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Characterization of opioid overdose and response in a high-risk community corrections sample: A preliminary study

Karen L. Cropsey, PsyD, Stephen Martin, MD, EdM, C. Brendan Clark, PhD, Cheryl B. McCullumsmith, MD, PhD, Peter S. Lane, DO, Sonya Hardy, MS, Peter S. Hendricks, PhD, Nicole Redmond, MD, PhD, MPH


Opiate overdose is an increasingly common cause of death, yet could be easily treated with available opioid antagonists. Opiate use is very common in criminal justice populations, and individuals recently released from prisons or jails are an especially vulnerable group for both overdose and death, particularly in the immediate postrelease period. Participants (N =478) were individuals under community corrections supervision who were surveyed about their opioid use, overdose history, medical history, and demographics. Most participants were male (67.4 percent) and either African American (52.4 percent) or Caucasian (44.2 percent) with an average age of 35 years (SD = 11.1). Two hundred twenty participants (46 percent) reported lifetime use of opioids, whereas 88 (40 percent) reported experiencing an opioid-related overdose. Relative to those with no history of opioid overdose or lifetime opioid use, participants with a history of opioid overdose were more likely to be Caucasian, female, and report higher educational attainment; more likely to be willing to receive additional training about overdose; and reported double to triple the rates of witnessing an overdose or knowing someone who had died from overdose —78 percent and 69 percent, respectively. The rates of actions taken when witnessing overdose were relatively low: 59 percent had called 911, 33 percent had taken someone to a hospital with 23 percent providing no intervention, and only 4 percent having used an opioid antagonist, naloxone. These findings suggest that while opioid overdose is a significant problem in the criminal justice population, affected individuals are open to instruction in effective strategies, such as naloxone training, to prevent fatal opioid overdose.


opiates, criminal justice, overdose, community corrections

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Anon.: Community-based opioid overdose prevention programs providing naloxone - United States, 2010. Morb Mortal Wkly Rep. 2012; 61(6): 101-105.

Anon.: Vital signs: Overdoses of prescription opioid pain relievers–United States, 1999-2008. Morb Mortal Wkly Rep. 2011; 60(43): 1487-1492.

Seaman SR, Brettle RP, Gore SM: Mortality from overdose among injecting drug users recently released from prison: Database linkage study. BMJ. 1998; 316(7129): 426-428.

Binswanger IA, Blatchford PJ, Lindsay RG, et al.: Risk factors for all-cause, overdose and early deaths after release from prison in Washington state. Drug Alcohol Depend. 2011; 117(1): 1-6.

Binswanger IA, Stern MF, Deyo RA, et al.: Release from prison–A high risk of death for former inmates. N Engl J Med. 2007; 356(2): 157-165.

Spaulding AC, Seals RM, McCallum VA, et al.: Prisoner survival inside and outside of the institution: Implications for health-care planning. Am J Epidemiol. 2011; 173(5): 479-487.

Merrall ELC, Kariminia A, Binswanger IA, et al.: Meta-analysis of drug-related deaths soon after release from prison. Addiction. 2010; 105(9): 1545-1554.

Kim D, Irwin KS, Khoshnood K: Expanded access to naloxone: Options for critical response to the epidemic of opioid overdose mortality. Am J Public Health. 2009; 99(3): 402-407.

Enteen L, Bauer J, McLean R, et al.: Overdose prevention and naloxone prescription for opioid users in San Francisco. J Urban Health. 2010; 87(6): 931-941.

Wermeling DP: Opioid harm reduction strategies: Focus on expanded access to intranasal naloxone. Pharmacotherapy. 2010; 30(7): 627-631.

Ahalt C, Binswanger IA, Steinman M, et al.: Confined to ignorance: The absence of prisoner information from nationally representative health data sets. J Gen Intern Med. 2012; 27(2): 160-166.

Cropsey KL, Jones-Whaley S, Jackson DO, et al.: Smoking characteristics of community corrections clients. Nicotine Tob Res. 2010; 12(1): 53-58.

