The surge of opiate-related overdoses in the United States is a pressing public health issue. An underrepresented aspect of this epidemic is the disproportionately high risk of death that people reentering the community from jail or prison experience upon their release. Public health and correctional agencies share a responsibility in preventing avoidable mortality and morbidity associated with these events.

Vera’s Director of Research, Jim Parsons, recently spoke with Dr. Ingrid Binswanger, Associate Professor in the Division of General and Internal Medicine at the University of Colorado School of Medicine, whose widely-cited research reveals a range of factors that contribute to elevated morality risk among people recently released from prison and signals the need for better collaboration and communication between health and justice systems to improve continuity in care. Their interview is featured in a new Vera Voices podcast video, “Health Care Issues After Incarceration: Risk Factors, Mortality, and the Need for Prevention.”

Dr. Binswanger’s research primarily focuses on the United States, but reflects an internationally observed trend—people experience a high risk of death during the reentry phase, especially in the first few weeks after their release. Her research reveals a range of contributing factors that explain why this population is vulnerable to a higher risk of death upon release:

• High prevalence of substance use — While there are many causes of deaths post-release, the majority of the deaths occurring immediately after release are related to drug overdoses. The overrepresentation of people with substance use issues in the criminal justice system is therefore a partial contributing factor to the elevated mortality risk.

• Parole and probation violations — A substantial percentage of deaths that occur shortly after release from prison include individuals who were incarcerated for violating parole or probation terms—oftentimes these parole violations stem from failing a drug test.  
• Lack of evidence-based care in correctional facilities — “One of the things we’d like to see happen is more evidence-based addiction care for people who are incarcerated,” Dr. Binswanger said in the interview, explaining that only a small minority of jails and prisons provide medication-assisted treatment and other forms of treatment shown to be effective in treating people with chronic opiate addictions.    
• Disruption of continuity in care — In most states, people lose health insurance upon imprisonment, sometimes disrupting medication-based drug treatment that they were receiving. On the other end of the spectrum, there is often inadequate programming or institutional commitment to engaging people in appropriate health services in the community prior to their release.

While identifying these systemic problems that arise in the transition between prison and home, Dr. Bitswanger’s research also pointed to solutions that may reduce mortality risk, many of which coincide with work in Vera’s Substance Use and Mental Health Unit (SUMH) that seeks to break down the barriers between community health and criminal justice agencies.

• Employing patient navigators — “People don’t have any way to refill their medications after they are released from prison,” Dr. Binswanger pointed out. Specialized patient navigators can help with tasks such as enrolling people in insurance and making medical appointments, all of which improve continuity in care by enabling a smooth handoff to the community.  
• Capitalizing on the Affordable Care Act — Under the ACA, Medicaid expansions and stronger parity for behavioral health services create important opportunities for community health and correctional agencies to work collaboratively to ensure that people reentering the community from jail or prison are connected to the appropriate services upon release. It is imperative that justice systems focus on enrolling people in a health plan and connecting them to community-based services rather than disrupting care.  
• Increasing education about overdose risk — People with addictions and their families need to fully understand the elevated overdose risk upon reentry and be provided with meaningful information about how  to receive the services they need in the community before the release occurs. One strategy may be to bring in representatives from community-based harm reduction clinics to provide health education and service referrals.  
• Increasing the dispensation of lifesaving medications — Naloxone is an overdose reversal drug that is easy to administer, has zero abuse potential, and has been shown to be highly effective in saving lives. Yet barely any jails or prisons provide access to Naloxone upon release, which creates a clear and significant public health opportunity. However, promising progress has recently been made with the improved access to naloxone for police officers in the field.

Above all, Dr. Binswanger’s research signifies the need for breaking down the silos between community health and corrections. Vera’s Justice and Health Connect website advances this goal by helping criminal justice and community health stakeholders overcome the legal, cultural, and practical barriers to sharing information that can help maximize continuity of care and link people in transition to appropriate services. In 2013, Vera researches completed a study in Los Angeles County that demonstrated the limited communication and coordination between the county sheriff’s department, other government agencies, and the range of community-based service providers, which can exacerbate the risk of life-threatening events following release.

The important research being conducted by professionals like Dr. Binswanger helps to elevate the work of SUMH while echoing the clear need for better collaboration and communication between health and justice systems.