High Incarceration Rates Tied to More Drug-Related Deaths

Reduced household income and high incarceration rates are associated with drug-related deaths, according to a study published in the July issue of The Lancet Public Health.

Elias Nosrati, Ph.D., from the University of Oxford in the United Kingdom, and colleagues evaluated associations between economic decline and incarceration rates and age-standardized mortality from drug use disorders for 2,640 U.S. counties between 1983 and 2014. Data came from the U.S. National Vital Statistics System and the Institute for Health Metrics and Evaluation (age-standardized mortality), the U.S. Census Bureau (household income data), and the Vera Institute of Justice (county-level jail and prison incarceration data).

The researchers found that after adjusting for confounding variables, each one standard deviation (SD) decrease in median household income was associated with an increase in drug-related deaths within counties of 12.8 percent. Each one SD increase in jail and prison incarceration rates was similarly associated with an increase of 1.5 and 2.6 percent in drug-related mortality, respectively. After controlling for local opioid prescription rates, the association between drug-related mortality and income and incarceration remained. The model accounts for a large proportion of within-county variation in mortality from drug use disorders. High rates of incarceration were associated with a more than 50 percent increase in drug-related deaths between counties.

"Incarceration can lead to an increased number of overdose deaths in multiple ways," Nosrati said in a statement. "At the community level the criminal justice system removes working-age men from their local communities, separates families, and disrupts social networks. When coupled with economic hardship, prison and jail systems may constitute an upstream determinant of 'despair,' whereby regular exposures to neighborhood violence, unstable social and family relationships, and stress can trigger destructive behaviors."

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