WITHDRAWN: Opioid and Other Prescription Drug Use Among Prisoners and Visiting Family Members: Analyses Using Integrated Administrative Data from Multiple Systems

Abstract

Background

Drug overdose is now the leading cause of death for Americans under 50 years of age. Opioid overdose is more common among former prisoners re-entering communities, with both women and men at risk. To develop effective interventions to address this epidemic for persons involved in the criminal-legal system, we must understand how prescription opioid and other prescription drug use manifests within these populations relative to other populations.

Methods

This study uses integrated administrative data for a sample of 18,790 persons incarcerated in a Southeastern state between 2006-2008 and their 44,488 visitors. Here we describe the data set, archived at the state data warehouse, which was developed through a research in partnership with the state law enforcement division and departments of corrections, juvenile justice, alcohol/drug abuse, mental health, health and human services, and environmental control. The data include time periods before, during, and after the incarceration and information on arrests, dispositions, sentencing, drug/alcohol treatment, mental and physical health, pharmaceuticals, and deaths, among other things. We conducted analyses on pharmaceutical data of prisoners and that of their adult visitors for drugs including opioids and those used in treatment of mental health disorders. We also examined association of prescription drug use to fatal overdose.

Results

A total of 54,323 persons 17 years or older had Medicaid pharmacy records (visitors n = 35,562; prisoner n = 18,761). The sample was split evenly between males and females. Among the therapeutic classes of drugs examined, opiate agonists were the most commonly prescribed (for 23% of the sample), followed by antidepressants (10%), benzodiazepines for anxiety (7%), anticonvulsants such as those prescribed for pain or mood stabilization (5%), and antipsychotics (3%). Opiate partial agonists and antagonists such as naloxone were rarely prescribed (>1%). Among those who used prescription opioids (n = 12,136), the mean number of prescriptions for opioids was 12, and the mean days’ supply was 162. Furthermore, there was a substantial population with very high usage; Over 15% of the sample had over 200 days supply of opioids, and nearly 5% had over 1000 days’ supply. There were 753 persons who died within the time frame captured within the data, primarily those in the visitor sample and from natural causes. Drug poisoning was implicated in 3% of deaths. Among classes of drugs examined, only having ever had prescriptions for benzodiazepines and for opioids were associated with an outcome of death.

Conclusions and Implications

The scope of opioid use in this sample, as well as the association of opioids and other prescription drugs with death, underscore the importance of interventions that target not only persons reentering communities after incarceration, but also the families and social networks of persons involved in the criminal-legal system. These data demonstrate potential of big-data applications in combatting the opioid epidemic in the United States, including approaches that examine both fatal and nonfatal overdose as well as overdose before and after incarceration.