Friedmann Peter D, Dunn Devon, Michener Pryce, Bernson Dana, Stopka Thomas J, Pivovarova Ekaterina, Ferguson Warren J, Rottapel Rebecca, Hoskinson Randall, Wilson Donna, Evans Elizabeth A
University of Massachusetts Chan Medical School - Baystate and Baystate Health, Office of Research, 3601 Main Street, Springfield, MA 01107 USA.
Massachusetts Department of Public Health, Office of Population Health - Special Analytic Projects, 250 Washington Street, 6th Floor, Boston, MA 02108 USA.
Drug Alcohol Depend Rep. 2023 Mar;6:100141. doi: 10.1016/j.dadr.2023.100141. Epub 2023 Feb 27.
Release from incarceration is a high-risk period for opioid overdose. Concern about COVID-19 spread in jails led to early releases; it is unknown whether pandemic era releases of persons with opioid use disorder (OUD) contributed to increases in community overdose rates.
Observational data compared overdose rates three months after release among jailed persons with OUD released before (9/1/2019-3/9/2020) and during the pandemic (3/10/2020-8/10/2020) from seven jails in Massachusetts. Data on overdoses come from the Massachusetts Ambulance Trip Record Information System and Registry of Vital Records Death Certificate file. Other information came from jail administrative data. Logistic models regressed overdose on release period, controlling for MOUD received, county of release, race/ethnicity, sex, age, and prior overdose.
Pandemic releases with OUD had a higher risk of fatal overdose (adjusted odds ratio [aOR] 3.06; 95% CI, 1.49 to 6.26); 20 persons released with OUD (1.3%) experienced a fatal overdose within three months of release, versus 14 (0.5%) pre-pandemic. MOUD had no detectable relationship with overdose mortality. Pandemic release did not impact non-fatal overdose rates (aOR 0.84; 95% CI 0.60 to 1.18), though in-jail methadone treatment was protective (aOR 0.34; 95% CI 0.18 to 0.67).
Persons with OUD released from jail during the pandemic experienced higher overdose mortality compared to pre-pandemic, but the number of deaths was small. They did not experience significantly different rates of non-fatal overdose. Early jail releases during the pandemic were unlikely to explain much, if any, of the observed increase in community overdoses in Massachusetts.
从监禁中获释是阿片类药物过量服用的高风险时期。对新冠病毒在监狱中传播的担忧导致了提前释放；目前尚不清楚大流行时期阿片类药物使用障碍（OUD）患者的释放是否导致了社区过量服用率的上升。
观察性数据比较了在马萨诸塞州七所监狱中，在大流行之前（2019年9月1日至2020年3月9日）和大流行期间（2020年3月10日至2020年8月10日）被释放的患有OUD的在押人员获释三个月后的过量服用率。过量服用的数据来自马萨诸塞州救护车行程记录信息系统和生命记录登记死亡证明文件。其他信息来自监狱管理数据。逻辑模型将过量服用情况回归到释放时期，并控制了接受的药物辅助治疗（MOUD）、释放县、种族/民族、性别、年龄和先前的过量服用情况。
患有OUD的大流行期间获释人员发生致命过量服用的风险更高（调整后的优势比[aOR]为3.06；95%置信区间，1.49至6.26）；20名患有OUD的获释人员（1.3%）在获释后三个月内发生了致命过量服用，而大流行前为14人（0.5%）。MOUD与过量服用死亡率没有可检测到的关系。大流行期间获释并未影响非致命过量服用率（aOR为0.84；95%置信区间为0.60至1.18），不过监狱内的美沙酮治疗具有保护作用（aOR为0.34；95%置信区间为0.18至0.67）。
与大流行前相比，大流行期间从监狱获释的患有OUD的人员过量服用死亡率更高，但死亡人数较少。他们非致命过量服用率没有显著差异。大流行期间监狱提前释放不太可能解释马萨诸塞州观察到的社区过量服用增加情况（如果有的话）。
