The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons.
We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race.
Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide.
Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.
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"Little is known whether these same factors are associated with use among a criminal justice sample supervised in the community. Understanding factors associated with concurrent opioid and benzodiazepine use in this high-risk population is important as individuals under community corrections supervision are at heightened risk for overdose in the community (Binswanger et al., 2007). This high risk of overdose persists even though these individuals receive mandatory random drug testing as part of community supervision that carries the risk of sanctions, including jail or prison time, for use of illicit drugs. "
[Show abstract][Hide abstract] ABSTRACT: The use of heroin and prescription opioids has increased over the past decade. The concurrent use of opioids with other depressants such as benzodiazepines increases the risk of overdose death compared with use of either drug alone. This study examined factors associated with concurrent use of opioids and benzodiazepines in a criminal justice sample in the state of Alabama.
The Addiction Severity Index (ASI) and urine drug screen results from 28,570 individuals who were under community corrections supervision from 2002-2012 were examined for independent or concurrent opioid and benzodiazepine use. Multinomial logistic regression analyses were conducted to determine associations between socio-demographic characteristics and drug use.
Concurrent use was detected in 11.5% of the sample. Concurrent use of opioids and benzodiazepines or use of either drug alone was associated with being White, female, married, prescribed psychiatric medications, having seen a physician in the past two years, cannabis use, and having a drug-related offense. Concurrent users were more likely to be unemployed or disabled and have received counseling, and less likely to have completed college, live with relatives or friends, have a history of hallucinations, or have an offense against a person relative to nonusers.
While significant overlap of risk factors exists between individuals with concurrent use versus sole use of opioids or benzodiazepines, individuals with concurrent use generally have more social dysfunction than individuals who tested for either substance alone. Concurrent users may need more psychosocial resources and intensive treatments to promote recovery.
Published by Elsevier Ireland Ltd.
Drug and Alcohol Dependence 10/2015; 154. DOI:10.1016/j.drugalcdep.2015.06.038 · 3.42 Impact Factor
"Yet, few studies examine psychiatric and substance abuse disorder with violent death among released prisoners. All-cause mortality rates were found to be higher for former inmates with mental and behavioral disorders or inmates with psychiatric hospitalization (Binswanger et al., 2007; Kariminia, Butler, et al., 2007). Kariminia, Law, et al. (2007a) found inmates who had been admitted to the prison psychiatric hospital have double the risk of suicide postrelease from prison (RR 5 2.3 for men; RR 5 2.0 for women). "
[Show abstract][Hide abstract] ABSTRACT: Released prisoners face high risk of early mortality. The risk of violent death, specifically homicide and suicide, are addressed in this study. Data on inmates released from the North Carolina Division of Adult Corrections (N = 476) matched to the Violent Death Reporting System are analyzed to estimate rates and demographic and criminal justice-related predictors. Violent death rates for persons released from prison were more than 7 times higher than for the general adult population. Results from multinomial logistic regression indicate decreased homicide risk for every year of age, whereas male gender and minority race increased risk. For suicide, minority race, release without supervision, and substance abuse treatment in prison decreased fatality risk. By contrast, a history of mental illness increased suicide risk. Implications for practice and research are discussed.
Violence and Victims 10/2015; DOI:10.1891/0886-6708.VV-D-13-00137 · 1.28 Impact Factor
"For this reason, we prefer the term 'heroin-related overdose' (HOD). Users who return to heroin after a period of abstinence are at a high risk of overdosing, eg after a period of incarceration or treatment (Darke and Hall, 2003; Binswanger et al., 2007). This makes sense in terms of the tolerance-overdose model since we know that tolerance rapidly decreases with abstinence (White et al., 1999 a). "