistent with this result. Conclusions and Relevance: After adjusting for the rapid escalation of fentanyl, analysis found no association between M110 and fatal drug overdose rates. Future evaluations of the health effects of drug policies should account for confounding changes in the composition and potency of unregulated drug markets.

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Opioid Overdose Deaths Among Formerly Incarcerated Persons and the General Population: North Carolina, 2000‒2018

Cited by 14 publications

References 6 publications

Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study

Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study

Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities

Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon

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