Prevalence and risk factors for opioid related mortality among probation clients in an American city

Substance use disorder researchers and treatment professionals have long recognized that risk of opioid-related mortality (ORM) is elevated after release from jail and prison. However, there are gaps in knowledge around ORM among people on probation and the relationship of ORM to drug testing and treatment referral while under supervision. Understanding this relationship is critical for probation officers who are often tasked with referring clients to treatment and monitoring compliance with treatment, without having a clinical background. In this cross-sectional study we estimate the prevalence and risk factors for ORM in a large, urban probation department.

We joined mortality records and probation records for 2018 and 2019 to determine the rate of ORM for the probation population. We stratified ORM rates by risk factors, including demographics, drug testing results, and treatment placements.

Individuals on probation were fifteen times more likely to die from ORM (361 per 100,000) than the general county population (23 per 100,000), largely driven by fentanyl (detected in 86.8% of deaths). Risk was elevated for clients over age 45 (838 per 100,000; 95% CI [655-1057]), clients with at least one positive drug test for opioids (1995 per 100,000; 95% CI [1419-2727]) or cocaine (1200 per 100,000; 95% CI [841-1661]), and clients with previous placements in drug treatment (692 per 100,000; 95% CI [503-929]). Positive urine tests for opioids were associated with 80 times greater risk of ORM than the general population. Although Black clients experienced ORM in greater numbers, white clients had relatively greater ORM risk.

Elevated risk for ORM among the probation population justifies urgent and data-driven partnerships between public health and community corrections to train probation staff; to identify high-risk clients for evidence-based treatment and overdose prevention strategies; and to institute policies to support and sustain these activities.