A conceptual model for understanding post-release opioid-related overdose risk

Paul J. Joudrey, Maria R. Khan, Emily A. Wang, Joy D. Scheidell, E. Jennifer Edelman, D. Keith McInnes, Aaron D. Fox

Research output: Contribution to journalReview article

Abstract

Post-release opioid-related overdose mortality is the leading cause of death among people released from jails or prisons (PRJP). Informed by the proximate determinants framework, this paper presents the Post-Release Opioid-Related Overdose Risk Model. It explores the underlying, intermediate, proximate and biological determinants which contribute to risk of post-release opioid-related overdose mortality. PRJP share the underlying exposure of incarceration and the increased prevalence of several moderators (chronic pain, HIV infection, trauma, race, and suicidality) of the risk of opioid-related overdose. Intermediate determinants following release from the criminal justice system include disruption of social networks, interruptions in medical care, poverty, and stigma which exacerbate underlying, and highly prevalent, substance use and mental health disorders. Subsequent proximate determinants include interruptions in substance use treatment, including access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone access, and a return to solitary opioid use. This leads to the final biological determinant of reduced respiratory tolerance and finally opioid-related overdose mortality. Mitigating the risk of opioid-related overdose mortality among PRJP will require improved coordination across criminal justice, health, and community organizations to reduce barriers to social services, ensure access to health insurance, and reduce interruptions in care continuity and reduce stigma. Healthcare services and harm reduction strategies, such as safe injection sites, should be tailored to the needs of PRJP. Expanding access to opioid agonist therapy and naloxone around the post-release period could reduce overdose deaths. Programs are also needed to divert individuals with substance use disorder away from the criminal justice system and into treatment and social services, preventing incarceration exposure.

Original languageEnglish (US)
Number of pages1
JournalAddiction science & clinical practice
Volume14
Issue number1
DOIs
StatePublished - Apr 15 2019

Fingerprint

Opioid Analgesics
Prisons
Criminal Law
Mortality
Naloxone
Social Work
Harm Reduction
Polypharmacy
Continuity of Patient Care
Poverty
Health Insurance
Mental Disorders
Chronic Pain
Social Support
HIV Infections
Substance-Related Disorders
Cause of Death
Mental Health
Therapeutics
Organizations

Keywords

  • Conceptual model
  • Criminal justice system
  • Mortality
  • Opioid-related overdose

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A conceptual model for understanding post-release opioid-related overdose risk. / Joudrey, Paul J.; Khan, Maria R.; Wang, Emily A.; Scheidell, Joy D.; Edelman, E. Jennifer; McInnes, D. Keith; Fox, Aaron D.

In: Addiction science & clinical practice, Vol. 14, No. 1, 15.04.2019.

Research output: Contribution to journalReview article

Joudrey, Paul J. ; Khan, Maria R. ; Wang, Emily A. ; Scheidell, Joy D. ; Edelman, E. Jennifer ; McInnes, D. Keith ; Fox, Aaron D. / A conceptual model for understanding post-release opioid-related overdose risk. In: Addiction science & clinical practice. 2019 ; Vol. 14, No. 1.
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