Incarceration Is Associated With Subsequent Overdose-related Death

Drug overdose is a growing cause of mortality in North America. Previous studies have found that recent incarceration is associated with an increased risk of overdose compared with the general population. Researchers used data from British Columbia health insurance and incarceration records to examine the association between incarceration during the 5-year period of 2010-2014 and subsequent overdose-related death over the 3-year period of 2015-2017.

• Of the 765,690 people in the cohort, 5743 were incarcerated during the initial 5-year period. Those who were incarcerated were younger, more likely to be male, to have substance use disorder (SUD), and to live in more materially deprived neighborhoods.
• During the 3-year follow-up period, 634 people died from drug overdose. In unadjusted analyses, those who had prior incarceration were 41 times more likely to die from drug overdose than those who did not.
• After adjusting for individual and neighborhood characteristics, the hazard ratio was substantially reduced but still elevated at 4; SUD alone accounted for 84% of the reduction.

Comments: Although the mechanism of this association is not clear, this study suggests that overdose-related death should be added to the list of harms of incarceration on individuals and communities. We need to explore alternatives to incarceration and, at a minimum, incarceration should be used as opportunity to engage individuals with SUD in treatment.

Darius A. Rastegar, MD

Reference: Gan WQ, Kinner SA, Nicholls TL, et al. Risk of overdose-related death for people with a history of incarceration. Addiction. 2021;116(6):1460–1471.