Structural and healthcare predictors of substance use-related death following release from incarceration: A retrospective cohort study in Rhode Island, 2018–2020

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-04-04 DOI:10.1016/j.drugpo.2025.104783

Lauren Brinkley-Rubinstein , Katherine LeMasters , Justin Berk , Sara N. Levintow , Sarah Martino , Rahul Vanjani

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引用次数: 0

Abstract

Background

Incarcerated individuals are at a high risk of substance use-related death after release. While prior research has demonstrated that this is partially due to loss of tolerance during incarceration and return to use after release, structural and healthcare use factors that may also impact overdose risk have been underexplored. We assessed the relationship between structural factors (e.g., housing services received) and health care use (e.g., emergency department use) and overdose risk at 12-months post-incarceration in Rhode Island in the United States.

Methods

We used a retrospective cohort study design. Rhode Island Department of Corrections (RIDOC) data were linked with individual-level data across state agencies. Cumulative incidence of substance use-related death was estimated as a function of structural and healthcare factors using hazard ratios from cause-specific cox landmark models for dynamic predictions.

Results

There were 9696 individuals in the analytic sample. Most deaths that occurred within 12 months post-release involved substance use (N = 96). People who had more previous incarcerations had a higher risk of substance use-related death. Reporting taxable wages (aHR: 0.52; 95 % CI: 0.25, 1.09) was weakly associated with in a lower risk of substance use-related death while being admitted to the hospital (aHR: 1.79; 95 % CI: 0.91, 3.53) was weakly associated with a slightly higher risk of substance use-related death 12-months post-release.

Conclusion

Structural factors were weakly associated with reduced risk of substance use-related death post-release from incarceration. Conducting needs assessments (e.g., identifying employment needs) and interventions (e.g., employment training programs) prior to or at release that address these structural factors are critical for reducing this risk. Further, these findings contribute to the evidence that decarceration should be used a public health tool given the high risk of substance use-related death post-release.

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背景被监禁者获释后发生与药物使用相关的死亡的风险很高。先前的研究表明，造成这种情况的部分原因是在监禁期间丧失了耐受性，出狱后又重新使用药物，但对可能影响用药过量风险的结构性因素和医疗保健使用因素的研究还不够。我们评估了美国罗德岛州入狱后 12 个月内结构性因素（如接受的住房服务）和医疗保健使用（如急诊室使用）与用药过量风险之间的关系。我们采用了回顾性队列研究设计，将罗德岛惩教署（RIDOC）的数据与各州机构的个人数据进行了关联。使用特定病因 cox 地标模型的危险比进行动态预测，将药物使用相关死亡的累积发生率估算为结构和医疗保健因素的函数。释放后 12 个月内发生的死亡大多与药物使用有关（N = 96）。曾被监禁次数越多的人与药物使用相关的死亡风险越高。报告应税工资（aHR：0.52；95 % CI：0.25, 1.09）与药物使用相关死亡风险较低关系不大，而入院（aHR：1.79；95 % CI：0.91, 3.53）与释放后 12 个月内药物使用相关死亡风险略高关系不大。在释放前或释放时进行需求评估（如确定就业需求）和干预（如就业培训计划），以解决这些结构性因素，对于降低这种风险至关重要。此外，鉴于释放后与药物使用相关的死亡风险很高，这些研究结果有助于证明应将非监禁作为一种公共卫生工具来使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.