Former inmates at high risk for opioid overdose following prison release

July 20, 2018, University of North Carolina at Chapel Hill

A recent study in North Carolina found that in the first two weeks after being released from prison, former inmates were 40 times more likely to die of an opioid overdose than someone in the general population.

When restricted to heroin overdoses only, formerly incarcerated individuals' likelihood of overdose death increased to 74 times the norm within the first two weeks after release. Even an entire year after release, overdose death rates remained 10-18 times higher among formerly incarcerated individuals as compared to the general North Carolina population.

These findings, published online July 19 by the American Journal of Public Health, were co-authored by five researchers from the University of North Carolina at Chapel Hill Gillings School of Global Public Health and two representatives of the North Carolina Division of Public Health and the North Carolina Department of Public Safety.

The U.S. is experiencing an unprecedented opioid epidemic. Between 2000 and 2016, opioid overdose death rates quadrupled and more than 300,000 Americans died of an opioid overdose. Despite many policy initiatives and interventions, the death toll continues to rise.

Until this study, the ongoing epidemic's impact on formerly incarcerated individuals, who are at especially high risk for opioid use, was not well known. To conduct the study, the researchers linked North Carolina inmate release records to North Carolina death records, calculated opioid overdose death standardized mortality ratios to compare former inmates with North Carolina residents and calculated hazard ratios to identify predictors of time until opioid overdose death.

"We know from fighting other epidemics that treating and preventing disease among high-risk—or vulnerable—populations benefits not only members of that population, but everyone around them," said Shabbar Ranapurwala, assistant professor in the Gillings School of Global Public Health's department of epidemiology. "The same is true here. Preventing overdose deaths and treating substance use disorders in formerly incarcerated people may prevent the spread of the epidemic in the general population."

In North Carolina, between 22,000 and 27,000 individuals are released from prison each year. These individuals are particularly vulnerable to the opioid epidemic for three key reasons. First, two-thirds of them already have a substance use disorder, which is classified as a condition. In fact, many former inmates initially were imprisoned for offenses that stemmed from substance use.

Second, formerly incarcerated individuals undergo forced withdrawal during incarceration, and therefore have a very low tolerance when released from prison. Finally, there are few support systems in place for most inmates upon release—this includes a lack of access to health care.

"A host of other problems like stigmatization, loss of dignity, loss of family for some, and discrimination in housing and employment only compound existing substance use problems," Ranapurwala explained. "This leads to premature deaths."

"As a society, we do not do enough to rehabilitate formerly incarcerated individuals back into our world," he added. "What's more, both medically and scientifically, we know that substance use disorder is a health condition—an illness. The only way to treat an illness is by providing medical help."

The study findings are a clear call to action, according to Kody H. Kinsley, interim senior director of the state's Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

"We must reduce the deaths in this population, and we know how to do it," Kinsley said. "We are working to partner across North Carolina to treat those suffering from substance use disorders in all settings. We hope our partners will join us by implementing proven methods such as medication-assisted treatment for opioid use disorders."

With funding from the 21st Century Cures Act's Grants for State Targeted Response to the Opioid Crisis, Kinsley's division already has provided funding to the North Carolina Division of Adult Correction and Juvenile Justice (DACJJ) so that all state probation and parole officers who interact with criminal justice-involved individuals and community members are equipped with naloxone kits. Naloxone is a medication designed to rapidly reverse overdose.

The division also plans to purchase additional naloxone kits to distribute to people as they leave prison, if those individuals completed substance use disorder treatment while incarcerated.

Timothy Moose, the North Carolina Department of Public Safety deputy secretary for adult correction and juvenile justice, commented on how the use of naloxone kits by probation and parole officers while in the field has substantially helped individuals with substance use disorders.

"Officers who supervise criminal justice-involved individuals have had wide success with naloxone kits," he reported, "so much so, that Community Corrections may expand naloxone distribution to individuals and families returning from the department's substance abuse treatment facilities in Dart Cherry and Black Mountain, as well as from probation violation and re-entry facilities across the state."

