Key points are not available for this paper at this time.
Abstract Objective: To assess whether injecting drug users have a higher than usual risk of death from overdose in the 2 weeks after release from prison. Design: Soundex coding of surnames and information on date of birth were used to link entry and release dates from the local prison between 1983 and 1994 with clinical data from Edinburgh City Hospital9s cohort of male injecting drug users who are infected with HIV. Setting: Edinburgh City Hospital and Edinburgh Prison. Subjects: 316/332 male injecting drug users infected with HIV in the City Hospital HIV cohort; 16 were excluded because they were enrolled after developing AIDS or because their precise date of death was not available. Main outcome measure: Relative risk of dying from overdose before developing AIDS and relative risk of dying of all causes before developing AIDS during the 2 weeks after release from prison; this was compared with relative risks of death during other time at liberty. Results: 238/316 (75%) injecting drug users served time in the prison between 1983 and 1994. 33 out of 316 injecting drug users who were infected with HIV died before developing AIDS during 517 177 days at risk. 20 of these men died of an overdose; 6 of these deaths occurred within 2 weeks of release during 5903 days at risk. Death rates from overdose before the development of AIDS were 1.02/1000 days during the 2 weeks after release (recently released) and 0.029/1000 days during other times of liberty. The relative risk of death from overdose became 7.7 (1.5 to 39.1) after temporal matching (when the comparison was limited to the first 2 weeks after release v the next 10 weeks). The crude relative risk in an analysis combining stratified prison term and the 2 weeks after release was 4.5 (1.7 to 11.7) for death from overdose. After temporal matching these risks became 1.8 (0.4 to 9.2). Conclusion: Prisons should evaluate interventions to reduce the risk of death from overdose after release. Key messages Overall, imprisonment does not seem to increase injecting drug users9 risks of dying from an overdose Between 1983 and 1994 the risk of death from overdose was eight times higher within 2 weeks after release from prison among injecting drug users infected with HIV than it was during the next 10 weeks after release Further studies will need to determine if the estimate of 1 death from overdose per 1000 days spent recently released can be generalised to those who are not infected with HIV, and to dependent drug users who do not inject drugs Deaths from overdose occurring in the 2 weeks after release from prison may outnumber the deaths from suicide in Scottish prisons by 3 to 1 Lives could be saved by implementing prison based, randomised trials of interventions to reduce the number of deaths from overdose that occur soon after release
Seaman et al. (Sat,) studied this question.