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

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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.