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The relationship between incarceration history and overdose in North America: A scoping review of the evidence.

ABSTRACT:

Introduction

Rates of opioid overdose (OD) have risen to unprecedented numbers and more than half of incarcerated individuals meet the criteria for substance use disorder, placing them at high risk. This review describes the relationship between incarceration history and OD.

Methods

A scoping review was conducted and criteria for inclusion were: set in North America, published in English, and non-experimental study of formerly incarcerated individuals. Due to inconsistent definitions of opioid OD, we included all studies examining OD where opioids were mentioned.

Results

The 18 included studies were all published in 2001 or later. Four associations between incarceration history and OD were identified: (1) six studies assessed incarceration history as a risk factor for OD and four found a significantly higher risk of OD among individuals with a history of incarceration compared to those without; (2) nine studies examined the rate of OD compared to the general population: eight found a significantly higher risk of fatal OD among those with a history of incarceration and three documented the highest risk of death immediately following release; (3) six studies found demographic, substance use and mental health, and incarceration-related risk factors for OD among formerly incarcerated individuals; and (4) four studies assessed the proportion of deaths due to OD and found a range from 5 % to 57 % among formerly incarcerated individuals.

Discussion

Findings support the growing call for large-scale implementation of evidence-based OD prevention interventions in correctional settings and among justice-involved populations to reduce OD burden in this high-risk population.

SUBMITTER: Mital S

PROVIDER: S-EPMC7683355 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAs several regulatory and environmental changes have occurred in North America, trends in overdose deaths were examined in the United States (US), Ontario and British Columbia (BC), including changes in consumption levels of prescription opioids (PO) and overdose deaths, changes in correlations between consumption levels of PO and overdose deaths and modeled differences between observed and predicted overdose deaths if no changes had occurred.MethodsConsumption levels of PO included defined daily doses for statistical purposes per million inhabitants per day for the US and Canada (2001-2015). Overdose deaths included opioid overdose deaths for the US (2001-2017) and Ontario (2003-2017) and illicit drug overdose deaths for BC (2001-2017). The analytic techniques included structural break point analyses, Pearson product-moment correlations and multivariate Gaussian state space modeling.ResultsConsumption levels of PO changed in the US in 2010 and in Canada in 2012. Overdose deaths changed in the US in 2014 and in Ontario and BC in 2015. Prior to the observed changes in consumption levels of PO, there were positive correlations between consumption levels of PO and overdose deaths in the US (r = 0.99, p < 0.001) and Ontario (r = 0.92, p = 0.003). After the observed changes in consumption levels of PO, there was a negative correlation between consumption levels of PO and overdose deaths in the US (r = - 0.99, p = 0.002). Observed overdose deaths exceeded predicted overdose deaths by 5.7 (95% Confidence Interval [CI]: 4.8-6.6), 3.5 (95% CI: 3.2-3.8) and 21.8 (95% CI: 18.6-24.9) deaths per 100,000 people in the US, Ontario and BC, respectively in 2017. These excess deaths corresponded to 37.7% (95% CI: 31.9-43.6), 39.2% (95% CI: 36.3-42.1) and 72.2% (95% CI: 61.8-82.6) of observed overdose deaths in the US, Ontario and BC, respectively in 2017.ConclusionsThe opioid crisis has evolved in North America, as a sizeable proportion of overdose deaths are now attributable to the several regulatory and environmental changes. These findings necessitate substance use policies to be conceptualized more broadly as well as the continued expansion of harm reduction services and types of pharmacotherapy interventions.

Project description:BackgroundThe burden of chronic conditions, like diabetes, is disproportionately carried by people facing social disadvantages (e.g., those with experiences of incarceration). A dearth of knowledge remains about this topic. We conducted a scoping review to determine the extent of literature about diabetes management and/or self-management in relation to incarceration.MethodsWe used the Arksey and O'Malley five stage process, recommendations by Levac et al., and the PRISMA Extension for Scoping Reviews Checklist. Core search terms for diabetes were combined using the Boolean operator AND with terms relevant to incarceration. We initially searched the following electronic academic databases on January 5, 2021, and then updated these searches on September 7, 2022: APA PsycInfo, CINAHL, Criminal Justice Abstracts, EMBASE, MEDLINE, Scopus, and SocINDEX. There were no restrictions on language, study design, quality, location, time, and sex or gender differences. We searched for research articles, conference proceedings, dissertations and theses, government documents, and organization documents. We then searched for other forms of literature using an electronic database (ProQuest Dissertations and Theses - Global), the internet search engine Google, and various corrections and diabetes websites in August 2021 and then updated these searches in September 2022. We also reviewed the reference lists of the final selected documents to identify additional literature.FindingsThe search from the seven databases identified 3076 records. The search from other sources (e.g., websites) identified an additional 1077 records. A total of 40 documents met our final inclusion criteria and were included in this review. The type of research conducted was primarily quantitative in nature. Clinic and education interventions were most commonly investigated. Clinical outcomes were often reported. Most guidelines were targeted at healthcare providers. Much of the literature originated from high-income countries, which may not be fully applicable for different contexts like low-income countries. Many interventions were associated with improved outcomes.InterpretationAdministrators can use our findings to develop appropriate policies for this population. Tailored diabetes education for this population and healthcare providers may improve management practices. Our findings offer key insights for improving diabetes care and outcomes for this underserved population. Addressing the diabetes-specific health needs of these people may improve overall public health.FundingKD has received the O'Brien Institute for Public Health Postdoctoral Scholarship (University of Calgary), Cumming School of Medicine Postdoctoral Scholarship (University of Calgary), and the Libin Cardiovascular Institute's 2021 Person to Population Seed Grant (University of Calgary).