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Newly released inmates face high risk of death, study finds

Drug overdose, heart disease are among top killers

TRENTON, NJ -- Prison life may be dangerous, but getting out can be deadly, too. Newly released inmates were almost 13 times more likely than the general public to die during their first two weeks of freedom, a study in Washington state found.

Drug overdoses were the top killer, with former convicts 129 times more likely to die that way within two weeks of their release than the general population. That cause of death was followed by heart disease, homicide, and suicide, according to the study, the first major look at the issue.

Over an average of two years, the study found the former inmates were 3 1/2 times more likely than other state residents and nearly four times more likely than current inmates to die.

"The differences are more striking for women then they are for men," said lead researcher Dr. Ingrid Binswanger, a public health researcher and assistant professor at University of Colorado at Denver.

While 87 percent of former prisoners in the study were men, the risk of death for the women was 5 1/2 times higher than for other women in the state.

Specialists said the rest of the country probably has a similar, or even worse, situation than Washington state, although the specific drugs causing overdoses might vary by region.

Binswanger, who did her research with colleagues while at the University of Washington, noted that studies in Europe and Australia found similarly high death rates, particularly right after release from prison.

The new findings show the need for more programs to help former inmates with a history of addiction and poor health cope with the stress of finding housing, a job, healthcare, and other necessities and stay clean, said Christy Visher of the Justice Policy Center at the Urban Institute.

Other specialists said the results don't surprise them, because inmates have far more physical and mental health problems than other citizens, often get inadequate treatment behind bars, and get little help making the huge transition to society after a highly structured life.

"People need much more than a job and a place to put their heads," said Nancy Wolff, who heads Rutgers University's Center for Mental Health and Criminal Justice Research and is developing a curriculum for prisons to train inmates before release.

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 probably "will reassociate 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 one in 10 former inmates died within seven years, mostly because of substance abuse.

Binswanger's study is reported in today's New England Journal of Medicine.

It included 26,270 men and 3,967 women released from Washington state prisons from mid-1999 through 2003 and used two national databases to track their deaths. It compared them with deaths among other state residents of similar age, race, and gender. Over that time, 443 inmates died, 38 in the first two weeks; an average of three deaths occurred among the same number of state residents over two weeks.

During the four-year study period, the highest number of deaths came from overdoses of alcohol and drugs, 103; heart problems, 56; homicides, 54; suicides, 40; and cancer deaths, 39. Many of the cancer deaths related to smoking, which was later banned in Washington prisons.

Former inmates were twice as likely as other citizens to die from heart disease, the country's top killer, even though only 3 percent of the released prisoners were 55 or older.

The study was funded by the US Department of Veterans Affairs and the Robert Wood Johnson Foundation of Plainsboro, N.J.

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 them 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 former inmates to hospital emergency rooms -- at taxpayers' expense -- and society gets stuck with other costs. Roughly half 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 former offenders with chronic health problems or planning early for the transition back to society. Far more funding is needed, though, he said.

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