Lia N Pizzicato1, Rebecca Drake2, Reed Domer-Shank3, Caroline C Johnson4, Kendra M Viner5. 1. Philadelphia Department of Public Health, Opioid Surveillance, Epidemiology, and Prevention Program, 1101 Market St., Suite 1320, Philadelphia, PA 19107, USA; CSTE Applied Epidemiology Fellowship, 2872 Woodcock Blvd., Suite 250, Atlanta, GA 30341, USA. Electronic address: lia.pizzicato@phila.gov. 2. Philadelphia Department of Public Health, Medical Examiner's Office, 321 University Ave., Philadelphia, PA 19104, USA. 3. Philadelphia Department of Prisons, 7901 State Rd., Philadelphia, PA 19136, USA. 4. Philadelphia Department of Public Health, Office of the Health Commissioner, 1101 Market St., Suite 1320, Philadelphia, PA 19107, USA. 5. Philadelphia Department of Public Health, Opioid Surveillance, Epidemiology, and Prevention Program, 1101 Market St., Suite 1320, Philadelphia, PA 19107, USA.
Abstract
BACKGROUND: High overdose mortality after release from state prison systems is well documented; however, little is known about overdose mortality following release from local criminal justice systems (CJS). The purpose of this study was to assess overdose mortality following release from a local CJS in Philadelphia, PA. METHODS: We conducted a retrospective cohort study of individuals released to the community from a local CJS between 2010 and 2016. Incarceration records were linked to overdose fatality data from the Medical Examiner's Office and death certificate records. All-cause, overdose, and non-overdose mortality were examined. RESULTS: Of the 82,780 individuals released between 2010 and 2016, 2,522 (3%) died from any cause, of which 837 (33%) succumbed to overdose. Individuals released from incarceration had higher risk of overdose death compared to the non-incarcerated population (Standardized Mortality Ratio [SMR]: 5.29, 95% CI 4.93-5.65), and risk was greatest during the first two weeks following release (SMR: 36.91, 95% CI: 29.92-43.90). Among released individuals, black, non-Hispanic individuals (Hazard Rate [HR]: 0.17, 95% CI: 0.14-0.19) and Hispanic individuals (HR: 0.41, 95% CI: 0.34-0.50) were at lower risk for overdose than white, non-Hispanic individuals. Individuals released with a serious mental illness (SMI) were at higher risk of overdose (HR: 1.54, 95% CI: 1.27-1.87) than those without a SMI. DISCUSSION: Previously incarcerated individuals are at high risk of overdose death following release from a local CJS, especially in the earliest weeks following release. Prevention measures including behavioral health treatment and referral and take-home naloxone may reduce overdose mortality after release.
BACKGROUND: High overdose mortality after release from state prison systems is well documented; however, little is known about overdose mortality following release from local criminal justice systems (CJS). The purpose of this study was to assess overdose mortality following release from a local CJS in Philadelphia, PA. METHODS: We conducted a retrospective cohort study of individuals released to the community from a local CJS between 2010 and 2016. Incarceration records were linked to overdose fatality data from the Medical Examiner's Office and death certificate records. All-cause, overdose, and non-overdose mortality were examined. RESULTS: Of the 82,780 individuals released between 2010 and 2016, 2,522 (3%) died from any cause, of which 837 (33%) succumbed to overdose. Individuals released from incarceration had higher risk of overdose death compared to the non-incarcerated population (Standardized Mortality Ratio [SMR]: 5.29, 95% CI 4.93-5.65), and risk was greatest during the first two weeks following release (SMR: 36.91, 95% CI: 29.92-43.90). Among released individuals, black, non-Hispanic individuals (Hazard Rate [HR]: 0.17, 95% CI: 0.14-0.19) and Hispanic individuals (HR: 0.41, 95% CI: 0.34-0.50) were at lower risk for overdose than white, non-Hispanic individuals. Individuals released with a serious mental illness (SMI) were at higher risk of overdose (HR: 1.54, 95% CI: 1.27-1.87) than those without a SMI. DISCUSSION: Previously incarcerated individuals are at high risk of overdose death following release from a local CJS, especially in the earliest weeks following release. Prevention measures including behavioral health treatment and referral and take-home naloxone may reduce overdose mortality after release.
Authors: Alexandria Macmadu; William C Goedel; Joëlla W Adams; Lauren Brinkley-Rubinstein; Traci C Green; Jennifer G Clarke; Rosemarie A Martin; Josiah D Rich; Brandon D L Marshall Journal: Drug Alcohol Depend Date: 2020-01-18 Impact factor: 4.492
Authors: Christine E Grella; Erika Ostlie; Christy K Scott; Michael L Dennis; John Carnevale; Dennis P Watson Journal: Subst Abuse Treat Prev Policy Date: 2021-02-22