Former Ontario inmates saw higher risk of overdose death as COVID-19 emerged: study

Former Ontario inmates saw their risk of dying from a toxic-drug overdose jump as much as 50 per cent at the start of the pandemic compared to the years before COVID-19, says a study.

The study in the medical journal PLOS One compared pandemic impacts on opioid toxicity death rates between people who had and had not been incarcerated in Ontario between 2015 and 2020.

It found overall risk jumped substantially when COVID-19 emerged with a slew of public health restrictions that reduced services, but the increase in risk was particularly large for people who had been behind bars or released during the years studied.

Lead author Amanda Butler, assistant professor of criminology at Simon Fraser University in British Columbia, says COVID-19 further exacerbated risk by 1.5 times for men and 1.2 times for women who were incarcerated.

The most substantial impact was on individuals between the ages of 25 and 49 who experienced incarceration.

"Our interest was in whether COVID disproportionately impacted people who experienced custody," Butler said of the Oct. 24 study that also included researchers from the University of Toronto and McMaster University in Hamilton.

"The highest risk time for death is in the first two weeks after release from custody," she said of related Ontario findings from her previous research over the same period, published in May in BMJ (British Medical Journal) Open.

"Even if you have been out for over a year, your risk of death is still substantially higher than somebody [who never went to prison]."

The death rate for inmates is 288 per 10,000 person years in the four to seven days after release before it trickles off, Butler's study shows.

Employment, affordable housing additional barriers

Men who had been incarcerated were 25 times more likely to die of an overdose compared to men who were not. And women who had been incarcerated were 67 times more likely to die compared to women who were not, said Butler.

Researchers looked at data for all 129,152 people — 110,629 men and 18,146 women — from every provincial correctional facility between 2015 and 2020. They found that 2,207 of them fatally overdosed. Among those, 58 were in custody.

The vast majority of inmates were released during the study period. Deaths among those released and incarcerated accounted for one quarter of all opioid overdose fatalities in Ontario during the six-year period.

People transitioning to the community face challenges in continuing health care they may have received in a correctional facility. Employment, affordable housing and learning to navigate government services are additional barriers, Butler said.

Pandemic restrictions and isolation contributed to more people in general using drugs alone, leading to a sharp rise in overdoses across the country.

However, those factors put former inmates at greater risk because they were more vulnerable at a time when services for people who use drugs were greatly reduced or unavailable, Butler said.

The study captured data at the beginning of the pandemic, from April to December 2020.

Data from the Public Health Agency of Canada shows 5,148 deaths nationally during those nine months, an 89 per cent increase from the same period in 2019. Most the 38,514 fatal overdoses between 2016 and March 2023 were in British Columbia, Alberta and Ontario.

More help needed to transition into community

More health services are needed to help people transition into the community, Butler said.

"What we did hear from a group of people with lived experience of incarceration in Ontario is that the supports are extremely limited."

The Solicitor General Ministry said designated correctional staff help inmates connect with community agencies so they can continue to access services when they are released.

It has also hired 25 reintegration officers for "select" correctional institutions to help people plan their return to the community, the ministry said in an email, though it did not include information about how long those supports are available or whether inmates could access specific medical or other support from nurses or social workers.

In October 2020, the B.C. government extended services for former inmates to 90 days from 30 days to help with housing, health care, transportation and treatment from community transition teams. Nurses and patient navigators who are Indigenous were added to the roster of social workers and peer support workers.

At the time, British Columbia's mental health and addictions minister said starting over can be overwhelming and triggering for people released from custody and that those who use illicit substances are 12 times more likely to die of an overdose.

Between September 2022 and September 2023, the teams served 1,315 clients, up from 803 a year earlier, the ministry said.

Angela Vos, whose 26-year-old son Jordan Sheard was found unresponsive in his jail cell in Lindsay Ont., in June 2020, said health services for inmates and those who have been released should be handled by the Health Ministry.

"The solicitor general doesn't have the health perspective on the quality of treatment that people need when they're trying to heal and recover from traumas," she said from Hamilton.

An expert advisory committee on health care transformation in Ontario's corrections system also called for that change in 2018. That was a year after an independent review made the same recommendation.

Vos said her family has supported former inmates in their home and tried to connect them to health services, including a doctor who could prescribe a safer supply of drugs. But many people end up homeless while waiting and relapsing, she added.

"It's just really a trainwreck of events. Unless people really have that strong support network to keep them getting their treatment they fall off because it's hard. When you get out you get nothing."