![]() Participants were provided $25 in the form of a check or grocery gift card. The one-on-one interview format allowed participants to express their ideas and experiences and avoid issues of mistrust of groups. Team members met periodically to debrief the interviewers. Two experienced interviewers (one male and one female) were trained in interviewing criminal-justice populations, qualitative methods, and behaviors to increase rapport and participant comfort level. Interviews were conducted from March through June 2009. What about you?" We also asked, "Have you had any personal experiences with overdose after release from prison or jail?" and, "Can you tell me about a time, or more than one time, when you've seen or heard about someone overdosing after their release?" This analysis includes data from all parts of the interview, but focuses on direct questions on drug use and overdose, e.g., "After being released from prison (this time), have you used any illegal drugs or prescription drugs you got on the street? (If so,) when was the first time? What kind of drugs did you use? What led you to use drugs since your release? How have you avoided drugs since your release? What helped you the most?" On the topic of overdose, we asked, "Some people worry about overdosing on drugs when they get out of prison, while others don't worry about this. The interview guide was developed by the authors and included questions regarding challenges during the immediate post-release period, health-care access, HIV risk, overdose experiences, and drug use after release. We also excluded current inmates and those whose most recent release was from jails (compared with prisons, these usually hold detainees prior to sentencing or individuals serving short sentences). We excluded juveniles because they have access to different post-release programs than adults. Eligibility criteria included ability to speak English, ability to comprehend and consent to the study procedures, and age ≥ 18 years. ![]() Individuals who called inquiring about the study had an initial eligibility screening by phone eligibility was confirmed in person prior to informed consent. ![]() We recruited participants by placing flyers and brochures in waiting areas and examination rooms and informing providers about eligibility criteria. Participants were initially recruited from a community health center, an urgent care center, and addiction treatment centers in the Denver, Colorado area, with subsequent snowball sampling (those who agreed to participate were asked to tell their friends and acquaintances about the study). Specifically, this study was designed to better understand the drug-use experiences, perceptions, knowledge of overdose risk, and overdose experiences of former prison inmates. This information is essential to developing effective interventions that reduce risk in a real-world context. We sought to better define the risk and protective factors that impact drug use and risk for overdose from the perspective of former inmates in the immediate post-release period. Prior studies have shown that former inmates face challenges including poor housing, unemployment, psychosocial problems and barriers to health care. ĭespite the epidemiologic data that describes a high rate of death from overdose after release from prisons, little is understood about the conditions that lead to relapse and overdose after release. Suicide was the 4 th leading cause of death and likely included intentional overdoses. Accidental overdoses accounted for nearly one-quarter of deaths post-release and were related to cocaine, other psychostimulants, opioids, alcohol, tricyclic antidepressants, and multiple drugs in combination. In the first two weeks after release, the risk of overdose was even greater, with an adjusted relative risk of 129. For instance, in prisoners released in Washington State, overdose mortality rates were 12-fold higher than what would be expected in similar demographic groups in the general population. Overdose rates peak in the first few weeks after release. Studies in the United States and other countries have shown a high risk of drug-related death after release from prison. Therefore, inmates are often released without the tools to avoid returning to drugs after release from prison. Despite the magnitude of the problem of substance use disorders among criminal justice populations, prisoners have limited access to evidence-based substance abuse treatment during incarceration, during the transition to the community, or while under community supervision. A history of drug use or misuse is pervasive among prison inmates by every measure, including prior use, use at the time the offense is committed, drug abuse, and drug dependence. ![]() Over 7.2 million people were incarcerated or on probation/parole at year-end 2009.
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