Alcohol and drug overdose a leading cause of death in people recently released from prison

Alcohol and other drug overdoses were the leading causes of death among people recently released from prison in seven out of eight countries analysed in a new study published in The Lancet.

The data also showed that, overall, deaths were at their highest rate in the week immediately after release.

Led by Professor Rohan Borschmann, Visiting Academic at the Department of Psychiatry, University of Oxford, researchers combined prison records with death records for more than 1.4 million people who had been released from prisons in Australia, Brazil, Canada, New Zealand, Norway, Scotland, Sweden, USA between 1980 and 2018.

In the first few weeks after release, alcohol and other drug overdoses were the leading causes of death in all countries analysed except for Brazil, where deaths due to interpersonal violence predominated.

As the length of time between prison release and death increased, the cause shifted to suicide, accidental injuries, and non-communicable diseases including cardiovascular diseases and cancer. Infectious diseases such as HIV accounted for 3.5 per cent of all deaths.

Professor Borschmann, who is Professorial Fellow at the University of Melbourne, said:

There are several factors contributing to the high rate of death after release from prison. Firstly, people who spend time in prison typically have much poorer health than those who do not. Second, most prisons provide insufficient physical and mental healthcare. Third, investment in transitional care to ensure that people released from prisons are connected to community health and social care providers is woefully inadequate in many countries. Fourth, the stigma of incarceration, combined with interruptions in healthcare, housing, relationships, employment, and other forms of social capital, produces a ‘perfect storm’ of marginalisation and exclusion for these vulnerable individuals.”

More than 30 million people worldwide pass through prisons every year. Studies in many countries have shown that people who spend time in prison typically have poorer physical and mental health compared with people who have never been to prison.

This includes higher rates of infectious diseases, cognitive disabilities, mental illness, substance use problems, chronic and non-communicable diseases, and self-harm and suicide attempts. These complex and co-occurring health conditions are often set against a backdrop of trauma, abuse, and disadvantage. They are also at dramatically increased risk of preventable death after release from prison.

Professor Borschmann argues that, in accordance with international standards, prison healthcare providers can take three steps towards preventing these deaths.

1. routinely assess each person’s health status and comprehensively identify healthcare needs when they enter prison.
2. provide – free of charge and without discrimination on the grounds of legal status – a standard of healthcare at least equivalent to that available in the community.
3. support a healthier transition back to the community by conducting a comprehensive pre-release needs assessment and coordinating transitional healthcare around the time of release.

Professor Borschmann added: “The best available international evidence suggests that incarceration has little impact on health, either negative or positive. Incarceration is, therefore, all too often a missed opportunity to improve health outcomes, including reducing preventable deaths in those most at risk.

“Although correctional healthcare providers have a key role to play, reducing preventable deaths after incarceration will require a coordinated, whole-of-government response, as recommended by the World Health Organisation.

“For example, community healthcare providers can proactively engage with people prior to release, to facilitate continuity of care and prevent relapse to poor health and health risk behaviours.

“The high rate of death after release from incarceration is tragic and avoidable. We can, and must, do more to ensure that people released from prison have an equal opportunity not only to survive, but to thrive.”