Justice-Involved Individuals Returning to the Community are at High Risk for Overdose Fatality within First Two Weeks after Release from Incarceration; Research Shows MAT Reduces Risk by 75%

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In 2018, over 67,000 Americans died from drug overdoses and opioid overdose fatalities rose by 10 percent from the previous year.1 Nearly 11 million individuals passing through the criminal justice system every year and they are one of the most vulnerable groups exposed to the drug crisis.2

In separate studies conducted in Washington state and North Carolina, researchers found that individuals released from prison and jail were 13 to 40 times more likely to die during the first two weeks after release, with drug overdoses as the leading cause of death.3,4 These risk factors have significant implications for reentry planning and services to ensure quality care among justice-involved individuals as they transition to the community.

The Takeaway:

Justice-involved individuals are up to 40 times more likely to die of a drug overdose during the first two weeks of reentry (Binswanger, 2007; Ranapurwala et al., 2018). Substance use disorder treatment initiation prior to release and continuation during reentry cuts the risk of death up to 75% (Degenhardt, 2014).

What did these studies find?

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 13 times more likely to die than state residents, mostly because of overdoses. Similarly, in a more recent study conducted in North Carolina, researchers monitored death rates among almost 230,000 individuals after release from prison over 16 years compared to those of the general public. Researchers found that they were 40 times more likely to die within the first two weeks. The majority of deaths during this initial two-week period were attributed to drug overdose, and especially to heroin overdoses.

What this means for practitioners

Fortunately, researchers and practitioners have made advances in determining how to support individuals released from prison with addiction through evidence-based treatment—especially medication. Treatment with buprenorphine or methadone during reentry cuts the risk of death by 75 percent.5 And a Rhode Island program that provided methadone, buprenorphine, or naltrexone during and after incarceration decreased deaths by nearly 61 percent, despite the easy availability of fentanyl.6 Studies show that it is most beneficial to provide medications for opioid use disorder (MOUD) early and continuously after release. The risk of death for individuals released from prison with an opioid disorder (OUD) is lowest for those who continue MOUD. In the face of stubbornly high overdose deaths, the widespread prevalence of opioid use disorders, and acute impact on individuals released from prison, MOUD gives reentry services the chance to reduce fatalities.

Key facts and figures:

  • People who’ve been incarcerated are from 13 to 40 times more likely to die, mostly because of drug overdoses.
  • Over 67,000 people died from overdoses in 2018.
  • 11 million people pass through the criminal justice system every year.
  • Treatment with buprenorphine or methadone during reentry cuts the risk of death by 75 percent.
  • MOUD during and after incarceration in one state cut deaths by almost 61 percent.


  1. 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
  2. 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
  3. 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 medicine356(2), 157–165. https://doi.org/10.1056/NEJMsa064115 
  4. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder, Mancher, M., & Leshner, A. I. (Eds.). (2019). Medications for Opioid Use Disorder Save Lives. National Academies Press (US). https://doi.org/10.17226/25310
  5. 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 health108(9), 1207–1213. https://doi.org/10.2105/AJPH.2018.304514
  6. 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. https://doi.org/10.1111/add.12536
  7. 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. https://doi.org/10.1001/jamapsychiatry.2017.4614