Ex-convicts die at high rate in first weeks out of prison

Cause often is overdose of narcotics after forced clean years, study finds

January 11, 2007|By Alan Zarembo | Alan Zarembo,Los Angeles Times

During their first two weeks out of prison, former convicts have a nearly 13 times greater risk of death than the general population, according to a study published today of more than 30,000 former inmates.

The leading cause was overdose of illegal narcotics, the researchers found.

Though the study did not look at the reason for the high number of drug overdoses, the researchers surmised that the stress of release and the ex-prisoners' reduced tolerance to drugs after their sentences were major factors.

"If people have been avoiding drug use and they return to their usual doses after release, they will have lost tolerance," said lead researcher Dr. Ingrid Binswanger, of the University of Colorado Health Sciences Center.

The study, published in The New England Journal of Medicine, suggests that the criminal justice system is doing an inadequate job easing the transition to society, experts said.

It "highlights the critical period immediately following release, which corrections policy has not yet really focused on," said University of California, Irvine criminologist Joan Petersilia, who was not involved in the research.

There are more than 1.5 million adults in state and federal prisons, and more than 650,000 are released each year.

Despite the large number of prisoners re-entering society each year, there have been no previous studies of their mortality rates in the United States, Binswanger said.

The research team tracked 30,237 inmates in Washington state released between July 1999 and December 2003.

The ex-prisoners were followed for an average of 1.9 years after release.

While 87 percent of ex-prisoners in the study were men, the risk of death for the women was 5.5 times higher than for other women in the state.

Experts said there is no reason the Washington state findings would not apply nationwide.

Over the entire study period, a total of 443 of the people died. Their death rate - adjusted for age, sex and race - was 3.5 times greater than that of the general population.

They died at a higher rate for every major cause of death: 12.2 times the rate for drug overdose compared with the general population, 10.4 times for homicide, 4.7 times for liver disease, 3.4 times for suicide, 3.4 times for motor vehicle accidents, 2.1 times for cardiovascular disease and 1.7 times for cancer.

To a large extent, the death rates are a reflection of a poor, uneducated inmate population, experts said. More than 70 percent of the subjects had been diagnosed with drug or alcohol dependence.

By far, the highest death risk occurred in the first two weeks after release.

Of all the ex-prisoners who died over the course of the study, 38, or 10 percent, died in the two-week period. Of those deaths, 27 were the result of drug overdose, most commonly cocaine.

"It is a time of enormous social stressors," said Dr. Clarissa Krinsky, of the University of New Mexico Health Center, who is preparing to publish a study of ex-prisoners in New Mexico that came to similar conclusions. "You're suddenly without a home, without a job."

Dr. Jacqueline Tulsky, a professor of clinical medicine at University of California, San Francisco who has studied the difficult transition from prison to freedom, said lives could be saved by offering drug treatment, transitional housing and other services to newly released ex-convicts.

Dr. Scott Allen, co-director of the Center for Prisoner Health and Human Rights at Brown University and a former prison medical director, said that without help, released offenders likely "will re-associate with the group of people they got in trouble with in the first place."

"We see this every day," said Allen, whose study in Rhode Island in the 1990s found that 1 in 10 ex-inmates died within seven years, mostly because of substance abuse.

Allen said a big part of the problem is that inmates generally are released with the clothes they came in with, a nominal amount of money, a bus pass to town and a couple of weeks' worth of medication.

"We are setting than up to fail, both in terms of health outcomes and in terms of recidivism," he said.

Dr. Scott Chavez, of the National Commission on Correctional Health Care, said the health problems often send ex-inmates to hospital emergency rooms - at taxpayers' expense - and society gets stuck with other ex-con costs.

Roughly half of them commit a new crime and go back to prison, he said.

Chavez said a handful of states are trying innovative programs to break that cycle, such as providing continuing care for ex-offenders with chronic health problems or beginning planning early on for the transition back to society.

Alan Zarembo writes for the Los Angeles Times. The Associated Press contributed to this article.

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