Aims: To assess if 15-35-year-old males released after 14 + days' imprisonment in Scotland, 1996-99, had a higher drugs-related death rate in 2 weeks after release than during subsequent 10 weeks; higher than expected death rate from other causes; and if drugs-related deaths in the first fortnight were three times as many as prison suicides.
Design: Confidential linkage of ex-prisoner database against deaths.
Setting: Scotland's male prisons and young offenders' institutions during July to December 1996-99; 19 486 index releases after 14+ days' incarceration.
Measurements: Relative risk of drugs-related death in the first 2 weeks after release (34 deaths) versus subsequent 10 weeks (23). Other causes of death (21) relative to expectation. Drugs-related deaths in first 2 weeks after release relative to suicides in prison (12).
Findings: Drugs-related mortality in 1996-99 was seven times higher (95% CI: 3.3-16.3) in the 2 weeks after release than at other times at liberty and 2.8 times higher than prison suicides (95% CI: 1.5-3.5) by males aged 15-35 years who had been incarcerated for 14+ days. We estimated one drugs-related death in the 2 weeks after release per 200 adult male injectors released from 14 + days' incarceration. Non-drugs-related deaths in the 12 weeks after release were 4.9 times (95% CI: 2.8-7.0) the 4.3 deaths expected.
Conclusion: Investment in, and evaluation of, prison-based interventions is needed to reduce substantially recently released drugs-related deaths.