A conceptual model for understanding post-release opioid-related overdose risk

Area of Science:

• Public Health
• Criminology
• Addiction Medicine

Background:

• Post-release opioid-related overdose mortality is the leading cause of death for individuals leaving correctional facilities.
• Incarceration exposes individuals to unique risk factors for opioid overdose.

Purpose of the Study:

• To present the Post-Release Opioid-Related Overdose Risk Model.
• To explore determinants contributing to post-release opioid overdose mortality among justice-involved individuals.

Main Methods:

• Utilized the proximate determinants framework to analyze risk factors.
• Examined underlying, intermediate, proximate, and biological determinants of overdose risk.

Main Results:

• Identified incarceration as an underlying exposure, with moderators like chronic pain, HIV, trauma, race, and suicidality.
• Highlighted intermediate determinants such as social network disruption, interrupted medical care, poverty, and stigma.
• Pinpointed proximate determinants including treatment interruptions, limited access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone, and solitary opioid use.
• Concluded with biological determinants of reduced respiratory tolerance leading to overdose mortality.

Conclusions:

• Mitigation requires coordinated efforts between criminal justice, health, and community organizations.
• Tailored healthcare services, harm reduction strategies, and expanded access to opioid agonist therapy and naloxone are crucial.
• Diverting individuals with substance use disorder from the criminal justice system into treatment can prevent incarceration exposure and reduce overdose risk.