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Psychostimulant-Related Deaths Among Former Inmates

Calcaterra, Susan MD; Blatchford, Patrick PhD; Friedmann, Peter D. MD, MPH; Binswanger, Ingrid A. MD, MPH

Journal of Addiction Medicine: June 2012 - Volume 6 - Issue 2 - p 97–105
doi: 10.1097/ADM.0b013e318239c30a
Original Research

Objectives: Psychostimulants are highly addictive and their use is increasing. Little is known about psychostimulant-related deaths. This study identified characteristics, risk factors, and contributing substances reported upon death among former prison inmates who died from a psychostimulant-related death.

Methods: This retrospective cohort study of released inmates from 1999 to 2003 (N = 30,237) linked data from the Washington State Department of Corrections with the National Death Index. We examined characteristics of individuals who died with psychostimulants listed among their causes of death. These were categorized into 3 groups: (1) noncocaine psychostimulants, (2) cocaine only, and (3) all psychostimulants. Cox proportional hazards regression determined risk factors for death in each group, and the risk of death in the first 2 weeks after release from prison

Results: Of the 443 inmates who died, 25 (6%) had noncocaine psychostimulants listed among their causes of death. Six of these 25 deaths had both noncocaine psychostimulants and cocaine listed among their causes-of-death. Most of the former inmates who died with noncocaine psychostimulants were male (n = 21, 84%) and non-Hispanic white (88%, n = 22). Cocaine only was listed among the causes-of-death for 49 former inmates; most were male (n = 35, 71%) and non-Hispanic white (n = 27, 55%). Longer length of incarceration was associated with a reduced risk of death from any psychostimulant use (hazard ratio = 0.76, confidence interval = 0.63–0.920 for each additional year of incarceration) and from use of noncocaine psychostimulants (hazard ratio = 0.42, 95% CI = 0.22–0.80). Risk of death was highest during the first 2 weeks postrelease for cocaine only–related deaths (incidence mortality ratio = 1224.0, confidence interval = 583–1865).

Conclusions: Former prisoners have a significant risk of death from psychostimulants, especially within the first 2 weeks postrelease.

From the Division of General Internal Medicine (SC, IAB), Colorado Health Outcomes Program (SC), and Division of Substance Dependence (IAB), University of Colorado School of Medicine, Denver; Denver Health Medical Center (SC, IAB), Denver, CO; Univeristy of Colorado School of Public Health (PB), Denver; Center on Systems, Outcomes and Quality in Chronic Disease and Rehabilitation (PDF), Health Services Research & Development Service and Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation (PDF), Providence VA Medical Center, Providence, RI; Division of General Internal Medicine (PDF), Rhode Island Hospital, Providence; and Brown University Alpert School of Medicine (PDF), Providence, RI.

Send correspondence and reprint requests to Susan Calcaterra, MD, Division of General Internal Medicine, University of Colorado Denver School of Medicine, 13119 East Montview Suite 300 W308-D, Aurora, CO 80045. E-mail:

The authors have declared no conflicts of interest.

Funding sources for authors during the study include Health Resources and Services Administration, the National Institute on Drug Abuse, and Robert Wood Johnson Foundation.

Received June 23, 2010

Accepted June 26, 2011

© 2012 American Society of Addiction Medicine