Clark BC, Perkins A, McCullumsmith CB, et al.: What does self-identified drug of choice tell us about individuals under community corrections supervision? J Addict Med. 2012; 6(1): 57-67.

Green TC, Heimer R, Grau LE: Distinguishing signs of opioid overdose and indication for naloxone: An evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. 2008; 103(6): 979-989.

Baca CT, Grant KJ: Take-home naloxone to reduce heroin death. Addiction. 2005; 100(12): 1823-1831.

Hakansson A, Schlyter F, Berglund M: Factors associated with history of non-fatal overdose among opioid users in the Swedish criminal justice system. Drug Alcohol Depend. 2008; 94: 48-55.

Goldstein A, Herrera J: Heroin addicts and methadone treatment in Albuquerque: A 22-year follow-up. Drug Alcohol Depend. 1995; 40(2): 139-150.

Smyth B, Hoffman V, Fan J, et al.: Years of potential life lost among heroin addicts 33 years after treatment. Prev Med. 2007; 44(4): 369-374.

Grella CE, Lovinger K: 30-Year trajectories of heroin and other drug use among men and women sampled from methadone treatment in California. Drug Alcohol Depend. 2011; 118(2-3): 251-258.

Jimenez-Treviño L, Saiz PA, García-Portilla MP, et al.: A 25-year follow-up of patients admitted to methadone treatment for the first time: Mortality and gender differences. Addict Behav. 2011; 36(12): 1184-1190.

Dhalla I a, Mamdani MM, Sivilotti ML a, et al.: Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ. 2009; 181(12): 891-896.

Warner M, Chen LH, Makuc DM: Increase in Fatal Poisonings Involving Opioid Analgesics in the United States, 1999–2006. NCHS Data Brief, September 2009. Available at Accessed September 19, 2013.

Center for Disease Control and Prevention: Prescription Painkiller Overdoses: Use and Abuse of Methadone as a Painkiller. July 2012. Available at Accessed September 19, 2013.

McIntosh C, Ritson B: Treating depression complicated by substance misuse. Adv Psychiatr Treat. 2001; 7: 357-364.

Cropsey KL, Lane PS, Hale GJ, et al.: Results of a randomized controlled trial of buprenorphine for opioid dependent women in the criminal justice system. Drug Alcohol Depend. 2011; 119: 172-178.

Wright NM, Shead L, Adams CE, et al.: Comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): A randomized controlled trial. Br J Gen Pract. 2011; 61(593): e772-e780.

Magura S, Lee JD, Hershberger J, et al.: Buprenorphine and methadone maintenance in jail and post-release: A randomized clinical trial. Drug Alcohol Depend. 2009; 99: 222-230.

Garcia CA, Correa GC, Viver AD, et al.: Buprenorphine-naloxone treatment for pre-release opioid-dependent inmates Puerto Rico. J Addict Med. 2007; 1(3): 126-132.

Darke S, Ross J, Hall W: Overdose among heroin users in Sydney, Australia: II. Responses to overdose. Addiction. 1996; 91(3): 413-417.

Hoffman RS: Toxicology from across the pond. J R Coll Physicians Edinb. 2010; 40(2): 152-158.

Inciardi JA: The War on Drugs IV. Boston: Pearson, Allyn & Bacon, 2007.

Bjornaas MA, Teige B, Hovda KE, et al.: Fatal poisonings in Oslo: A one-year observational study. BMC Emerg Med. 2010; 10: 13.

Spertus JA, Ross JS, Curtis JP, et al.: Reduction in acute myocardial infarction mortality in the United States. JAMA. 2009; 302(7): 767-773.

Choudhry NK, Avorn J, Glynn RJ, et al.: Full coverage for preventive medications after myocardial infarction. N Engl J Med. 2011; 365(22): 2088-2097.

Weisfeldt ML, Sitlani CM, Ornato JP, et al.: Survival after application of automatic external defibrillators before arrival of the emergency medical system: Evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. 2010; 55(16): 1713-1720.



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