College of Pharmacy, Oregon State University, Portland, OR, United States of America.
College of Pharmacy, Oregon State University, Portland, OR, United States of America.
J Subst Use Addict Treat. 2023 Apr;147:208971. doi: 10.1016/j.josat.2023.208971. Epub 2023 Feb 10.
Among individuals who are released from prison, opioid overdose is a leading cause of death with a risk more than ten-fold the general population. Although the epidemiology of opioid-related fatalities has been described, few studies have characterized both fatal and nonfatal opioid-related poisonings. The objective of this study was to estimate risk of fatal and nonfatal opioid overdose among adults released from prison.
The study estimated fatal and nonfatal opioid overdose rates using linked corrections, Medicaid, hospital discharge, and vital statistics from the state of Oregon from 2014 to 2018. Multivariable proportional hazards models identified demographic and prison-related factors associated with overdose.
Between 2014 and 2017, 18,258 individuals were released from prison. A majority of individuals were male (87 %) and ages 26 to 64 (83 %). Two-thirds had a documented substance use disorder treatment need and 20 % demonstrated mental health treatment need. Following prison release, 579 opioid overdose events occurred; 65 (11 %) were fatal. The rate of opioid overdose was 1085.7 per 100,000 person-years (PY). Rates were highest in the first two weeks (2286.7 per 100,000 PY), among women (1582.9 per 100,000 PY), and those with mental health (1624.3 per 100,000 PY) or substance use disorder treatment needs (1382.6 per 100,100 PY). Only mental health (adjusted hazard ratio [aHR] 1.54, 95 % CI 1.24 to 1.90) and substance use need (aHR 2.59; 95 % CI 2.01 to 3.34) remained significant in multivariable models.
The rate of opioid overdose is markedly elevated after prison release, particularly in the first two weeks. In women, the higher rate of opioid overdose is mediated by a greater mental health burden.
在出狱人群中，阿片类药物过量是导致死亡的主要原因，其风险是普通人群的 10 多倍。尽管已经描述了阿片类药物相关死亡的流行病学，但很少有研究描述致命和非致命阿片类药物中毒。本研究的目的是估计从监狱获释的成年人发生致命和非致命阿片类药物过量的风险。
本研究使用来自俄勒冈州的监狱、医疗补助、医院出院和公共卫生数据，从 2014 年到 2018 年，对致命和非致命阿片类药物过量率进行了估计。多变量比例风险模型确定了与过量相关的人口统计学和监狱相关因素。
在 2014 年至 2017 年期间，有 18258 人从监狱获释。大多数人是男性（87%）和 26 至 64 岁（83%）。三分之二的人有记录的药物使用障碍治疗需求，20%的人有心理健康治疗需求。在出狱后，发生了 579 例阿片类药物过量事件；其中 65 例（11%）为致命性。阿片类药物过量的发生率为每 100000 人年 1085.7 例。在最初的两周内（每 100000 人年 2286.7 例）、女性（每 100000 人年 1582.9 例）和有心理健康（每 100000 人年 1624.3 例）或药物使用障碍治疗需求（每 100100 人年 1382.6 例）的人中，发生率最高。只有心理健康（调整后的危险比 [aHR] 1.54，95%置信区间 1.24 至 1.90）和药物使用需求（aHR 2.59；95%置信区间 2.01 至 3.34）在多变量模型中仍然显著。
出狱后阿片类药物过量的发生率明显升高，尤其是在最初的两周内。在女性中，更高的阿片类药物过量发生率是由更大的心理健康负担所介导的。
