AIDS TREATMENT NEWS - February 20, 2007
John S. James

Summary: During the first two weeks after release, prisoners in Washington State had 129 times the death rate from drug overdose, compared to other state residents -- probably because they did not know how much less drug they could tolerate, after taking little or none of it prison. Cardiovascular disease, homicide, suicide, cancer, and traffic accidents also caused excessive deaths.

A study of over 30,000 recently released prisoners (regardless of HIV) in Washington State found that they had a 3.5 times increased risk of death after release than other residents of the state, much higher than the death rate in prison. [1] The first two weeks after release were particularly dangerous, with a risk of death 12.7 times that of the general population.

The three leading causes of death were drug overdose (103 deaths, a quarter of all the deaths), cardiovascular disease (56 deaths, 10 of them from a heart attack), and homicide (54 deaths). Suicide, cancer, and traffic accidents also caused many deaths.

The risk of death from overdose during the two weeks after release was 129 times the risk in the general population. The article noted that death might have occurred because prisoners lost their tolerance to the drugs due to relative abstinence in prison (so doses they took before prison might kill them when they got out, because then they were not used to such high doses).

"Possible interventions after release include providing intensive case management during the period immediately following release and improving access to and continuity of medical and mental health care." [1]

Comment

Even when funding for proper prisoner re-entry cannot be found, the huge overdose risk shortly after release might be reduced by educating drug cultures. Explain that people can die after taking a customary high dose of cocaine, meth or other stimulants, heroin, other narcotics (including methadone, responsible for 18 deaths in this study), tricyclic antidepressants (Elavil and many others), and some other prescription drugs, after being off of the drug for a time. Interaction with HIV drugs (especially ritonavir, including the smaller combination doses) can cause severe overdose of some drugs.

Marijuana (not mentioned in this research report) is different, as no one has ever been known to have died from an overdose. [2] In contrast, a large overdose of water can be fatal -- a serious risk when people drink enormous amounts trying to pass a drug test.

References

1. Binswanger IA, Stern MF, Deyo RA and others. Release from prison -- A high risk of death for former inmates. N Engl J Med. 2007 Jan 11;356(2):157-65.

(Note: the Feb. 1 correction in Journal does not affect the AIDS Treatment News article.)

2. Editorial. Comparing cannabis with tobacco -- again. BMJ. 2003 Sep 20;327(7416):635-6.

2007-02-20
ATN070204

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