AddictoScope | Impact of jail-based methadone or buprenorphine treatment on non-fatal opioid overdose after incarceration

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Impact of jail-based methadone or buprenorphine treatment on non-fatal opioid overdose after incarceration

[Diffusé le 19-04-2024]

Source : Drug and alcohol dependence 2024; AOP:10.1016/j.drugalcdep.2024.111274

Cherian, Teena; Lim, Sungwoo; Katyal, Monica; Goldfeld, Keith S.; McDonald, Ryan; Wiewel, Ellen; Khan, Maria; Krawczyk, Noa; Braunstein, Sarah; Murphy, Sean M.; Jalali, Ali; Jeng, Philip J.; Rosner, Zachary; MacDonald, Ross; Lee, Joshua D.

Abstract

Background Non-fatal overdose is a leading predictor of subsequent fatal overdose. For individuals who are incarcerated, the risk of experiencing an overdose is highest when transitioning from a correctional setting to the community. We assessed if enrollment in jail-based medications for opioid use disorder (MOUD) is associated with lower risk of non-fatal opioid overdoses after jail release among individuals with opioid use disorder (OUD).
Methods This was a retrospective, observational cohort study of adults with OUD who were incarcerated in New York City jails and received MOUD or did not receive any MOUD (out-of-treatment) within the last three days before release to the community in 2011-2017. The outcome was the first non-fatal opioid overdose emergency department (ED) visit within 1 year of jail release during 2011-2017. Covariates included demographic, clinical, incarceration-related, and other characteristics. We performed multivariable cause-specific Cox proportional hazards regression analysis to compare the risk of non-fatal opioid overdose ED visits within 1 year after jail release between groups.
Results MOUD group included 8,660 individuals with 17,119 incarcerations; out-of-treatment group included 10,163 individuals with 14,263 incarcerations. Controlling for covariates and accounting for competing risks, in-jail MOUD was associated with lower non-fatal opioid overdose risk within 14 days after jail release (adjusted HR=0.49, 95% confidence interval=0.33-0.74). We found no significant differences 15-28, 29-56, or 57-365 days post-release.
Conclusion MOUD group had lower risk of non-fatal opioid overdose immediately after jail release. Wider implementation of MOUD in US jails could potentially reduce post-release overdoses, ED utilization, and associated healthcare costs.

Keywords: Opioid use disorder; medication for opioid use disorder; non-fatal overdose; emergency department; jail; urban population.