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Canada Ontario study shows former prisoners at higher risk of early death

A medical cell is pictured at the new Toronto South Detention Centre on Oct. 3, 2013.

Fred Thornhill/REUTERS

Women who spend time in an Ontario correctional facility can expect to live a full decade less than the Canadian average, just one of a slew of alarming figures contained in a new study of long-term mortality rates for provincial inmates.

By tracking when and how people died among a sample size of nearly 50,000 former prisoners, the study, published Wednesday in the online journal CMAJ Open, fills a huge void in Canadian research on the fate of inmates once they leave prison walls behind.

What emerges is a statistical representation of something former inmates and criminal justice workers have long known by anecdote: Jail time is frequently a precursor to an early death by preventable means.

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The life expectancy for women in the study was 10.6 years shorter than the general Canadian population and 4.2 years shorter for men. The mean age of death for the group was just 47.5.

"We just have people at all ages who are dying more quickly than the rest of the population," said researcher Fiona Kouyoumdjian, a public-health physician and postdoctoral fellow with the Centre for Research on Inner City Health at St. Michael's Hospital in Toronto.

"And for women, the risk is strikingly high over time. It's a huge issue, especially when we're thinking about the fact that many of these deaths are preventable. There's a significant impact on our communities and families when people are dying prematurely like this."

The chief causes of death were injury and poisoning, which accounted for 38.2 per cent of the 4,126 deaths recorded in the study group from 2000 to 2012 – a death rate four times that of the general Canadian population.

The injury and poisoning category includes a slew of brutish fatality types that befall former inmates at rates far ahead of Canadian averages. Compared with the general population, the former inmates were 15 times more likely to die from homicide and 4.3 times more likely to die by suicide.

Nearly 14 per cent of those studied died by overdose, a rate 20 times national norms.

That overdose risk ramps up considerably in the two weeks immediately after release, a precarious time for former inmates. Job and housing prospects are usually bleak and drug tolerances are generally at a low point because of the relative scarcity of drugs in prison. And, correspondingly, the risk of death by overdose spikes to 56 times the national average, according to the study.

Unlike in British Columbia and Scotland, Ontario inmates do not receive drug-tolerance education or opioid antidotes, such as naloxone, upon release. "There is no standard program like that in place here," Dr. Kouyoumdjian said, "which I think would be very valuable."

This dearth of programming can be particularly problematic at a time when many former inmates are most motivated to change their lives.

"In that immediate time after release, it's such a good opportunity to intervene" said Amber Kellen, director of community initiatives, policy and research at the John Howard Society of Toronto. "They don't want to come back. But all it takes is a few moments of anxiety, or being approached by a dealer, or a bad phone call to set a person off down a high-risk path. We know all this, and yet there's so little available. "

Treatable diseases such as HIV, viral hepatitis and diabetes also killed group members far more frequently than what would be expected for the general population, highlighting gaps in health care for those who have served time in prison.

"Even if people choose to do things that are risky, they are entitled to access health-care services," Dr. Kouyoumdjian said. "If I don't wear a seatbelt, I should still have good access to health care. It is in our best interests to improve their health."

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