Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors

Abstract

Background Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners. Methods This qualitative study included former prison inmates (N = 29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis. Results The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family. Conclusions Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs.

How to Talk with Patients about Incarceration and Health

“…It is widely known that drug use is happening in prisons and jails [10][11] and that patients are at high risk of overdose and other addiction-related harms upon release from prison or jail [12]. Patients also are exposed to high-salt diets and cannot even access a heart-healthy diet should they desire to do so; the high sodium and high fat content of food available in these settings exacerbate conditions such as hypertension, congestive heart failure, and end-stage liver disease [13,14].…”

Hoping Against Hope: The Prison-to-Community Transition Experience of Men With Co-Occurring Severe Mental Illness and Substance Use Disorder

“…Binswanger et al (2012) also found that "the environments to which participants returned immediately following prison made it difficult to avoid relapse due to ubiquitous triggers to use" (p. 5). Rhodes (2002) is emphatic that harm reduction related to drug use has tended to centre on individual risk behaviour that is "context-free" (p. 86) rather than a recognition of risk environments impacting on relapse and drug use.…”

“…Binswanger et al (2012) found relapse to drug use after release from prison related to depression, anxiety and frustration. Rhodes (2009), drawing on the work of Farmer, Connors, and Simmons (1996), linked drug use with socio-economic stress and stressful life events, conceptualising it as a form of self-medication for "oppression illness" (Rhodes 2009, p. 196).…”

“…Research in the United States has found that relapse to drug use after prison often occurred in the context of poor social support and lack of financial resources (Binswanger et al, 2012) and that practical considerations for released prisoners tend to come before mental health and drug treatment and rehabilitation needs (Davis et al, 2011). Interventions such as longer-term stable housing, transition to employment and family support have consistently been identified in the literature as essential to successful transition for this population (Davis, et al, 2012;Graffam et al, 2005;La Vigne et al, 2009;Petersilia, 2005).…”

“…Khan et al (2011) found, for example, that 55% of primary partnerships ended during incarceration in a sample of 64 participants. Links between social isolation and return to drug use have been made by Binswanger et al (2012), with important implications for post-release deaths related to drug overdoses.…”