Tobacco, alcohol, and illicit substance use continue to result in substantial morbidity and mortality and significant societal economic costs despite considerable efforts to minimize use of licit substances and prevent use of illicit substances. Each year, more than 400,000 Americans die from cigarette smoking, and one in every five deaths in the United States is believed to be smoking related (1). Consequences of alcohol and illicit substance abuse include, among others, cirrhosis, job loss, and criminal behavior related to the acquisition and sale of illicit drugs. The economic costs of addiction were estimated as $400 billion yearly in the United States in 1999 (2). Substance use is associated with a wide range of risk behaviors. For the more commonly used substances, risk behavior includes symptoms of both dependence (e.g., reducing important activities because of use of the substance) and abuse (e.g., driving a car more than once while intoxicated, getting into trouble with superiors or co-workers because of intoxication). For example, in 2002, 4.7 percent of the population reported driving under the influence of an illicit drug and 14.2 percent reported driving under the influence of alcohol at least once during the past year (3).

/pdf/the-social-epidemiology-of-substance-use-35kvyllrv2.pdf

The social epidemiology of substance use.

Aims To investigate drug-related deaths among newly released prisoners in England and Wales. Design Database linkage study. Participants National sample of 48 771 male and female sentenced prisoners released during 1998– 2000 with all recorded deaths included to November 2003. Findings There were 442 recorded deaths, of which 261 (59%) were drug-related. In the year following index release, the drug-related mortality rate was 5.2 per 1000 among men and 5.9 per 1000 among women. All-cause mortality in the first and second weeks following release for men was 37 and 26 deaths per 1000 per annum, respectively (95% of which were drug-related). There were 47 and 38 deaths per 1000 per annum, respectively, among women, all of which were drug-related. In the first year after prison release, there were 342 male deaths (45.8 were expected in the general population) and there were 100 female deaths (8.3 expected in the general population). Drug-related deaths were attributed mainly to substance use disorders and drug overdose. Coronial records cited the involvement of opioids in 95% of deaths, benzodiazepines in 20%, cocaine in 14% and tricyclic antidepressants in 10%. Drug-related deaths among men were more likely to involve heroin and deaths among women were more likely to involve benzodiazepines, cocaine and tricyclic antidepressants. Conclusions Newly released male and female prisoners are at acute risk of drug-related death. Appropriate prevention measures include overdose awareness education, opioid maintenance pharmacotherapy, planned referral to community-based treatment services and a community overdose-response using opioid antagonists.

http://www.antoniocasella.eu/archila/Farrell_Marsden_2007.pdf

Acute risk of drug-related death among newly released prisoners in England and Wales

Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners.

Adding Spice to the Porridge: The development of a synthetic cannabinoid market in an English prison

Evaluation of drugs of abuse use and trends in a prison through wastewater analysis.

Aims To investigate heroin and cocaine use in a sample of British prisoners, and to explore the characteristics of inmates who use these drugs for the first time while in prison. Design, participants A cross-sectional survey of all prisons in England and Wales conducted as part of a major national study of psychiatric morbidity. A total of 3142 prisoners (88.2% of those selected) completed a structured interviewer-administered questionnaire. Measurements Interview measures of personal demographics, social history, psychiatric morbidity and drug use. Personality disorders were diagnosed via the Structured Clinical Interview for DSM-IV (SCID-II) and neurotic symptoms were assessed using the revised Clinical Interview Schedule (CIS-R). Findings More than 60% of the heroin users and cannabis users reported that they had used these drugs in prison compared with less than a quarter of the life-time cocaine users. More than a quarter of the heroin users reported that they had initiated use of this drug in prison. The extent of an individual’s experience of prison was related more consistently to heroin and/or cocaine use in and out of prison than other personal background, social history or psychiatric variables assessed. Conclusions The findings indicate that prisons are a high-risk environment for heroin and other drug initiation and use. Although related to drug use, psychiatric variables were not generally associated with initiation in prison, which was dominated by prison exposure. There is a need to explore ways of reducing heroin initiation in prison as part of a broader risk-prevention strategy.

Drug use and initiation in prison: results from a national prison survey in England and Wales.

Mental Health 13-15 years: results from the Child and Adolescent Survey of Psychiatric morbidity and substance use in young people aged

results from a national survey of prisoners results from a national survey of prisoners

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Drug use and initiation in prison: results from a national prison survey in England and Wales.

Mental Health 13-15 years: results from the Child and Adolescent Survey of Psychiatric morbidity and substance use in young people aged

results from a national survey of prisoners results from a national survey of prisoners