Fatal overdoses after release from prison in British Columbia: a retrospective data linkage study

Abstract

Background: People recently released from prison are at increased risk of preventable death; however, the impact of the current overdose epidemic on this population is unknown. We aimed to document the incidence and identify risk factors for fatal overdose after release from provincial prisons in British Columbia. Methods: We conducted a retrospective, population-based, open cohort study of adults released from prisons in BC, using linked administrative data. Within a random 20% sample of the BC population, we linked provincial health and correctional records from 2010 to 2017 for people aged 23 years or older as of Jan. 1, 2015, who were released from provincial prisons at least once from 2015 to 2017. We identified exposures that occurred from 2010 to 2017 and deaths from 2015 to 2017. We calculated the piecewise incidence of overdose-related and all-cause deaths after release from prison. We used multivariable, mixed-effects Cox regression to identify predictors of all-cause death and death from overdose. Results: Among 6106 adults released from prison from 2015 to 2017 and followed in the community for a median of 1.6 (interquartile range 0.9–2.3) years, 154 (2.5%) died, 108 (1.8%) from overdose. The incidence of all-cause death was 16.1 (95% confidence interval [CI] 13.7–18.8) per 1000 person-years. The incidence of overdose deaths was 11.2 (95% CI 9.2–13.5) per 1000 person-years, but 38.8 (95% CI 3.2–22.6) in the first 2 weeks after release from prison. After adjustment for covariates, the hazard of overdose death was 4 times higher among those who had been dispensed opioids for pain. Interpretation: People released from prisons in BC are at markedly increased risk of overdose death. Overdose prevention must go beyond provision of opioid agonist treatment and naloxone on release to address systemic social and health inequities that increase the risk of premature death.

Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study

“…With population-level over-representation of each of these factors, people who experience incarceration are at particularly high risk of experiencing drug-related harms including fatal and non-fatal overdose,9–12 illness or injury requiring hospitalisation12 and frequent emergency department use 13. Prior North American studies have shown that the risk of drug toxicity death (ie, death from drug overdose) is increased for people who experience incarceration compared with others in the general population, especially in the days and weeks following prison release,10 14–16 however, we lack evidence on the absolute and relative burden of opioid mortality in the fentanyl-dominant era.…”

Exploring the contextual risk factors and characteristics of individuals who died from the acute toxic effects of opioids and other illegal substances: listening to the coroner and medical examiner voice

“…Quantitative research has demonstrated that many of these factors (e.g. decreased tolerance after release from a correctional, health care or treatment facility, [37][38][39] mental illness and substance use disorders 40 ) are associated with the risk of acute toxicity events; however, these analyses have typically been limited to one or two of these factors. Our findings illustrate that there are often multiple contextual factors and how these may intersect, which highlights the need for a better understanding of patterns of factors that may increase risk of fatal acute toxicity events.…”

COVID-related disruptions and adaptations to prison-based mental health and substance use services: a narrative review

“…The heightened prevalence of mental health and substance use disorders among people in prison is profound (Fazel et al , 2016; Baillargeon et al , 2009). Mental illness and substance use disorders are risk factors for repeated involvement with the criminal justice system (Fazel and Yu, 2011), mortality and homelessness postrelease and reincarceration (Binswanger et al , 2007; Kinner et al , 2021; Baillargeon et al , 2010). Adequate and accessible health services are critical to improving health and re-entry outcomes (Binswanger et al , 2010; Domino et al , 2019; Johnson et al , 2014; Pelissier et al , 2001).…”