Fatal drug overdose after liberation from prison: A retrospective study offemale 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 (Sco tland), possibly due to reduced tolerance to opiates. Design and participan ts: data on all imprisoned female drug users previously resident in Strathc lyde were collected from admissions/liberations and medical records of Scot land's only female prison for the time period of October 1993 until Septemb er 1995. Records were matched by name and date of birth to the drug death r ecords for Strathclyde. Results: of liberated ex-prisoners, 331/690 (48%) w ere recorded as known drug users. There were 14 sudden and unexpected death s matched in the Strathclyde death records. Of these, ten (10/14) were reco rded as fatal drug overdoses, which represents approximately 28% of the num ber of female fatal drug overdoses in Strathclyde over the sample period. T hree of ten fatal overdoses occurred within 38 days of liberation, the rema inder at least 147 days after liberation (mean 147.3 days, range 15-347 day s). There were no significant differences in the drug using, sociodemograph ic or imprisonment characteristics of dead and surviving known drug users. HIV/AIDS prevalence was low among this sample and was not a contributory fa ctor in the recorded deaths. Morphine/heroin, Temazepam, benzodiazepines an d alcohol were in the bodies of the fatal drug overdoses. Conclusions: It w as estimated that from one quarter to one third of female drug fatalities i n Strathclyde each year the person had been in prison within the previous y ear. However, the hypothesis that after liberation, individuals typically s oon relapse to heroin use and fatally overdose due to reduced tolerance was not supported. Nonetheless, the deaths represent 1.5% of the overall numbe rs 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 overd ose. Closer follow-up of liberated drug users is required.