Drug-Related Risk for Death After Release from Prison

描述（由申请人提供）：刑事司法人口庞大，不断增长，物质使用障碍的患病率很高。宾斯万格博士（PI）先前的研究表明，前囚犯死亡的风险很高，特别是在出狱后的头两周。近四分之一的死亡是由于药物过量;许多其他死亡原因与药物滥用有关。艾滋病毒感染者，特别是艾滋病毒药物依赖者，面临与过量用药相关的死亡风险。此外，药物过量死亡率在美国一直在增加，特别是阿片类镇痛药的使用。然而，人们对出狱后与毒品有关的死亡危险因素知之甚少。拟议的研究将审查与十年内从监狱释放后死亡有关的药物相关风险和保护因素，重点是物质依赖、释放前不久的麻醉剂处方、艾滋病毒状况和监狱内物质依赖治疗。本研究的目的是在前囚犯中检查以下目标：1）确定出狱后全因和过量死亡的药物相关风险因素，包括在监狱中确定的物质依赖、释放前不久提供的麻醉剂处方和已知的艾滋病毒感染; 2）确定在监狱中提供的物质依赖治疗是否降低出狱后死亡的风险;以及3）确定1999-2008年释放后因各种原因死亡和药物过量的风险。这些目标将通过使用来自华盛顿州惩教部释放的约50，000名男性和女性囚犯的数据进行回顾性纵向队列设计来实现，然后对约1600名具有临床图表摘要的前囚犯进行嵌套病例对照研究。了解物质依赖的流行病学、物质依赖治疗和出狱后与毒品有关的死亡率，将指导在更广泛的刑事司法人群中进行进一步研究，包括其他州的囚犯、联邦拘留所和监狱。这些结果还将为进一步研究惩教设施中的药物依赖筛查和治疗以及制定有针对性的干预措施以减少出狱后与毒品有关的死亡风险提供信息。 公共卫生相关性：刑事司法人口庞大，不断增长，药物使用障碍和艾滋病毒的流行率很高。前囚犯在出狱后死亡的风险很高，特别是由于与毒品有关的原因。该提案将确定物质依赖、释放前使用处方麻醉品和艾滋病毒是否与出狱后死亡风险增加有关，以及监狱中的物质依赖治疗是否具有保护作用。这些调查结果将用于制定干预措施，以减少从监狱到社区过渡期间的死亡风险。

DESCRIPTION (provided by applicant): The criminal justice population is large, growing, and has a high prevalence of substance use disorders. Prior research by Dr. Binswanger (PI) has demonstrated that former inmates were at high risk for death, especially in the first two weeks after release from prison. Nearly one quarter of all deaths was due to drug overdose; many other causes of death were related to substance abuse. Individuals with HIV are at risk for overdose- related mortality, particularly drug-dependent individuals with HIV. Furthermore, drug overdose mortality has been increasing in the United States, especially from opioid analgesic use. However, little is known about drug- related risk factors for death after release from prison. The proposed study will examine the drug-related risk and protective factors associated with death after release from prison over a ten year period, with an emphasis on substance dependence, narcotic prescriptions shortly before release, HIV status, and in-prison substance dependence treatment. The objectives of this study are to examine the following aims in former inmates: 1) determine the drug-related risk factors for all-cause and overdose mortality after release from prison, including substance dependence, as identified in prison, narcotic prescriptions provided shortly before release, and known HIV infection; 2) determine if substance dependence treatment delivered in prison reduces the risk of death after release from prison; and 3) determine the risk of death from all causes and drug overdose after release from 1999-2008. These aims will be achieved using a retrospective longitudinal cohort design with data from approximately 50,000 male and female inmates released from the Washington State Department of Corrections, followed by a nested case control study of approximately 1600 former inmates with clinical chart abstraction. Understanding the epidemiology of substance dependence, substance dependence treatment, and drug- related mortality after release from prison will guide further research in a broader range of criminal justice populations including prisoners in other states, federal custody and jail. These results will also inform further research into substance dependence screening and treatment in correctional facilities and the development of a targeted intervention to reduce the risk of drug-related deaths after release from prison. PUBLIC HEALTH RELEVANCE: The criminal justice population is large, growing, and has a high prevalence of substance use disorders and HIV. Former inmates are at high risk for death after release from prison, particularly from drug-related causes. This proposal will determine if substance dependence, prescribed narcotic use prior to release, and HIV are associated with an elevated risk of death after release from prison, and if substance dependence treatment in prison is protective. These findings will be used to develop interventions aimed at reducing the risk of death during the transition from prison to the community.