Drug-Related Risk for Death After Release from Prison

描述(由申请人提供)：刑事司法人员数量庞大，不断增长，药物使用障碍的患病率很高。Binswanger博士(PI)之前的研究表明，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吸毒过量；许多其他死因与药物滥用有关。艾滋病毒携带者面临与服药过量相关的死亡风险，特别是携带艾滋病毒的药物依赖者。此外，在美国，药物过量死亡率一直在上升，特别是由于阿片类止痛剂的使用。然而，人们对出狱后死亡的与毒品相关的风险因素知之甚少。这项拟议的研究将审查十年期间出狱后死亡与毒品相关的风险和保护因素，重点是药物依赖、释放前不久的麻醉处方、艾滋病毒状况和监狱内的药物依赖治疗。这项研究的目的是审查前囚犯的以下目标：1)确定释放后各种原因死亡和服药过量死亡的与药物有关的风险因素，包括监狱中确定的药物依赖、释放前不久提供的麻醉药品处方以及已知的艾滋病毒感染；2)确定在监狱中进行的药物依赖治疗是否降低了释放后死亡的风险；3)确定1999-2008年期间释放后各种原因死亡和药物过量的风险。这些目标将通过追溯纵向队列设计实现，数据来自华盛顿州惩教部公布的大约50,000名男性和女性囚犯，然后对大约1600名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、物质依赖治疗和出狱后与毒品相关的死亡的流行病学将指导对更广泛的刑事司法人群的进一步研究，包括其他州的囚犯、联邦拘留和监狱。这些结果还将有助于进一步研究惩教设施中的物质依赖筛查和治疗，并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。 与公共卫生相关：刑事司法人员数量庞大，而且还在不断增长，药物使用障碍和艾滋病毒的流行率很高。前囚犯出狱后死亡的风险很高，特别是因为与毒品有关的原因。这项提案将确定物质依赖、释放前的处方麻醉药物使用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性。这些调查结果将被用来制定干预措施，以减少从监狱向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.