title: Acute risk of drug-related death among newly released prisoners in England and Wales.
abstract: OBJECTIVE
  To investigate drug-related deaths among newly released prisoners in England and Wales.
  
  
  METHODS
  Database linkage study.
  
  
  METHODS
  National sample of 48,771 male and female sentenced prisoners released during 1998-2000 with all recorded deaths included to November 2003.
  
  
  RESULTS
  There were 442 recorded deaths, of which 261 (59%) were drug-related. In the year following index release, the drug-related mortality rate was 5.2 per 1000 among men and 5.9 per 1000 among women. All-cause mortality in the first and second weeks following release for men was 37 and 26 deaths per 1000 per annum, respectively (95% of which were drug-related). There were 47 and 38 deaths per 1000 per annum, respectively, among women, all of which were drug-related. In the first year after prison release, there were 342 male deaths (45.8 were expected in the general population) and there were 100 female deaths (8.3 expected in the general population). Drug-related deaths were attributed mainly to substance use disorders and drug overdose. Coronial records cited the involvement of opioids in 95% of deaths, benzodiazepines in 20%, cocaine in 14% and tricyclic antidepressants in 10%. Drug-related deaths among men were more likely to involve heroin and deaths among women were more likely to involve benzodiazepines, cocaine and tricyclic antidepressants.
  
  
  CONCLUSIONS
  Newly released male and female prisoners are at acute risk of drug-related death. Appropriate prevention measures include overdose awareness education, opioid maintenance pharmacotherapy, planned referral to community-based treatment services and a community overdose-response using opioid antagonists.
authors.affiliation: National Addiction Centre, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK. m.farrell@iop.kcl.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Farrell
authors.forename: John
authors.initials: J
authors.lastname: Marsden
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D001569:Benzodiazepines / Q000506:poisoning; D002423:Cause of Death; D003042:Cocaine / Q000506:poisoning; D003625:Data Collection; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D011329:Prisoners / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000401:mortality*; D013405:Suicide / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D003042:Cocaine