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PAPERS: S R Seaman, R P Brettle, and S M Gore Mortality from overdose among injecting drug users recently released from prison: database linkage study BMJ 1998; 316: 426-428 [Abstract] [Full text]

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Harm reduction: time for action

Tim Harding   (27 July 1998)

O.D on Release - A Reality

Steve Simpson   (20 January 1999)

Harm reduction: time for action 27 July 1998
Tim Harding, Professor Institute of Legal Medicine Send response to journal: Re: Harm reduction: time for action	Another excellent study from Sheila Gore and her colleages, with a clear message for prevention within prisons. The UK seems capable of producing excellent studies demonstrating the needs, but when will harm reduction activities really start. The risk of death after release from prison, mainly due to overdoses following loss of tolerance, was already clealy established in a study published in the BMJ 10 years ago(British Medical Journal, vol 297 p.596) to which the authors do not refer. I would suggest that the editors give prioriy to intervention studies in prisons rather than further research demonstrating health risks associated with imprisonment. Condoms are not yet freely available to prisoners, methadone maintenance (which could reduce dramatically the risk of overdose on release) is provided to only a tiny minority of potential prisoner patients and needle exchange seems a tabou subject.
O.D on Release - A Reality 20 January 1999
Steve Simpson, Peer Program Advisor Melbourne Assessment Prison Send response to journal: Re: O.D on Release - A Reality	EDITOR - I wish to address one point from the paper of Seaman et al. In Australia the drug use in prison is widely accepted as problomatic and the risk of overdose on release is great. As a worker in a maximum security prison I have learned of the nature of drug trafficking in our prison system. At this time a cap of heroin can be purchased on the street for fifty dollars. However this cap (when it reaches prison) becomes four caps and sold at fifty dollars each. A handsome profit and considering the strength of street heroin at this time not many complaints at the quality so business booms. With tolerance dropping fairly quickly and finances from those outside waning, particularly from partners who have many other needs for the cash tolerance drops quickly. Upon release a return to a street cap (on the way home in many instances) leads to a false beleif that 'the old dose is fine'and overdose follows. The other concern is that this is almost the perfect murder alabi, another user got out and o'd, perhaps more common than we think.