Pubdate: Thu, 07 Jul 2016
Source: Record, The (Kitchener, CN ON)
Page: B6
Copyright: 2016 Metroland Media Group Ltd.
Contact:  http://www.therecord.com/
Details: http://www.mapinc.org/media/225
Author: Sheryl Ubelacker

OVERDOSE DEATHS HIGH AMONG EX-INMATES

Rate 12 Times That of Public Among Newly Released, Study Finds

TORONTO - Inmates of Ontario correctional facilities are 12 times 
more likely than the general public to die of a drug overdose within 
the first year following their release from incarceration, say 
researchers, who believe concrete interventions are needed to reduce 
these preventable deaths.

In a study published Wednesday in the journal PLOS ONE, researchers 
found that 702 of the almost 7,000 Ontarians who overdosed on drugs 
between 2006 and 2013 had been released from custody in a provincial 
jail or remand centre.

"The highest risk period is shortly after their release, in the days 
and the weeks following their release," said principal researcher Dr. 
Nav Persaud, a physician in the department of family and community 
medicine at St. Michael's Hospital in Toronto.

Nine per cent of these men and women died within the first two days 
of leaving custody and 20 per cent within the first week, the 
researchers found.

Three-quarters of them were under age 45.

Although more men than women died due to a opiate overdose, women had 
a much higher risk of death from drug toxicity compared to the 
general population - 27 times greater versus 10 times for men.

Persaud said 77 per cent of the deaths involved the use of one or 
more opioids, a powerful class of painkillers that includes 
oxycodone, fentanyl and morphine.

"The possible explanation for that is a loss of tolerance," he said. 
"It could be the case that the person before being incarcerated was 
using a substance at a certain dose, then during incarceration they 
either stopped using this substance or they were using it at a lower dose.

"And then after they are released they might return to their previous 
level of use, which because of a loss of tolerance, that medication 
can cause death."

In more than half of the cases involving opioid toxicity, the 
researchers determined from coroner and police reports that the 
victim had been with another person "who in principle could have 
intervened," he said.

One intervention would be injecting the person with the medication 
naloxone, which acts as an antidote to reverse the effects of opioid toxicity.

Naloxone does not work for other types of drugs.

Up until early this week, those released from provincial custody 
apparently had no access to naloxone kits, which are available to 
substance abusers through public health units and community-based 
organizations through the Ontario Harm Reduction Distribution Program.

But following news reports about a bureaucratic tussle between the 
ministries of health and corrections that had prevented the 
distribution of naloxone to departing inmates, Health Minister Eric 
Hoskins announced Monday that the naloxone program would immediately 
be ramped up to include those newly released from provincial jails 
and remand centres.

"It's good that the Ministry of Health is taking action on this 
important issue and I support the distribution of naloxone kits to 
people being released from incarceration," said Persaud, adding that 
the change in policy needs to be evaluated over time to make sure the 
measure is effective in preventing deaths.

A similar program in Scotland, for instance, has had mixed results, he said.

Dr. Fiona Kouyoumdjian, a public health physician at St. Michael's 
Hospital and McMaster University in Hamilton, said the results of 
this study are in line with a recent study she also coauthored, which 
found that an inmate's risk of dying from an overdose was 56 times 
the national average in the first two weeks after release.

By one year, the risk was about 14 times higher, she said of the 2000 
study, which looked at death rates among 50,000 inmates.

"It shows things haven't improved significantly, the death rates are 
still extremely high in the period after people are released from 
provincial facilities," said Kouyoumdjian, who also works as a 
part-time physician at the Hamilton-Wentworth Detention Centre.

While making naloxone available to inmates leaving custody is a 
significant step forward, she also believes the period of 
incarceration offers opportunities for improving a person's health 
and dealing with the social factors that can contribute to the risk 
of death from a drug overdose after they leave.

"We see people coming into jail who have a lot of challenges at the 
time of release. They need to reunite with family, sometimes repair 
situations that have happened with the family. They need to try to 
get their job back. They need to get their social services restarted. 
They have to find housing," she said Wednesday from Hamilton.
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MAP posted-by: Jay Bergstrom