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Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

High risk of overdose on prison release

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15 year Norwegian study shows 85% of all deaths in the first week of release from prison are from drug overdoses.

A perfect storm?

The recent and prolonged increase in the number of drug-related deaths, together with news of more offenders dying in the community and worries about the general impact of austerity in terms of reduced access to services, have all combined to raise concerns about the risk of overdose among those released from prison.

We do not have reliable data on this in the UK but a recent Norwegian study suggests that we should be taking action urgently.

Norwegian study

The Norwegian study looks at the deaths of all prisoners in the first six months of their release over a fifteen year period (1 Jan 200 to 31 December 2014); the sample comprised 92,663 prisoners released a total of 153,604 times.

The study, authored by Anne Bukten, Marianne Riksheim Stavseth, Svetlana Skurtveit, Aage Tverdal, our own John Strang  and Thomas Clausen, found that overdose was the most common reason for death at every time period within this first six months.

During the first week post-release, overdose deaths accounted for 85% of all deaths, with accidents accounting for 6% and suicide for 3% 

Overdose deaths peaked during the first days post-release, and thereafter declined gradually during the first month post-release. During the second week post-release, the total number of deaths approximately halved (versus first week), with overdose deaths accounting for 68% of all deaths. 

During weeks 3–4 and months 2–6, overdose death accounted for 62 and 46% of all deaths, respectively. We observed this pattern during all release periods.  

Importantly, although the pattern remained the same over the whole 15 year time period, the rate of overdose deaths was higher between 2000-2004 than over the next ten years.

Discussion

 The authors suggest that the high proportion of overdoses in the immediate period following incarceration might reflect prison settings where released inmates typically have a history of heroin or opioid use, and may also be particularly high in settings where polydrug injection is the common mode of administration. For several years, Norway, like the UK, has been ranked as one of the European countries with the highest rates of overdose mortality, often explained by high rates of injecting drug use and an ageing polydrug-using population.

Overall, this means that drug use patterns both in terms of substances consumed as well as mode of administration will be reflected in mortality both in the general populations as well as in prison-release populations. The reducing levels of post-release mortality (also found in similar studies in Australia and Scotland) may be explained by a number of factors.

 For Norway, the reduced risk of overdose is due probably to increasing numbers of patients enrolled into the national opioid maintenance programme, with gradually the same access to treatment for prison inmates as those outside prisons, introduced progressively in Norway from 1998 onwards. In Norway, the number of patients in opioid maintenance treatment has increased from 2000 in 2002 to 7000 in 2014At the same time, there have been parallel
increases in the number of maintenance patients entering the correctional system, annually estimated to approximately 10% of the patient population.

Conclusions

The value in this study lies in the way it pinpoints the time periods of most risk following release. We already know from a number of studies that continuity of care for prisoners receiving Opioid Substitution Therapy inside is poor. We also know that we are failing to use the one major antidote to opioid overdoses in England and within the prison system in particular with the distribution (and training in the use) of naloxone extremely patchy to say the least.

The questions is whether the prison system in its current beleaguered state can organise the effective distribution of naloxone to the dozens of  individuals with long term opiate problems it releases every day.

 

The mission of Breaking Free Group is to create the widest possible access to evidence-based psychological interventions. 

To realise this, we have developed a powerful and adaptable digital health platform which targets the underlying psychological and lifestyle factors that drive addictive behaviours.

Breaking Free Online is a clinically-robust computerised treatment and recovery programme for substance misuse. It is enhanced by Staying Free, a powerful relapse prevention toolkit in an Android and iOS smartphone app. It has been commissioned by over 60 Local Authorities and implemented across the spectrum of alcohol and drug services by several leading national service providers.

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