Increased Overdose Risk Among Previously Incarcerated With Opioid, Stimulant Use Disorders

Among individuals with a history of incarceration, those with opioid use disorder (OUD) and/or stimulant use disorder (STUD) were found to be at increased risk for fatal and nonfatal overdose, according to results of a study published in JAMA Network Open.

Data for this study were sourced from the Provincial Overdose Cohort, which was a 20% random sample of the general population of British Colombia in Canada. Risk for overdose on the basis of OUD and/or STUD during a 5-year follow-up period was evaluated among a subset of individuals (N=6816) who were released from a correctional center between 2010 and 2014.

Study participants were categorized as having the following:  neither OUD nor STUD (n=5847), STUD only (n=395), OUD only (n=293), or both OUD and STUD (n=281). The population of men in the cohorts ranged from 67.3% to 89.9%, and between 40.2% and 45.6% were younger than 30 years. A diagnosis of mental illness was reported in as few as 34.9% among those with neither OUD nor STUD to as many as 86.8% of those with both OUD and STUD. The frequency of an existing comorbidity was highest among those with OUD and STUD and lowest among those with neither OUD nor STUD. All baseline characteristics differed on the basis of use disorder diagnoses (all P <.001).

During the follow-up period, 3781 nonfatal and 245 fatal overdose events were document, occurring at incidence rates (IRs) of 122.5 and 7.9 per 1000 person-years (py), respectively.

Stratified by characteristics, rates of nonfatal overdoses were greatest among individuals with both OUD and STUD (IR, 467.5 per 1000 py), those with 8 or more incarceration events (IR, 346.3 per 1000 py), individuals with OUD only (IR, 312.4 per 1000 py), and individuals with STUD only (IR, 243.4 per 1000 py). For fatal overdoses, rates were highest for individuals with both OUD and STUD (IR, 23.1 per 1000 py), individuals with an Elixhauser comorbidity index of 2 or greater (IR, 18.8 per 1000 py), those with OUD only (IR, 13.4 per 1000), and those with STUD only (IR, 13.2 per 1000 py).

The IRs for fatal and nonfatal overdose events were positively correlated with the number of prior incarcerations.

In the adjusted analyses, compared with no substance use disorders, risk for nonfatal overdose was associated with both OUD and STUD (adjusted hazard ratio [aHR], 2.45; 1.94-3.11), OUD alone (aHR, 2.03; 95% CI, 1.57-2.62), and STUD alone (aHR, 1.52; 95% CI, 1.20-1.92). For fatal overdose, risk was assoicated with both OUD and STUD (aHR, 2.39; 95% CI, 1.48-3.86).

These findings may not be generalizable for the population of individuals with a substance use disorder but who are not in contact with the health care system, as ICD-9 and ICD-10 codes were used by the investigators to identify substance use disorders.

Study authors conclude that risk for nonfatal and fatal overdoses among individuals with a history of incarceration was associated with OUD and/or STUD. These data indicate there is likely an unmet need for addiction services among individuals with a history of incarceration. They advise that “[p]atients’ existing contact with the health care system for OUD (eg, OAT) can be leveraged to expand services and to integrate STUD interventions into care.”

This article originally appeared on Clinical Pain Advisor