Reducing drug overdose for ex-prisoners -- the view from outside the prison gates

Prison inmates frequently have a strong history of drug use and misuse, especially during the time prior to incarceration, and drugs often are the driving force behind the offense itself. New research, published in BioMed Central's newly launched open access journal Addiction Science & Clinical Practice, shows that ex-offenders struggle to remain drug free after release from prison and identifies factors that can help them succeed. Interviews with former inmates show that they themselves recognize that returning to former living environments (former friends and an easy access to drugs) is a strong trigger for drug use and overdose.

Researchers from the University of Colorado School of Medicine and Kaiser Permanente Colorado interviewed former prisoners within two months of their release from prison. The interviews focused on experience of drug and alcohol use after release from prison, perception of risk of overdose, and experience of overdose amongst other ex-inmates.

Four main points came clearly across from these interviews. Return to drug use was felt to be due to poor social support, or provided a way to cope with inadequate economic resources and health problems. Secondly, drugs were readily available in their living environment and a constant temptation. Studies based in the US have shown that there is a high risk of drug-related death after release from prison, and these ex-prisoners reported that while overdose was seen as a 'way out' in the face of overwhelming difficulties, accidental overdose, due to decreased drug tolerance, was also common. Finally, 'protective' factors including structured drug treatment programs, spirituality or religion, self-help groups, and family were identified as factors which strengthened them against relapse.

Dr Ingrid Binswanger, a Robert Wood Johnson Foundation Physician Faculty Scholar who led the study, summarized, "These interviews show that former inmates with a history of drug use, and criminal behavior related to their drug use, are often released back into environments with significant social and economic challenges, little support and readily available drugs. A consequence of this is a high risk of intentional and unintentional overdose. These people need structured treatment, a gradual transition back into the community, and coping strategies. They also need access to 'protective' factors, as well as improved resources, to reduce the main triggers for relapse."

In the words of one ex-prisoner, "...the hardest thing is not going back to the lifestyle that got me put in prison."

Addiction Science & Clinical Practice, relaunched today with BioMed Central, publishes research dedicated to improving the quality of care for people with unhealthy alcohol, tobacco, and other drug use, or addictive behaviors.

1. Return to drug use and overdose after release from prison: A qualitative study of risk and protective factors
Ingrid A Binswanger, Carolyn Nowels, Karen F Corsi, Jason Glanz, Jeremy Long, Robert E Booth and John F Steiner
Addiction Science & Clinical Practice (in press)

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2. Addiction Science & Clinical Practice is an open access, peer-reviewed journal which provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviors across a spectrum of clinical settings.

3. BioMed Central (http://www.biomedcentral.com/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

4. The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.