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Rise in prison population has significantly increased drug-related deaths in the US, says study

Counties with the highest imprisonment rates linked with a more than 50% increase in drug-mortality compared to counties with the lowest imprisonment, say researchers

Rise in imprisonment rates have significantly increased drug-related deaths in the US, says a new analysis. Major increases in admissions rates to local jails (with an average rate of 7,018 per 100,000 population) and state prisons (averaging 255 per 100,000 people) are associated with a 1.5% and 2.6% increase in death rates from drug overdoses respectively, say the findings by an international team comprising researchers from the University of Oxford, UK; Vera Institute of Justice, New York; University of Massachusetts, USA; London School of Hygiene and Tropical Medicine, UK; and Institute of Health Equity, University College London, UK.

This, according to the team, is over and above the effects of household income and other factors such as crime, ethnicity, and education. Counties with the highest imprisonment rates have been linked with a more than 50% increase in drug-mortality compared to counties with the lowest imprisonment.

The observational study, involving 2,640 US counties between 1983 and 2014, says that growing rates of imprisonment in the US since the mid-1970s can be linked with a rise in drug-related deaths, and it can aggravate the harmful health effects of economic hardship.

“The rapid expansion of the prison and jail population since the mid-1970s, largely driven by a series of sentencing reforms, including mandatory sentences for drug convictions, is likely to have made a substantial contribution to the more than 500,000 overdose deaths across America over the past 35 years,” say the researchers.

This is the first study to examine the link between the expansion of the jail and prison population and overdose deaths at the county level and comes as the opioid epidemic continues to harm communities across the country.

In 2017, over 72,000 people died from an overdose in the US. Even after taking into account the role of opioid prescription rates, the "association between incarceration and overdose mortality persists", says the research team.

The study explains that imprisonment can lead to an increased number of overdose deaths in multiple ways. The researchers explain that imprisonment is are directly associated with stigma, discrimination, poor mental health, and chronic economic hardship, all of which are linked to drug use disorders.

Further, says the study, at the community level, the criminal justice system removes working-age men from their local communities, separates families, and disrupts social networks. The researchers say when coupled with economic hardship, prison and jail systems may constitute “an upstream determinant of despair, whereby regular exposure to neighborhood violence, unstable social and family relationships, and psychological stress can trigger destructive behaviors.”

The number of overdose deaths has increased in every county since 1980, but at very different rates, and ranges from 8% to more than 8,000%. According to the research team, the findings indicate that the 3,000 local jails in the US are an overlooked but crucial independent contributor to overdose deaths and may help to explain the geographical differences in drug-related deaths - identifying a potential cause that has remained elusive until now.

Major increases in admissions rates to local jails and state prisons are associated with a 1.5% and 2.6% increase in death rates from drug overdoses respectively, says the study. (Getty Images)

According to the team, even though only 5% of the world’s population lives in the US, the country has nearly 25% of all incarcerated people globally - the highest rate of imprisonment in the world. 

“Counties with the highest incarceration rates had an average of two excess drug-related deaths per 100,000 population compared to counties with the lowest rates (5.4 deaths per 100,000 versus 3.5 deaths per 100,000), a more than 50% increase in drug-mortality. For counties experiencing large decreases in average household income (equivalent to a drop of about $12,000 from an average income of $46,841), there was an associated 13% increase in drug-related deaths, even after controlling for the same county-level factors,” say the findings.

The study says that county jails generally house inmates who are serving less than a year or awaiting trial. State and federal prisons, on the other hand, hold inmates convicted of more serious crimes serving lengthier sentences. At any given time, jails hold about half as many inmates as prisons (744,600 versus 1,562,000). However, many more people (over 11 million people) enter jail every year (most awaiting trial)--almost 20 times more than the roughly 600,000 admitted to prison, says the paper. 

The researchers suggest reform of the criminal justice system. “Although policies that might reverse regional economic decline are likely to be both difficult and expensive to implement, reform of arrest and sentencing policies is technically simple and would not only be economical but could potentially save many lives,” they say in the study.

In the study, the authors used data from the US National Vital Statistics, the US Census Bureau, and previously unavailable county-level imprisonment data from the Vera Institute of Justice between 1983 and 2014, to model associations between county-level economic decline, incarceration rates, and deaths from drug use.

The findings were published on July 4 in The Lancet Public Health journal.