Mortality After Prison Release: Opioid Overdose and Other Causes of Death, Risk Factors, and Time Trends From 1999 to 2009

Abstract

Background Among former prisoners, a high rate of death has been documented in the early postrelease period, particularly from drug-related causes. Little is known about risk factors and trends in postrelease mortality in the past decade, especially given general population increases in overdose deaths from pharmaceutical opioids. Objective To determine postrelease mortality between 1999 and 2009; cause-specific mortality rates; and whether sex, calendar year, and custody factors were risk factors for all-cause, overdose, and opioid-related deaths. Design Cohort study. Setting Prison system of the Washington State Department of Corrections. Participants 76 208 persons released from prison. Measurements Identities were linked probabilistically to the National Death Index to identify deaths and causes of death, and mortality rates were calculated. Cox proportional hazards regression estimated the effect of age, sex, race or ethnicity, whether the incarceration resulted from a violation of terms of the person’s community supervision, length of incarceration, release type, and calendar year on the hazard ratio (HR) for death. Results The all-cause mortality rate was 737 per 100 000 person-years (95% CI, 708 to 766) (n = 2462 deaths). Opioids were involved in 14.8% of all deaths. Overdose was the leading cause of death (167 per 100 000 person-years [CI, 153 to 181]), and overdose deaths in former prisoners accounted for 8.3% of the overdose deaths among persons aged 15 to 84 years in Washington from 2000 to 2009. Women were at increased risk for overdose (HR, 1.38 [CI, 1.12 to 1.69]) and opioid-related deaths (HR, 1.39 [CI, 1.09 to 1.79]). Limitation The study was done in only 1 state. Conclusion Innovation is needed to reduce the risk for overdose among former prisoners. Primary Funding Source National Institute on Drug Abuse and the Robert Wood Johnson Foundation.

Mortality over 12 years of follow-up in people admitted to provincial custody in Ontario: a retrospective cohort study

“…44 The high mortality in this cohort is consistent with the findings of recent studies from other countries. 2,32,33 Also consistent with other studies, 2 we found that standardized mortality rates were particularly high for women, and we also noted that mortality seemed lower in people with longer periods of incarceration and higher in people who self-identified as white or Aboriginal, which deserves further attention in future research. Other studies have identified that people who experience incarceration are at greater risk of overdose, especially in the weeks after release, 2,32,49 suggesting a role for interventions including diversion programs for people with addictions, training in overdose prevention and distribution of naloxone before release or after release including through probation and parole programs, access to opioid substitution therapies and drug treatment programs, and appropriate use of prescribed opioids.…”

“…Other studies have identified that people who experience incarceration are at greater risk of overdose, especially in the weeks after release, 2,32,49 suggesting a role for interventions including diversion programs for people with addictions, training in overdose prevention and distribution of naloxone before release or after release including through probation and parole programs, access to opioid substitution therapies and drug treatment programs, and appropriate use of prescribed opioids. 32,50 Other studies have also noted high rates of death due to HIV and hepatitis C, 32,33 each of which caused 2% of deaths in this cohort. That notwithstanding, the increased risk of death due to almost all causes and behavioural risk factors (Table 2) compared with the general population indicates that upstream and broad interventions are also needed for this population, 8 for example, programs focused on behavioural factors such as smoking and alcohol use, 51 release planning and the provision of case management at the time of release, 52 and improving linkage with and access to primary care.…”

“…The postrelease period has been identified across international studies as very risky for death. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] We aimed to define rates and causes of death in custody and after release in people who were admitted to provincial custody in Ontario in 2000, and to compare these data with data for the general population.…”

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

“…3 People with a history of incarceration have higher rates of chronic medical conditions [4][5][6][7] and risk of death than the general population. [8][9][10] Importantly, cardiovascular disease is a leading cause of death among individuals with prior incarceration. 8,11,12 The association between a history of incarceration and increased risk of cardiovascular disease may be partially explained by an increased prevalence of cardiovascular risk factors in this population, especially hypertension, although the mechanisms are not known.…”

A Systematic Review of Randomized Controlled Trials of Interventions to Improve the Health of Persons During Imprisonment and in the Year After Release

“…Although there is an imperative for the state to provide health care during imprisonment, the high burden of mortality, morbidity, and hospitalization postrelease suggested that a greater focus on improving health in this population during and after release is warranted. [156][157][158] Limitations There were several limitations to the included studies and to our review. As an indicator of quality, a high or unclear risk of bias brought into question the validity of most studies.…”