Fatal and Non-Fatal Opioid Overdose Risk Following Prison Release: Associations with Individual Risk Factors, In-Prison Medications for Opioid Use Disorder, and Peer Navigation

项目摘要 解决从监禁中释放的个人中的阿片类药物使用障碍（OUD）和过量使用至关重要 来减少阿片类药物的危害释放后经常复发和过量。关键要坚持 确定有效的干预措施，以改善这些成果。有希望的干预措施包括药物治疗， 阿片类药物使用障碍（MOUD）的启动前释放，和同行导航程序，以支持护理过渡， 重返大气层和回收然而，需要更多证据来证明这些干预措施的结果。在 建议的补充研究，我们将使用链接的新泽西数据库，以检查过量和其他 物质使用障碍（SUD）相关的结果释放后，在一个队列的新泽西囚犯与 2016-2020年发布的SUD。检查的结果包括过量（致命和非致命）和其他SUD- 相关急诊科就诊和住院。数据将从以下链接：1.）行政数据 来自新泽西州惩教部（NJDOC）的监禁历史，服务和诊断， 监禁，释放日期和累犯; 2.）所有被释放的州囚犯的电子医疗记录数据， 新泽西，包括物质使用障碍评估和释放前参与MOUD的数据; 3.）第三章发布后死亡率和死因数据来自新泽西州的生命统计系统，和4。发布后数据 在住院和急诊科（艾德）访问，从所有付款人通用帐单（UB）的数据在新泽西州的 放电数据采集系统（DDCS）。这些关联数据将用于实现以下目标。1.） 在患有SUD的囚犯中，检查致命和非致命过量风险的模式和时间过程，以及 其他SUD相关的艾德就诊和住院，在监狱释放后。评估风险与 囚犯的人口统计学、临床和刑事司法史，包括精神健康和物质使用 科摩罗。评估COVID-19疫情期间的风险变化。2.）在OUD囚犯中，检查 （a.）预释放MOUD，按方式和持续时间，和B.）参与同行导航员重返 程序.检查参与这些计划和释放后结果之间的关联，包括 致死性和非致死性阿片类药物过量;其他阿片类药物相关艾德和住院治疗;释放后 过量、自杀、杀人和其他行为健康相关原因导致的死亡;以及累犯。 评估种族/族裔在接受干预措施和干预措施结果方面的差异。3.）第三章进行半结构化 参与者和同行导航员访谈，以更好地确定接受MOUD的促进者和障碍， 从监狱释放的个人中的同伴导航服务，以及参与者/同伴导航者对 实际交付的干预措施。结果将确定驱动释放后结果的因素和 创新的干预措施，旨在改善对这一高风险人群的护理，并将提供可操作的 改善涉及公正的人群的结果的证据。

Project Abstract Addressing opioid use disorder (OUD) and overdose among individuals released from incarceration is crucial for reducing the opioid epidemic's harms. Relapse and overdose are frequent following release. It is vital to identify effective interventions to improve these outcomes. Promising interventions include medications for opioid use disorder (MOUD) initiation prior to release, and peer navigator programs to support care transitions, re-entry, and recovery. However, more evidence is needed on outcomes of these interventions. In the proposed supplemental study, we will use linked New Jersey databases to examine overdoses and other substance use disorder (SUD) related outcomes following release in a cohort of New Jersey prisoners with SUD released from 2016-2020 . Outcomes examined include overdoses (fatal and non-fatal) and other SUD- related emergency department visits and hospitalizations. Data will be linked from: 1.) Administrative data from NJ Department of Corrections (NJDOC) on incarceration history, services and diagnoses received while incarcerated, release dates and recidivism; 2.) Electronic medical record data on all released state prisoners in New Jersey, including a substance use disorder assessment and data on pre-release participation in MOUD; 3.) Post-release mortality and cause-of-death data from NJ's Vital Statistics system, and 4.) post-release data on hospitalizations and emergency department (ED) visits, from all-payer Universal Billing (UB) data in NJ's Discharge Data Collection System (DDCS). These linked data will be used to address the following aims. 1.) Among inmates with SUDs, examine patterns and time course of fatal and non-fatal overdose risk, and risk of other SUD-related ED visits and hospitalization, following prison release. Assess associations of risk with demographic, clinical, and criminal justice histories of inmates, including mental health and substance use comorbidity. Assess changes in risk during the COVID-19 epidemic. 2.) Among inmates with OUD, examine take-up of: a.) pre-release MOUD, by modality and duration, and b.) participation in a peer-navigator re-entry program. Examine associations between participation in these programs and post-release outcomes, including fatal and non-fatal opioid overdose; other opioid-related ED and hospitalization encounters; post-release mortality from overdose, suicide, homicide, and other behavioral health related causes; and recidivism. Assess racial/ethnic disparities in receipt and outcomes of interventions. 3.) Conduct semi-structured participant and peer navigator interviews, to better identify facilitators and barriers for receipt of MOUD and peer navigator services among individuals released from prison, and participant/peer navigator perspectives on interventions as actually delivered. Results will identify factors that drive post-release outcomes and effects of innovative interventions designed to improve care for this high-risk population, and will provide actionable evidence to improve outcomes for justice-involved populations.