Abstract
BackgroundDrug overdose is the leading cause of death after release from prison, and this risk is significantly higher among women compared to men. Within the first 2 weeks after release, the risk of death from drug overdose is 12.7 times higher than the general population, with risk of death further elevated among females. Although female inmates have higher rates of opioid use disorder and post-release overdose fatality, justice-involved women are under-represented in studies of medications for opioid use disorder. The Reducing Overdose After Release from Incarceration (ROAR) pilot intervention and evaluation (recruitment June 2019 through December 2020) aims to reduce opioid overdose among women released to the community following incarceration in state prison. The evaluation further assesses induction, acceptance and effectiveness of extended release naltrexone in a female post-prison population.Methods/designIn the week prior to their release, female adults in custody with moderate to severe opioid use disorder start treatment with extended release naltrexone, an injectable opioid antagonist that blocks the effects of opioids for up to 1 month. All ROAR participants receive training to use naloxone rescue kits and are provided nasal naloxone at release. Ongoing support from a certified recovery mentor to facilitate sustained engagement with treatment for substance use disorders begins in the month prior to release from prison and continues for 6 months in community. We evaluate the association between ROAR participation and the primary outcome of opioid overdose.Using administrative data provided by the Oregon Department of Corrections and the Oregon Health Authority, we compare the odds of overdose among ROAR participants versus a comparison group of females released from prison during the study period. Evaluation activities in community includes survey and qualitative interviews for 6 months post release, as well as a review of clinic records to assess retention on medication among the pilot cohort (N = 100).DiscussionROAR is a collaboration between Oregon’s public health, criminal justice, and medical communities. The ROAR intervention and evaluation provide critical information on improving interventions to prevent opioid overdose and improve retention on treatment in community in an overlooked, high-risk population: incarcerated women re-entering the community.Trial registrationClinical Trials.gov TRN: NCT03902821.
Highlights
Drug overdose is the leading cause of death after release from prison, and this risk is significantly higher among women compared to men
Risks of overdose are further elevated when heroin is used with other substances (Coffin et al, 2007), there is presence of comorbid medical disorders (e.g., HIV and mental health disorders) (Coffin et al, 2007), and there is a history of prior overdose (Coffin et al, 2007) or injection of drugs (Merrall et al, 2010)
Peer-supported recovery for justice-involved women Effective re-entry programming that includes interpersonal interactions with community social services is key to reducing return to incarceration (Kendall, Redshaw, Ward, Wayland, & Sullivan, 2018) and risk of overdose for individuals with opioid use disorder (OUD)
Summary
Oregon is well-positioned to successfully pilot and maintain a new model of pre-release linkage to MOUD and CRM services for incarcerated individuals. The pilot program excludes pregnant women and those planning to become pregnant, as XR-NTX is not indicated in pregnancy This is a major limitation of the project, as it does not address the treatment needs of pregnant women or those planning pregnancy soon after release from prison. The state of Oregon has recognized the need to strengthen cross-disciplinary partnerships and its Department of Corrections is prepared to begin playing a role in preventing overdose for a vulnerable population: women with OUD preparing for community re-entry. Alkermes donated samples of XR-NTX to the Oregon Department of Corrections for participants to initiate treatment prior to release from prison.
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