Non-fatal drug overdose after release from prison: A prospective data linkage study

Drug Alcohol Depend. 2020 Jan 1:206:107707. doi: 10.1016/j.drugalcdep.2019.107707. Epub 2019 Nov 9.


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.

Keywords: Ambulance; Cohort studies; Drug overdose; Emergency medical services; Hospital; Prisons.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Diagnosis, Dual (Psychiatry)
  • Drug Overdose / epidemiology*
  • Female
  • Humans
  • Incidence
  • Information Storage and Retrieval / statistics & numerical data*
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Prisons / statistics & numerical data*
  • Prospective Studies
  • Queensland / epidemiology
  • Risk Factors
  • Substance-Related Disorders / epidemiology*
  • Time Factors
  • Young Adult