
Opioid Use Disorder in Pennsylvanian State Correctional Institutions: Prevalence, Outcomes, and the Impact of Medicaid Policies
Background: To combat the rise in opioid overdose deaths, enhanced access to pharmacological treatment and medicaid assistance remains paramount, particularly for individuals released from state detention. Bearing this in thought, this integrative doctoral research in public health aims to: (1) examine the prevalence of substance use disorders among released individuals from Pennsylvanian state correctional institutions (PA-SCIs) between January 1, 2014 and December 31, 2020; (2) examine post-release rates of opioid overdose mortality for individuals released with an opioid use disorder (OUD) diagnosis from PA-SCIs, preceding and subsequent to the state authorization of coverage suspension of medicaid assistance for individuals in Pennsylvania (PA) prisons; and (3) examine the relationship between post-release opioid overdose mortality and medicaid assistance policies for PA-SCI released individuals with an OUD diagnosis.
Methods: This integrative doctoral research uses a retrospective cohort design with linked administrative data from five governmental databases. In the first paper, data from the Pennsylvania Department of Corrections (PA-DOC) was used to examine OUD prevalence, and corresponding treatment rates, of adults (≥18) released between January 1, 2014 and December 31, 2020 with comparison to the general population, respectively. To estimate prevalence rates of the general population, data from the National Survey on Drug Use and Health (NSDUH), Center for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER), and American Community Survey were used and adjusted with a capture recapture multiplier; a method used to correct for the underestimations of OUD. Two trend analyses—Cochran-Armitage (CA) and Jonckheere-Terpstra (JT) tests—were conducted to assess the significance of changes in annual prevalence and treatment estimates across years of release. In the second paper, administrative records of adults with an OUD diagnosis released from-PA-SCIs between January 1, 2015 and December 31, 2015 or January 1, 2018, and December 31, 2018 were probabilistically linked to death records from the CDC National Death Index (NDI) for deaths that occurred within a year of prison release. Demographic, treatment, and death characteristics were assessed with bivariate analyses. Multivariable logistic regressions were used to examine the association between qualification of medicaid suspension and post-release crude and opioid overdose mortality rates, as well as to assess potential demographic and custodial risk factors for mortality within a year after prison release.
Results: The sample contained 19,023 individuals aged ≥18 with an OUD that were released from Pennsylvanian SCIs between January 1, 2014, and December 31, 2020, which accounted for 22.1% of those released from SCIs in Pennsylvania. Within PA-SCIs, the prevalence of OUD grew from 2014 to 2020 (16.6% to 27.2%; p<.0001) with minimal pharmacological engagement (0.0% to 18.3%; p<.0001), particularly for agonist medications (0.0% to 4.5%; p<.0001), and reduced rates of behavioral health services (69.6% to 53.7%; p<.0001). Upon release, there is a growing risk of opioid-related overdose mortality for adults with an OUD diagnosis (0.6% to 1.7%; p<0.01), predominantly from synthetic narcotics (57.1% to 83.1%, p<0.001). Furthermore, the interaction of policy qualification and year of release was not statistically significant (-0.36, p=0.58), however, the direction of the association was consistent with the hypothesis that the policy change—from medicaid termination to medication suspension—was associated with reduced risk of post-release opioid overdose death for individuals with an OUD diagnosis.
Conclusion: Rising OUD prevalence, combined with low rates of pharmacological treatment and decreases in behavioral health services, suggest that further improvements in treatment access are necessary to meet the treatment need for individuals with OUD in PA-SCIs. Also, a statistically significant finding between the interaction of policy qualification and year of release was not found, which suggests the need for more research in larger samples before drawing conclusions on the nature of post-release importance. Further research is additionally needed to further understand the impact of other political and custodial mechanisms involved in post-release healthcare for individuals with an OUD diagnosis and the consequent impact on substance use outcomes as individuals transition to communities.
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Work Title | Opioid Use Disorder in Pennsylvanian State Correctional Institutions: Prevalence, Outcomes, and the Impact of Medicaid Policies |
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License | In Copyright (Rights Reserved) |
Work Type | Dissertation |
Publication Date | December 12, 2023 |
Deposited | December 12, 2023 |
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