A recent study in North Carolina found that in the first two weeks after being released from prison, former inmates were 40 times more likely to die of an opioid overdose than someone in the general population. The studies are published in the American Journal of Public Health

When restricted to heroin overdoses only, formerly incarcerated individuals' likelihood of overdose death increased to 74 times the norm within the first two weeks after release. Even an entire year after release, overdose death rates remained 10-18 times higher among formerly incarcerated individuals as compared to the general North Carolina population.

The U.S. is experiencing an unprecedented opioid epidemic. Between 2000 and 2016, opioid overdose death rates quadrupled and more than 300,000 Americans died of an opioid overdose. Despite many policy initiatives and interventions, the death toll continues to rise.

Ongoing epidemic's impact

Until this study, the ongoing epidemic's impact on formerly incarcerated individuals, who are at especially high risk for opioid use, was not well known. To conduct the study, the researchers linked North Carolina inmate release records to North Carolina death records, calculated opioid overdose death standardized mortality ratios to compare former inmates with North Carolina residents and calculated hazard ratios to identify predictors of time until opioid overdose death.

"We know from fighting other epidemics that treating and preventing disease among high-risk – or vulnerable – populations benefit not only members of that population, but everyone around them," said Shabbar Ranapurwala. "The same is true here. Preventing overdose deaths and treating substance use disorders in formerly incarcerated people may prevent the spread of the epidemic in the general population."

"A host of other problems like stigmatization, loss of dignity, loss of family for some, and discrimination in housing and employment only compound existing substance use problems," Ranapurwala explained. "This leads to premature deaths."

"As a society, we do not do enough to rehabilitate formerly incarcerated individuals back into our world," he added. "What's more, both medically and scientifically, we know that substance use disorder is a health condition – an illness. The only way to treat an illness is by providing medical help."

"We must reduce the deaths in this population, and we know how to do it," Kinsley said. "We are working to partner across North Carolina to treat those suffering from substance use disorders in all settings. We hope our partners will join us by implementing proven methods such as medication-assisted treatment for opioid use disorders."

The division also plans to purchase additional naloxone kits to distribute to people as they leave prison if those individuals completed substance use disorder treatment while incarcerated.

Criminal justice-involved individuals

"Officers who supervise criminal justice-involved individuals have had wide success with naloxone kits," he reported, "so much so, that Community Corrections may expand naloxone distribution to individuals and families returning from the department's substance abuse treatment facilities in Dart Cherry and Black Mountain, as well as from probation violation and re-entry facilities across the state."

"We know that many people transitioning out of prison facilities bear the weight of addiction to various illegal substances," said Hooks. "The goal of the SRCC plan is to proactively remove barriers and give people access to resources and services that will increase their chances of successful re-entry."