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Opioid overdose risk is 10 times greater for those recently released from prison

Findings from OHSU, OSU underscore need for expanded, improved programming to protect people re-entering communities
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Prison exterior with an electric fence. Researchers discover opioid overdose risk is “exceedingly high” among individuals recently released from incarceration—about 10 times that of the general public. (Getty Images)
Researchers discover opioid overdose risk is “exceedingly high” among individuals recently released from incarceration—about 10 times that of the general public. (Getty Images)

People recently released from incarceration face a risk of opioid overdose 10 times greater than the general public, according to researchers at Oregon Health & Science University, Oregon State University and the Oregon Department of Corrections.

The research, which will appear in the April issue of the Journal of Substance Use and Addiction Treatment, also found that risk of overdose is highest among women and in the first two weeks following release from incarceration.

Elizabeth Needham Waddell, Ph.D.
Elizabeth Needham Waddell, M.A., Ph.D., (OHSU)

“Drug overdose, and opioid overdose specifically, is a leading cause of death among people who have recently been in prison — and it’s happening right here in our Oregon communities,” said Elizabeth Waddell, Ph.D., associate professor in the OHSU-PSU School of Public Health and the study’s senior author. “It’s crucial that we do more to identify those who are at highest risk and implement interventions that support the health of these individuals who are at such a pivotal crossroad.”

Roughly 1.4 million people in the United States are held in state and federal prisons, and more than 600,000 are released from custody each year. Additionally, nearly two-thirds of all adults in custody in the United States have a documented substance use disorder.

Despite the large proportion of people with substance use disorders who occupy the criminal justice system, prisons and jails are not equipped to manage the health care needs of these individuals or identify those who are at greatest risk. This research aimed to establish the risk of overdose post-incarceration and open up a broader discussion around strategies to protect people re-entering the community during this vulnerable period.

The multidisciplinary team of experts involved in the research also included Thuan Nguyen, Ph.D., of the OHSU-PSU School of Public Health; Daniel M. Hartung, Pharm.D., M.P.H., and Caitlin McCracken, M.A., of the Oregon State College of Pharmacy; and Katherine Kempany, Ph.D., of the Oregon Department of Corrections.

Unique dataset

Using an innovative dataset that linked prison release, Medicaid records, hospital discharge data and death records in the state of Oregon, researchers were able to estimate the risk of both fatal and nonfatal overdoses among recently released individuals. Analysis showed that the frequency of overdose was “exceedingly high” among this population — about 10 times that of the general public.

Additionally, researchers were able to specifically examine overdose risk by sex, finding that women experience a significantly higher rate of opioid overdose compared with men. The risk was also higher among those with additional mental health or substance use disorder treatment needs.

In recent years, the Oregon Department of Corrections has significantly expanded efforts to support incarcerated individuals facing substance use disorder, the agency said. This includes a medication program that continues established treatment upon incarceration and offers eligible patients a medication protocol within 13 months of their predicted release date. While existing efforts have improved outcomes, researchers emphasize that criminal justice institutions must continue to develop and scale programs.

Daniel Hartung, Pharm.D., M.P.H.
Daniel Hartung, Pharm.D., M.P.H. (OHSU)

“Many people with substance use disorders end up in the criminal justice system, and prisons and jails have historically not been equipped to manage the health care needs of these individuals,” said Hartung, the study’s lead author.

Looking forward, researchers recommend expanded access to lifesaving medications for opioid use disorder and other harm-reduction strategies, such as increased availability of Narcan, both during and after their release into the community.

“We need to make sure everyone in the criminal justice system has access to the treatment and resources they need,” Waddell said. “It’s up to us to ensure these individuals can stay safe, healthy and be able to successfully re-enter the community.”

This research was funded by the Centers for Disease Control and Prevention (CDC Agency Award Number: 1 R01 CE003008-01-00).

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