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 解决阿片类药物使用障碍(OUD)和服药过量的问题至关重要 以减少阿片类药物泛滥的危害。在释放后，复发和过量用药经常发生。这是至关重要的 确定有效的干预措施以改善这些结果。有希望的干预措施包括治疗 阿片类药物使用障碍(MOUD)释放前的启动，以及支持护理过渡的同伴导航器计划， 重返大气层，并进行回收。然而，这些干预措施的结果还需要更多证据。在 建议的补充研究，我们将使用链接的新泽西州数据库来检查过量和其他 新泽西州一群囚犯获释后与物质使用障碍(SUD)相关的结果 SOD于2016-2020年间发布。检查的结果包括服药过量(致命和非致命)和其他SUD- 相关急诊科就诊和住院治疗。数据将从以下位置链接：1.)管理数据 来自新泽西州惩教部(NJDOC)的关于监禁历史、服务和在 监禁、释放日期和累犯；2)年所有被释放的州囚犯的电子病历数据 新泽西州，包括物质使用障碍评估和Moud释放前参与的数据； 3.)来自新泽西州生命统计系统的发布后死亡率和死因数据，以及4.发布后数据 关于住院和急诊科(ED)就诊，来自新泽西州的所有付款人通用账单(UB)数据 出院数据采集系统(DDCS)。这些关联数据将用于实现以下目标。1) 在患有肥皂水的囚犯中，检查致命性和非致命性服药过量风险的模式和时间进程，以及 其他与SUD相关的急诊室就诊和住院，在监狱获释后。评估风险与 囚犯的人口统计、临床和刑事司法史，包括精神健康和药物使用情况 合并症。评估新冠肺炎疫情期间的风险变化。2.)在有OUD的囚犯中，检查 采用：a.)预发行Moud，按模式和持续时间，以及b.)参与对等导航员重返大气层 程序。检查参与这些计划和释放后结果之间的联系，包括 致命性和非致命性阿片类药物过量；其他与阿片类药物有关的急症和住院；释放后 因服药过量、自杀、凶杀和其他与行为健康有关的原因而死亡；以及累犯。 评估接受干预措施和干预结果方面的种族/族裔差异。3.)进行半结构化操作 参与者和同行导航员访谈，以更好地确定促进者和接受Moud和 出狱人员之间的同行导航员服务，以及参与者/同行导航员对 实际提供的干预措施。结果将确定推动释放后结果的因素和影响 旨在改善对这一高危人群的护理的创新干预措施，并将提供可操作的 改善涉及正义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.