Using decision tree models and comprehensive statewide data to predict opioid overdoses following prison release.

Purpose: Identifying predictors of opioid overdose following release from prison is critical for opioid overdose prevention.
Methods: We leveraged an individually linked, state-wide database from 2015-2020 to predict the risk of opioid overdose within 90 days of release from Massachusetts state prisons. We developed two decision tree modeling schemes: a model fit on all individuals with a single weight for those that experienced an opioid overdose and models stratified by race/ethnicity. We compared the performance of each model using several performance measures and identified factors that were most predictive of opioid overdose within racial/ethnic groups and across models.
Results: We found that out of 44,246 prison releases in Massachusetts between 2015-2020, 2237 (5.1%) resulted in opioid overdose in the 90 days following release. The performance of the two predictive models varied. The single weight model had high sensitivity (79%) and low specificity (56%) for predicting opioid overdose and was more sensitive for White non-Hispanic individuals (sensitivity = 84%) than for racial/ethnic minority individuals.
Conclusions: Stratified models had better balanced performance metrics for both White non-Hispanic and racial/ethnic minority groups and identified different predictors of overdose between racial/ethnic groups. Across racial/ethnic groups and models, involuntary commitment (involuntary treatment for alcohol/substance use disorder) was an important predictor of opioid overdose.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Joshua A. Barocas reports financial support was provided by National Institutes of Health. Prasad Patil, Kristina Yamkovoy, Samantha K. Nall, Pallavi Aytha Swathi, Lauren Brinkley-Rubinstein reports financial support was provided by National Institutes of Health. Laura F. White, Prasad Patil, Yanjia Zhang reports financial support was provided by National Institute of General Medical Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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