Jail and overdose: assessing the community impact of incarceration on overdose

Background and aims Incarceration produces a specific public health threat for drug overdose, and correctional settings do not offer medication for opioid use disorder. This study examined the overall impact of jail incarceration on overdose, the specific hazard for those booked on a syringe-related charge and the proportion of all overdose decedents in the community who were in the jail prior to death. Design and setting A cohort study of fatal overdose outcomes among a sample of individuals booked into and released from jail between 1 January 2017 and 31 December 2019. Marion County, IN, USA. Participants All individuals released from one county jail between 1 January 2017 and 31 December 2017 and decedents who died within the county from an accidental fatal overdose between January 2017 and December 2019. Measurements and findings Using information on all jail booking events, including charge type, during a 5-year period (January 2015-December 2019), we looked at the hazard of accidental fatal overdose post-release, controlling for age, sex and race. Of all overdose deaths in the county, 21% (n = 237) had been in the county jail within 2 years prior to their death. Each prior booking increased the hazard of mortality by approximately 20% [hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.15, 1.28], while the presence of a syringe charge at most recent booking prior to release more than tripled the hazard of mortality (HR = 3.55, 95% CI = 2.55, 4.93). Conclusions In Marion County, IN, USA, there appears to be an association between increased risk of fatal drug overdose and both syringe-related arrests and repeat jail bookings.