COVID-19 impact on opioid overdose after jail release in Massachusetts

Peter D Friedmann; Devon Dunn; Pryce Michener; Dana Bernson; Thomas J Stopka; Ekaterina Pivovarova; Warren J Ferguson; Rebecca Rottapel; Randall Hoskinson Jr; Donna Wilson; Elizabeth A Evans

doi:10.1016/j.dadr.2023.100141

COVID-19 impact on opioid overdose after jail release in Massachusetts

Drug Alcohol Depend Rep. 2023 Mar:6:100141. doi: 10.1016/j.dadr.2023.100141. Epub 2023 Feb 27.

Affiliations

¹ University of Massachusetts Chan Medical School - Baystate and Baystate Health, Office of Research, 3601 Main Street, Springfield, MA 01107 USA.
² Massachusetts Department of Public Health, Office of Population Health - Special Analytic Projects, 250 Washington Street, 6th Floor, Boston, MA 02108 USA.
³ University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA.
⁴ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA.
⁵ Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant St, Amherst, MA 01003, USA.

Abstract

Introduction: Release from incarceration is a high-risk period for opioid overdose. Concern about COVID-19 spread in jails led to early releases; it is unknown whether pandemic era releases of persons with opioid use disorder (OUD) contributed to increases in community overdose rates.

Methods: Observational data compared overdose rates three months after release among jailed persons with OUD released before (9/1/2019-3/9/2020) and during the pandemic (3/10/2020-8/10/2020) from seven jails in Massachusetts. Data on overdoses come from the Massachusetts Ambulance Trip Record Information System and Registry of Vital Records Death Certificate file. Other information came from jail administrative data. Logistic models regressed overdose on release period, controlling for MOUD received, county of release, race/ethnicity, sex, age, and prior overdose.

Results: Pandemic releases with OUD had a higher risk of fatal overdose (adjusted odds ratio [aOR] 3.06; 95% CI, 1.49 to 6.26); 20 persons released with OUD (1.3%) experienced a fatal overdose within three months of release, versus 14 (0.5%) pre-pandemic. MOUD had no detectable relationship with overdose mortality. Pandemic release did not impact non-fatal overdose rates (aOR 0.84; 95% CI 0.60 to 1.18), though in-jail methadone treatment was protective (aOR 0.34; 95% CI 0.18 to 0.67).

Conclusions: Persons with OUD released from jail during the pandemic experienced higher overdose mortality compared to pre-pandemic, but the number of deaths was small. They did not experience significantly different rates of non-fatal overdose. Early jail releases during the pandemic were unlikely to explain much, if any, of the observed increase in community overdoses in Massachusetts.