A new study published in PLOS One finds that life outside prison bars is still plenty dangerous for those formerly incarcerated, especially soon after they return home.

The researchers pored over coroner's records in the province of Ontario, Canada, from 2006 to 2013, specifically looking for people who had died from a drug overdose. Out of the nearly 7,000 such deaths they tracked down, they found that one out of every ten (702 in total) had occurred in people released from a provincial correctional facility within the past year. Of these, 20 percent had occurred within a week’s time of release and 77 percent had involved opioids. Based on these figures, the researchers calculated that recently released former prisoners were substantially more likely to die of a fatal overdose than the general public.

"This is the first Canadian study to examine overdose mortality rates by matching incarceration records with coroner reports after release," said the study's senior author Dr. Nav Persaud, an assistant professor at the Department of Family and Community Medicine at the University of Toronto and staff member at St. Michael’s Hospital, in a statement released by the hospital. "We were surprised at how high the fatal overdose rate was among those who were recently released from provincial custody — almost 12 times higher than the general population."

In Canada, provincial correctional facilities are intended to hold people who are either on trial or have sentences two years long or less. This means the heightened risk doesn’t take very much time to manifest itself. According to the researchers, about 50,000 Canadians are released from these facilities annually; of these individuals, 88 will die from an overdose within a year’s time. And while the majority of deaths happen to young men, since they largely make up the prisoner population, women actually have a higher fatal overdose rate following release. In the current study, three-fourths of the deaths were in people younger than 45.

As for why the risk exists, Persaud notes there are several leading theories.

"Previous research has speculated that the higher risk for overdose immediately following release can be attributed to periods of no or less frequent drug use while individuals are incarcerated," he said. "Once released, these individuals may not realize that their tolerance has diminished and can accidentally overdose."

The understandable stress and anxiety that comes with trying to readjust to outside life or moving back to a neighborhood with high levels of drug use might also encourage the adoption of risky habits. Indeed, it’s become increasingly apparent that former prisoners often face a difficult road ahead of them once they leave their cells, both financially and mentally. A higher mortality rate has been seen among most every country’s former prisoner population, including the United States.

When Persaud and his colleagues took a closer look at the deaths from opioid overdoses alone, they found that as many as 59 percent happened in the presence of a nearby bystander, indicating that a good chunk of these deaths could have been prevented with added intervention training or access to medications like naloxone that has the power to counteract the drug’s harmful effects. As the authors note, when Scotland implemented a national naloxone-distribution program for recently released prisoners in 2013, it led to a marked decrease in opioid-related deaths within the first four weeks of release.

Ultimately, the authors believe that their findings highlight yet another crucial gap in helping former prisoners get back on their feet. "At least some of these deaths are preventable and there may be opportunities to prevent overdose deaths by supporting this vulnerable group — during incarceration and immediately following release," Persaud said. "Future research and policy should focus on immediate interventions such as directing people to treatment programs and providing better access to naloxone, drug substitution therapies and overdose prevention education."

Source: Groot E, Kouyoumdjian F, Kiefer L, et al. Drug Toxicity Deaths after Release from Incarceration in Ontario, 2006-2013: Review of Coroner’s Cases. PLOS One. 2016.