One in 10 people who died of a drug overdose in Ontario over a seven-year period had been released from a provincial prison within the previous 12 months, lending new urgency to calls to distribute the opioid antidote naloxone to inmates returning to the community.
A study by researchers at St. Michael's Hospital and the University of Toronto – the first in Canada to match coroner reports with records for incarcerated individuals – found that the risk of inmates dying of a drug overdose after they are released is almost 12 times higher than that for Ontarians over all.
"We were surprised at how high the fatal overdose rate was among those who were recently released from provincial custody," said Nav Persaud, a family physician and scientist with the Li Ka Shing Knowledge Institute at St. Michael's Hospital.
The World Health Organization recommends that individuals who are likely to witness an opioid overdose should have access to naloxone, says the study published on Wednesday in the medical journal PLOS ONE. The study found that the majority of overdose deaths involved opioids and that someone was present who could have intervened in more than half of the cases. Naloxone reverses the effects of an overdose within minutes.
Public-health doctors in Ontario have called on the province to hand out take-home naloxone kits to inmates, who can be in particular danger of overdosing on opioids after they leave prison.
This week, Ontario Health Minister Eric Hoskins overruled his bureaucrats and ordered them to immediately begin distributing naloxone to newly released inmates. His directive followed a Globe and Mail report about a turf battle between two provincial ministries that stalled efforts to distribute the life-saving antidote to prisons in Ontario.
"To my mind, this is a relatively easy solution to a very complex problem," said Fiona Kouyoumdjian, a prison physician and lead author of an earlier research paper, which found that jail time is frequently a precursor to an early death by preventable means. Nearly 14 per cent of the 50,000 former prisoners studied died of an overdose.
"It's very clear that this population is at very high risk and is contributing to the overall burden of overdose deaths disproportionately," she said.
The weeks immediately after release are a precarious time for former inmates. Job and housing prospects are usually bleak and drug tolerances are generally at a low point because of the relative scarcity of drugs in prison.
The new study found that just under 7,000 people across Ontario died of drug overdoses between 2006 and 2013. Of those, 702 people died of an overdose who had been released from prison in the year prior to their death.
Nine per cent of the overdose deaths occurred in the first two days after release and 20 per cent within the first week, the study found.
Correctional facilities in Ontario house inmates serving sentences of less than two years and those detained before and during a trial. The vast majority of overdose victims in the study had been remanded in custody.
Stephanie Massey, provincial program co-ordinator at PASAN, which provides support services for former inmates, said methadone therapy used to treat opioid addiction is not widely available behind bars in Ontario, leaving drug users at high risk of overdosing after their release. As well, she said, a loss of housing and a safe place to inject adds to the risk of overdosing.
Clare Graham, spokesperson for Minister of Community Safety and Correctional Services David Orazietti, responded to the study by noting that the government has expanded access to naloxone.
"We fully support any discussion around making our correctional facilities safer," Ms. Graham said.
Public health officials in Ontario expect a surge in opioid overdoses this year linked to illicit fentanyl. A recent Globe investigation found that traffickers can easily order the highly potent, low-cost drug online from overseas. While British Columbia and Alberta have been hardest hit by overdose deaths, the scourge of fentanyl is rapidly moving east.