Fatal drug overdose after liberation from prison: A retrospective study of female ex-prisoners from Strathclyde region (Scotland)

Aims: this study investigated the role of recent liberation from prison as a contributor to the high level of drug overdose deaths in Strathclyde (Scotland), possibly due to reduced tolerance to opiates. Design and participants: data on all imprisoned female drug users previously resident in Strathclyde were collected from admissions/liberations and medical records of Scotland's only female prison for the time period of October 1993 until September 1995. Records were matched by name and date of birth to the drug death records for Strathclyde. Results: of liberated ex-prisoners, 331/690 (48%) were recorded as known drug users. There were 14 sudden and unexpected deaths matched in the Strathclyde death records. Of these, ten (10/14) were recorded as fatal drug overdoses, which represents approximately 28% of the number of female fatal drug overdoses in Strathclyde over the sample period. Three of ten fatal overdoses occurred within 38 days of liberation, the remainder at least 147 days after liberation (mean 147.3 days, range 15-347 days). There were no significant differences in the drug using, sociodemographic or imprisonment characteristics of dead and surviving known drug users. HIV/AIDS prevalence was low among this sample and was not a contributory factor in the recorded deaths. Morphine/heroin, Temazepam, benzodiazepines and alcohol were in the bodies of the fatal drug overdoses. Conclusions: It was estimated that from one quarter to one third of female drug fatalities in Strathclyde each year the person had been in prison within the previous year. However, the hypothesis that after liberation, individuals typically soon relapse to heroin use and fatally overdose due to reduced tolerance was not supported. Nonetheless, the deaths represent 1.5% of the overall numbers of female Strathclyde prisoners liberated and is an issue which needs to addressed. It is possible that after liberation relapse more often occurs after some months of abstinence or moderation, which then risks fatal overdose. Closer follow-up of liberated drug users is required.