ABSTRACT
Background and Aims
Despite the high prevalence of substance use among people in the US criminal justice system, little is known about the incidence of overdose mortality by use patterns, drug convictions, and supervision setting. We examined the associations between these characteristics and overdose mortality.
Design
Retrospective cohort study.
Setting and participants
Individuals sentenced to prison, jail, probation, or jail and probation for a felony conviction in Michigan, USA from 2003 to 2006.
Measurements
Using the National Death Index, we assessed overdose mortality through December 2012. We calculated overdose mortality rates by pre‐sentence opioid use, drug convictions, and supervision setting. Multivariable analyses were conducted using competing risks regression with time‐varying covariates.
Findings
Among 140,266 individuals followed over a mean of 7.84 years (SD = 1.52), 14.9% of the 1,131 deaths were due to overdose (102.8 per 100,000 person‐years [PY]). Over the follow‐up, more than half of overdose deaths occurred in the community (57.7%), nearly a third (28.8%) on probation, and 12.8% on parole. The adjusted risk of overdose death was lower on probation (hazard ratio [HR] = 0.71, 95% CI = 0.60, 0.85) than in the community without probation or parole (HR = 1.00) but not significantly different on parole (HR = 1.13, 95% CI = 0.87, 1.47). Pre‐sentence daily opioid use (HR = 3.54, 95% CI = 3.24, 3.87) was associated with an increased risk. Drug possession (HR = 1.11, 95% CI = 0.93, 1.31) and delivery convictions (HR = 0.92, 95% CI = 0.77, 1.09) were not significantly associated with overdose mortality.
Conclusions
Based on the absolute or relative risk, parole, probation, and community settings are appropriate settings for enhanced overdose prevention interventions. Ensuring that individuals with pre‐sentence opioid use have access to harm reduction and drug treatment services may help to prevent overdose among people involved with the criminal justice system.