A conceptual model for understanding post-release opioid-related overdose risk
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, intermediat...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13722-019-0145-5 |
| _version_ | 1818327088657072128 |
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| author | Paul J. Joudrey Maria R. Khan Emily A. Wang Joy D. Scheidell E. Jennifer Edelman D. Keith McInnes Aaron D. Fox |
| author_facet | Paul J. Joudrey Maria R. Khan Emily A. Wang Joy D. Scheidell E. Jennifer Edelman D. Keith McInnes Aaron D. Fox |
| author_sort | Paul J. Joudrey |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T12:10:43Z |
| format | Article |
| id | doaj.art-bc9e6298ecca46e3b9b6e13ab47e9029 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-12-13T12:10:43Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-bc9e6298ecca46e3b9b6e13ab47e90292022-12-21T23:46:50ZengBMCAddiction Science & Clinical Practice1940-06402019-04-0114111410.1186/s13722-019-0145-5A conceptual model for understanding post-release opioid-related overdose riskPaul J. Joudrey0Maria R. Khan1Emily A. Wang2Joy D. Scheidell3E. Jennifer Edelman4D. Keith McInnes5Aaron D. Fox6VA Connecticut Healthcare SystemDepartment of Population Health, New York UniversityDepartment of Internal Medicine, Yale School of Medicine, Yale UniversityDepartment of Population Health, New York UniversityDepartment of Internal Medicine, Yale School of Medicine, Yale UniversityDepartment of Veterans Affairs, Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers VA HospitalAlbert Einstein College of MedicineAbstract 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.http://link.springer.com/article/10.1186/s13722-019-0145-5Criminal justice systemOpioid-related overdoseMortalityConceptual model |
| spellingShingle | Paul J. Joudrey Maria R. Khan Emily A. Wang Joy D. Scheidell E. Jennifer Edelman D. Keith McInnes Aaron D. Fox A conceptual model for understanding post-release opioid-related overdose risk Addiction Science & Clinical Practice Criminal justice system Opioid-related overdose Mortality Conceptual model |
| title | A conceptual model for understanding post-release opioid-related overdose risk |
| title_full | A conceptual model for understanding post-release opioid-related overdose risk |
| title_fullStr | A conceptual model for understanding post-release opioid-related overdose risk |
| title_full_unstemmed | A conceptual model for understanding post-release opioid-related overdose risk |
| title_short | A conceptual model for understanding post-release opioid-related overdose risk |
| title_sort | conceptual model for understanding post release opioid related overdose risk |
| topic | Criminal justice system Opioid-related overdose Mortality Conceptual model |
| url | http://link.springer.com/article/10.1186/s13722-019-0145-5 |
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