Association between jail-based methadone or buprenorphine treatment for opioid use disorder and overdose mortality after release from New York City jails 2011-17.
Association between jail-based methadone or buprenorphine treatment for opioid use disorder and overdose mortality after release from New York City jails 2011-17.
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2011-17 年纽约市监狱释放后因阿片类药物使用障碍而进行的监狱美沙酮或丁丙诺啡治疗与服药过量死亡率之间的关联。
DOI：
10.1111/add.16071
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Lee,JoshuaD
中科院分区：
文献类型：
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作者：
Lim,Sungwoo;Cherian,Teena;Katyal,Monica;Goldfeld,KeithS;McDonald,Ryan;Wiewel,Ellen;Khan,Maria;Krawczyk,Noa;Braunstein,Sarah;Murphy,SeanM;Jalali,Ali;Jeng,PhilipJ;MacDonald,Ross;Lee,JoshuaD
背景和目的阿片类药物过量是从监狱或监狱释放后立即死亡的主要原因。美国的大多数监狱不提供美沙酮和丁丙诺啡治疗阿片类药物使用障碍（MOUD），估计其在监狱环境中的影响的研究有限。我们的目的是检验监狱MOUD与释放后较低的过量死亡风险相关的假设。设计、设置和参与者回顾性、观察性队列研究，研究对象为2011-2017年从纽约市监狱释放到社区的15797名阿片类药物使用障碍成年人。他们经历了31382例监禁，并随访至1 year.MeasurementsThe主要结局是由意外药物中毒和全因死亡引起的死亡。暴露是在重返社区前的最后3天内接受MOUD（17 119起事件）与不接受治疗（14 263起事件）。协变量包括人口统计学、临床、行为、住房、医疗保健利用和法律的特征变量。我们进行了多变量，混合效应考克斯回归分析，以测试监狱MOUD和deaths.FindingsThe大多数是男性（82%）之间的关联，他们的平均年龄为42岁。接受MOUD与轻罪指控、女性、注射毒品和无家可归有关。在释放后的1年内，发生了111例过量死亡，监狱中MOUD和治疗外组的粗死亡率分别为0.49和0.83/100人年。考虑到混杂和随机效应，监狱MOUD与较低的药物过量死亡风险[校正风险比（aHR）= 0.20，95%置信区间（CI）= 0.08-0.46]和全因死亡风险相关（aHR = 0.22，95% CI = 0.11-0.42）结论美沙酮和丁丙诺啡治疗监禁期间阿片类药物使用障碍与80%的释放后第一个月的过量死亡风险降低。
Background and aimsOpioid overdose is a leading cause of death during the immediate time after release from jail or prison. Most jails in the United States do not provide methadone and buprenorphine treatment for opioid use disorder (MOUD), and research in estimating its impact in jail settings is limited. We aimed to test the hypothesis that in‐jail MOUD is associated with lower overdose mortality risk post‐release.Design, setting and participantsRetrospective, observational cohort study of 15 797 adults with opioid use disorder who were released from New York City jails to the community in 2011–2017. They experienced 31 382 incarcerations and were followed up to 1 year.MeasurementsThe primary outcomes were death caused by accidental drug poisoning and all‐cause death. The exposure was receipt of MOUD (17 119 events) versus out‐of‐treatment (14 263 events) during the last 3 days before community re‐entry. Covariates included demographic, clinical, behavioral, housing, health‐care utilization and legal characteristics variables. We performed a multivariable, mixed‐effect Cox regression analysis to test association between in‐jail MOUD and deaths.FindingsThe majority were male (82%) and their average age was 42 years. Receiving MOUD was associated with misdemeanor charges, being female, injection drug use and homelessness. During 1 year post‐release, 111 overdose deaths occurred and crude death rates were 0.49 and 0.83 per 100 person‐years for in‐jail MOUD and out‐of‐treatment groups, respectively. Accounting for confounding and random effects, in‐jail MOUD was associated with lower overdose mortality risk [adjusted hazard ratio (aHR) = 0.20, 95% confidence interval (CI) = 0.08–0.46] and all‐cause mortality risk (aHR = 0.22, 95% CI = 0.11–0.42) for the first month post‐release.ConclusionsMethadone and buprenorphine treatment for opioid use disorder during incarceration was associated with an 80% reduction in overdose mortality risk for the first month post‐release.