title: Incidence and predictors of non-fatal drug overdose after release from prison among people who inject drugs in Queensland, Australia.
abstract: BACKGROUND
  Release from prison is a period of elevated risk for drug-related harms, particularly among people who inject drugs (PWID). Non-fatal overdose can cause serious morbidity and predicts future fatal overdose, however neither the incidence nor the risk factors for non-fatal overdose following release from prison are well understood.
  
  
  METHODS
  Structured health-related interviews were conducted with 1051 adult prisoners in Queensland, Australia prior to release and approximately 1, 3 and 6 months post-release. Incidence of self-reported overdose in the community was calculated for PWID and all prisoners for three discrete time periods. Negative binomial regression with robust error variance was used to identify pre-release predictors of overdose among PWID.
  
  
  RESULTS
  The incidence of reported overdose was highest between 1 and 3 months post-release (37.8 per 100 person-years (PY) among PWID; 24.5/100 PY among all ex-prisoners). In adjusted analyses, the risk of post-release non-fatal overdose was higher for PWID who reported: being unemployed for >6 months before prison, having been removed from family as a child, at least weekly use of benzodiazepines and/or pharmaceutical opiates in the 3 months prior to prison, and ever receiving opioid substitution therapy (OST). Pre-release psychological distress and a lifetime history of mental disorder also predicted overdose, whereas risky alcohol use in the year before prison was protective.
  
  
  CONCLUSIONS
  PWID have a high risk of overdose following release from prison. Imprisonment is an opportunity to initiate targeted preventive interventions such as OST, overdose prevention training and peer-delivered naloxone for those with a high risk profile.
authors.affiliation: Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia. Electronic address: rwinter@burnet.edu.au.
authors.forename: R J
authors.initials: RJ
authors.lastname: Winter
authors.affiliation: Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Stoové
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia.
authors.forename: M E
authors.initials: ME
authors.lastname: Hellard
authors.affiliation: Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia; Victorian Infectious Diseases Service, Doherty Institute, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Centre for Population Health, Burnet Institute, Australia; Australian Institute of Family Studies, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Jenkinson
authors.affiliation: Centre for Population Health, Burnet Institute, Australia.
authors.forename: D R
authors.initials: DR
authors.lastname: McCarthy
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia; School of Medicine, University of Queensland, Australia.
authors.forename: S A
authors.initials: SA
authors.lastname: Kinner
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011329:Prisoners / Q000523:psychology; D011330:Prisons / Q000639:trends; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D057566:Self Report; D015819:Substance Abuse, Intravenous / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology
keywords: Drug overdose; Drug users; Injecting drug use; Prisoners