With the support of an additional federal grant, the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, in partnership with the North Carolina Division of Adult Correction and Juvenile Justice, is providing medication-assisted treatment to people under Community Corrections supervision in Iredell and Wilkes counties, too. Since program implementation in April 2017, 136 people have been enrolled. Among those completing a six-month update interview, substance use had decreased for all except alcohol. Opioid use was down by 50 to 100 percent, and full-time employment had increased by 50 percent.

The state of North Carolina also has created a new State Re-entry Council Collaborative (SRCC), led by DPS secretary Erik A. Hooks. The group is developing recommendations for a comprehensive plan aimed at facilitating the successful transition of formerly incarcerated people back into their communities. Substance misuse has been identified as a major threat that can derail the re-entry process.

"We know that many people transitioning out of prison facilities bear the weight of addiction to various illegal substances," said Hooks. "The goal of the SRCC plan is to proactively remove barriers and give people access to resources and services that will increase their chances of successful re-entry."

Explore further: Prison treatment program helps lower overdose deaths

More information: Shabbar I. Ranapurwala et al, Opioid Overdose Mortality Among Former North Carolina Inmates: 2000–2015, American Journal of Public Health (2018). DOI: 10.2105/AJPH.2018.304514

Related Stories

Prison treatment program helps lower overdose deaths

April 9, 2018
An expanded program to treat prisoners for opioid addiction helped lower the number of accidental drug overdose deaths in Rhode Island in 2017 after years of steady increases, state health officials said.

Any opioid use tied to involvement in criminal justice system

July 10, 2018
(HealthDay)—Any opioid use is associated with involvement in the criminal justice system in the past year, according to a study published online July 6 in JAMA Network Open.

Study reveals opioid patients face multiple barriers to treatment

July 12, 2018
In areas of the country disproportionately affected by the opioid crisis, treatment programs are less likely to accept patients paying through insurance of any type or accept pregnant women, a new Vanderbilt study found.

Opioid epidemic responses overlook gender

July 5, 2018
Yale health experts warn that current efforts to confront the growth of opioid addiction and overdose deaths must better incorporate an understanding of how women fit into this epidemic.

Opioid overdose survivors face continued health challenges, higher death rate

June 20, 2018
Survivors of opioid overdose are at great risk of dying in the year after overdose, but the deaths are not always caused by drug use, a new study reveals. In addition to succumbing to drug use, survivors were much more likely ...

Study: Wide distribution of naloxone can slash overdose deaths during epidemics

April 18, 2018
A new study in The Lancet Public Health shows the rapid expansion of British Columbia's Take Home Naloxone program significantly reduced the number of fentanyl-related overdose deaths in 2016.

Recommended for you

Shortcut strategy for screening compounds with clinical potentials for drug development

December 4, 2018
Developing a new drug often takes years and costs hundreds of millions of dollars. A shortcut has now been reported in a study led by City University of Hong Kong (CityU), which can potentially reduce the time and costs of ...

Drug wholesalers drove fentanyl's deadly rise, report concludes

December 4, 2018
Fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths in the United States last year, most likely spread because of heroin and prescription pill shortages, and also because it was cheaper for drug ...

Global review reports on administration of children's antibiotics

December 4, 2018
Researchers analyzing the sales of oral antibiotics for children in 70 high- and middle-income countries found that consumption varies widely from country to country with little correlation between countries' wealth and the ...

Opioid prescriptions from dentists linked to youth addiction risk

December 3, 2018
Teens and young adults who receive their initial opioid prescriptions from their dentists or oral surgeons are at increased risk for opioid addiction in the following year, a study from the Stanford University School of Medicine ...

Rise in meth and opioid use during pregnancy

November 29, 2018
Amphetamine and opioid use in pregnancy increased substantially over the last decade in the United States, a new Michigan Medicine-led study finds. And a disproportionate rise occurred in rural counties.

Mouse model aids study of immunomodulation

November 19, 2018
Because mice do not respond to immunomodulatory drugs (IMiDs), preclinical therapeutic and safety studies of the effects of IMiDs have not been possible in existing types of mice. This has led to an inability to accurately ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.