Emergency department utilization by individuals with opioid use disorder who were recently incarcerated.

INTRODUCTION: Individuals with opioid use disorder (OUD) are highly represented among the incarcerated population and are frequent utilizers of the emergency department (ED). Medications for opioid use disorder (MOUD) are a recognized treatment option for individuals with OUD. Although the field recognizes the benefits of MOUD, we know little about what mitigating effects MOUD offered in jail might have on post-release ED utilization. METHODS: In this retrospective cohort analysis, we searched electronic medical records (EMR) for incarcerations in the Santa Clara County jail between 8/1/2019 and 8/31/2021 for individuals with OUD (N = 4352) and collected demographic and medication administration data for these individuals. Individuals are considered as having received MOUD if they have at least one administration of methadone, naltrexone, or extended release (XR) buprenorphine during their incarceration. We also collected ED visit data from the same EMR for the 28 days following release from the identified incarcerations. Using logistic regression, we compared ED use within 24 h and 28 days for individuals who are incarcerated and treated with MOUD with those not receiving treatment. RESULTS: Individuals who received methadone or XR buprenorphine during their incarceration were less likely to present at the 28 days following release than those not receiving treatment, after controlling for age, race, sex assigned at birth, preferred language, and housing status. Most individuals accessing the ED within 28 days of release do so within the first seven days, and the greatest volume occurred in the first 24 h. Individuals released before noon had a lower likelihood of ED presentation within 24 h than those released in the afternoon. CONCLUSIONS: Offering methadone and XR buprenorphine to individuals with OUD who are incarcerated is beneficial in mitigating ED utilization within 28 days of release, although further research is needed to understand what other contributing variables, especially those related to follow-up care, could be influencing these results. If possible, release times for individuals could be shifted to the morning to maximize reduction in ED use within 24 h of release. Alternatively, further research should investigate why release times appear to influence ED utilization.

A combined ecological and epidemiologic investigation of metal exposures amongst Indigenous peoples near the Marlin Mine in Western Guatemala.

In August 2009 a combined epidemiological and ecological pilot study was conducted to investigate allegations of human rights abuses in the form of exposures to toxic metals experienced by mine workers and Indigenous Mam Mayan near the Marlin Mine in Guatemala. In the human study there were no differences in blood and urine metals when comparing five mine workers with eighteen non-mine workers, and there were no discernible relationships between metal exposures and self-reported health measures in any study group. On the other hand, individuals residing closest to the mine had significantly higher levels of certain metals (urinary mercury, copper, arsenic, and zinc) when compared to those living further away. The levels of blood aluminum, manganese, and cobalt were elevated in comparison to established normal ranges in many individuals; however, there was no apparent relationship to proximity to the mine or occupation, and thus are of unclear significance. In the ecological study, several metals (aluminum, manganese, and cobalt) were found significantly elevated in the river water and sediment sites directly below the mine when compared to sites elsewhere. When the human and ecological results are combined, they suggest that exposures to certain metals may be elevated in sites near the mine but it is not clear if the current magnitude of these elevations poses a significant threat to health. The authors conclude that more robust studies are needed while parallel efforts to minimize the ecological and human impacts of mining proceed. This is critical particularly as the impact of the exposures found could be greatly magnified by expected increases in mining activity over time, synergistic toxicity between metals, and susceptibility for the young and those with pre-existing disease.