Opioid Overdoses for Recently Incarcerated Individuals: Toxicology Results and Risk Evaluations

Background: The opioid epidemic continues to challenge the United States, fueled by illicitly manufactured fentanyl. All stakeholders involved in fighting the opioid epidemic, from medical providers to policy makers, will benefit from understanding what contributes to overdoses. Recently incarcerated individuals represent a particularly vulnerable population. Methods: We performed a retrospective review of Jefferson County Coroner data for overdose deaths by postmortem toxicology between January 2017 and December 2018. Patients were cross-referenced with Jefferson County Department of Corrections (DOC) records, with inclusion of individuals with violations after January 2016 to focus on recently incarcerated individuals. We analyzed substances found in toxicology reports and substance risk level assigned based on screening by the DOC. Results: A total of 575 opioid overdose deaths occurred in Jefferson County from 2017-2018, with 55 of these individuals having interaction with the DOC after January 1, 2016. DOC population individuals had statistically significant higher findings of amphetamines/methamphetamines. Individuals from the DOC population had higher frequencies of fentanyl, heroin, cocaine, and cannabinoid/THC; however, these differences were not statistically significant. Prisoners with substance risk assessment scores of high or very high had fewer days from release to overdose death. Conclusion: Fentanyl remains a major contributor to overdose death, including those recently incarcerated. Substance risk assessment tools should drive referral for treatment while in prison and at time of release. These results provide better insight into the opioid epidemic and may help guide medical care, specifically for recently incarcerated individuals.