Over 10 million individuals pass through the criminal justice system every year and they are one of the most vulnerable groups exposed to the drug crisis.1 Of the 2 million individuals in prison and jail in the United States, 19 percent have regularly used opioids and over half meet the criteria for a substance use disorder.2-4 Studies have found that individuals returning from incarceration to the community are at a high risk of a fatal overdose during the transition.
Study on Overdose Risk During Reentry
In the Washington state study, researchers compared the death rate of over 30,000 individuals released from prison to those of state residents over four years. It was determined that within their first 2 weeks, individuals released from prison were almost 129 times more likely to die than state residents, mostly because of overdoses.5 The majority of deaths during this initial two-week period were attributed to drug overdose, especially heroin overdoses.
What this means for practitioners
Fortunately, advances have been made to support individuals released from prison with addiction through evidence-based treatment—especially medications. Research shows that providing medications for addiction treatment (MAT) prior to and during reentry cuts the risk of death by 75 percent.6 Similarly, in Rhode Island, the Department of Corrections implemented a program to provide FDA-approved medications for opioid use disorder (MOUD), which includes methadone, buprenorphine, or naltrexone, during and after incarceration which led to a decrease in overdose fatalities by nearly 61 percent, despite the easy availability of fentanyl.7
Studies show that it is most beneficial to provide MOUD early and continuously after release.4 The risk of death for individuals released from prison with an opioid use disorder (OUD) is lowest for those who continue MOUD. In the face of stubbornly high overdose deaths, the widespread prevalence of OUD, and acute impact on individuals released from prison, MOUD gives reentry services the chance to reduce fatalities.
- Justice-involved individuals are up to 129 times more likely to die of a drug overdose during the first two weeks of reentry (Binswanger, 2007).
- Providing medications for addiction treatment prior to release and continuation during reentry cuts the risk of death up to 75% (Degenhardt, 2014).
- Hedegaard, H., Miniño, A.M., Warner, M. (2020). Drug overdose deaths in the United States, 1999–2018. NCHS Data Brief, no 356. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db356.htm
- Zeng, Z. (2018). Jail Inmates in 2016. U.S. Department of Justice Office of Justice Programs, Bureau of Justice Statistics Bulletin. NCJ251210. Retrieved from https://www.bjs.gov/content/pub/pdf/ji16.pdf
- Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from Prison—A High Risk of Death for Former Inmates. The New England Journal of Medicine, 356, 157-165. doi: 10.1056/NEJMsa06411
- National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. https://doi.org/10.17226/25310.
- Ranapurwala, S. I., Shanahan, M. E., Alexandridis, A. A., Proescholdbell, S. K., Naumann, R. B., Edwards, D., Jr, & Marshall, S. W. (2018). Opioid Overdose Mortality Among Former North Carolina Inmates: 2000–2015. American Journal of Public Health, 108(9), 1207–1213. https://doi.org/10.2105/ajph.2018.304514
- Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D.J., Gibson, A., Mattick, R., Butler, T., Burns, L. (2014). The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction, 109(8), 1306-17. doi: 10.1111/add.12536
- Green, T.C., Clarke, J., Brinkley-Rubinstein, L., et al. Implementing Medications for Addiction Treatment in a Statewide Correctional System. JAMA Psychiatry, 75(4), 405-407. doi: 10.1001/jamapsychiatry.2017.4614