Medications for Opioid Use Disorder Reduce Risk of Overdose Mortality Following Incarceration

Individuals with opioid use disorder (OUD) make up 15–20 percent of incarcerated populations in the US, and are at risk of overdose upon release. While incarcerated, many people with OUD are not provided medication for OUD (MOUD; e.g., methadone or buprenorphine). This retrospective observational cohort study examined 15,797 adults representing 31,382 incarceration events in the New York City jail system, 2011–2017. Researchers investigated rates of overdose and all-cause mortality within the first year after release among individuals who did and did not receive MOUD during incarceration.

  • Individuals who received MOUD were more likely to be female, unhoused, have injection drug use, have cocaine use disorder, and be incarcerated for a misdemeanor.
  • During the first month post-release, individuals who received MOUD were significantly less likely to experience a fatal overdose (adjusted hazard ratio [aHR], 0.20), and had lower overall risk of mortality (aHR, 0.22), compared with those who did not receive MOUD.
  • In the year following incarceration, individuals who received MOUD were significantly less likely to experience a fatal overdose due to heroin, compared with those who did not receive MOUD (crude death rate: 0.49 versus 0.83 per 100 person-years, respectively).

Comments: Providing MOUD to incarcerated individuals reduces the risk of overdose and overall mortality within the first month after release, and reduces the risk of fatal opioid overdoses up to one year. Lack of provision of MOUD to incarcerated individuals disproportionally affects Black and Hispanic individuals who are at heighted risk of incarceration in the US due to structural racism. Provision of MOUD within the jail and prison systems can be one step in alleviating this inequity.

Corey McBrayer, DO, MPH* & Darius A. Rastegar, MD

* Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Lim S, Cherian T, Katyal M, et al. Association between jail-based methadone or buprenorphine treatment for opioid use disorder and overdose mortality after release from New York City jails 2011–17Addiction. 2023;118(3):459–467.

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