Non-fatal drug overdose after release from prison: A prospective data linkage study. (1st January 2020)

• Record Type: Journal Article
• Authors: Keen, Claire; Young, Jesse T.; Borschmann, Rohan; Kinner, Stuart A.
• Is Part Of: Drug and alcohol dependence. Volume 206(2020)
• Publication Date: 2020-01-01
• Subjects: Drug overdose -- Prisons -- Cohort studies -- Ambulance -- Hospital -- Emergency medical services; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2019.107707
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Adults released from prison are at high risk of non-fatal overdose. The risk is highest in the 14 days immediately following release from prison. The strongest predictor is dual diagnosis of substance use disorder and mental illness. Abstract: Background: Adults released from prison are at increased risk of poor health outcomes and preventable mortality, including from overdose. Non-fatal overdose (NFOD) is a strong predictor of future overdose and associated with considerable morbidity. This study aims to the determine the incidence, predictors and clinical characteristics of NFOD following release from prison. Methods: We used pre-release interview data collected for a randomised controlled trial in 2008–2010, and linked person-level, state-wide ambulance, emergency department, and hospital records, from a representative sample of 1307 adults incarcerated in Queensland, Australia. The incidence of NFOD following release from prison was calculated. A multivariate Andersen-Gill model was used to identify demographic, health, social, and criminal justice predictors of NFOD. Results: The crude incidence rate (IR) of NFOD was 47.6 (95%CI 41.1–55.0) per 1000 person-years and was highest in the first 14 days after release from prison (IR = 296 per 1000 person-years, 95%CI 206–426). In multivariate analyses, NFOD after release from prison was positively associated with a recent history of substance use disorder (SUD), dual diagnosis of mental illness and SUD, lifetime history of injecting drug use, lifetime history of NFOD, being dispensed benzodiazepines after release, a shorter index incarceration, and low perceived social support. The risk of NFOD was lower for people with high-risk alcohol use and while incarcerated. Conclusions: Adults released from prison are at high risk of non-fatal overdose, particularly in the first 14 days after release. Providing coordinated transitional care between prison and the community is likely critical to reduce the risk of overdose.