Drugs-related death soon after hospital discharge among drug treatment clients in Scotland:record linkage, validation and investigation of risk factors.

We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29-90 days, 91 days-1 year, >1 year since most recent hospital discharge versus 'never admitted'. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0-1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients' high DRD-rate soon after hospital-discharge in 2006-2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006-2010, as in 1996-2006, especially for those with a history of injecting

Meta-analysis of drug-related deaths soon after release from prison

Aims The transition from prison back into the community is particularly hazardous for drug-using offenders whose tolerance for heroin has been reduced by imprisonment. Studies have indicated an increased risk of drug-related death soon after release from prison, particularly in the first 2 weeks. For precise, up-to-date understanding of these risks, a meta-analysis was conducted on the risk of drug-related death in weeks 1 + 2 and 3 + 4 compared with later 2-week periods in the first 12 weeks after release from prison. Methods English-language studies were identified that followed up adult prisoners for mortality from time of index release for at least 12 weeks. Six studies from six prison systems met the inclusion criteria and relevant data were extracted independently. Results These studies contributed a total of 69 093 person-years and 1033 deaths in the first 12 weeks after release, of which 612 were drug-related. A three- to eightfold increased risk of drug-related death was found when comparing weeks 1 + 2 with weeks 3–12, with notable heterogeneity between countries: United Kingdom, 7.5 (95% CI: 5.7–9.9); Australia, 4.0 (95% CI: 3.4–4.8); Washington State, USA, 8.4 (95% CI: 5.0–14.2) and New Mexico State, USA, 3.1 (95% CI: 1.3–7.1). Comparing weeks 3 + 4 with weeks 5–12, the pooled relative risk was: 1.7 (95% CI: 1.3–2.2). Conclusions These findings confirm that there is an increased risk of drug-related death during the first 2 weeks after release from prison and that the risk remains elevated up to at least the fourth week

Exploring Methods to Investigate Sentencing Decisions

The determinants of sentencing are of much interest in criminal justice and legal research. Understanding the determinants of sentencing decisions is important for ensuring transparent, consistent, and justifiable sentencing practice that adheres to the goals of sentencing, such as the punishment, rehabilitation, deterrence, and incapacitation of the offender, as well as reparation for the victim. It is important to frame research questions on sentencing that can feasibly be answered by appropriate research methods, within the constraints of limited time and resources. For illustration, this article presents three methodological approaches for investigating the factors that may influence sentencing decisions: multilevel analysis using existing sentencing data; sampling of, and data collection from, sentenced court case files; and experimental designs involving sentencers deciding on hypothetical cases. The strengths and weaknesses of each approach are compared and discussed.research techniques; court decisions; multilevel; sampling; experimental

Drugs-related Death Rates by Follow-up Era and Time Since Hospital-discharge: Unadjusted, SDMD Cohort, Scotland, 1996–2010.

<p>Abbreviations: DRD, drugs-related death; SDMD, Scottish Drugs Misuse Database; Pys, Person-years; CI, Confidence Interval</p><p>Drugs-related Death Rates by Follow-up Era and Time Since Hospital-discharge: Unadjusted, SDMD Cohort, Scotland, 1996–2010.</p

Drugs-related Death Rates Soon After Hospital-discharge for Ever-IDU Behavioral Risk-factor, SDMD Cohort, Scotland, 1996–2010.

<p>Drugs-related Death Rates Soon After Hospital-discharge for Ever-IDU Behavioral Risk-factor, SDMD Cohort, Scotland, 1996–2010.</p

Drugs-related Death Rates Soon After Hospital-discharge for Reported Misuse of Alcohol Behavioral Risk-factor, SDMD Cohort, Scotland, 1996–2010.

<p>Abbreviations: DRD, drugs-related death; SDMD, Scottish Drugs Misuse Database; Pys, Person-years; CI, Confidence Interval; IDU, Injecting Drug User</p><p>Drugs-related Death Rates Soon After Hospital-discharge for Reported Misuse of Alcohol Behavioral Risk-factor, SDMD Cohort, Scotland, 1996–2010.</p

Descriptive Statistics for outcomes by Follow-up Era, SDMD Cohort, Scotland, 1996–2010.

<p>Abbreviations: DRD, drugs-related death; SDMD, Scottish Drugs Misuse Database</p><p>^a Excluding DRD suicides which are included in the DRD total,</p><p>^b Restricted to individuals with first SDMD registration in 2006–2010 as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141073#pone.0141073.t001" target="_blank">Table 1(a)</a></p><p>Descriptive Statistics for outcomes by Follow-up Era, SDMD Cohort, Scotland, 1996–2010.</p

Descriptive Statistics for characteristics at First SDMD Registration by Registration Era, SDMD Cohort, Scotland, 1996–2010.

<p>Abbreviations: SDMD, Scottish Drugs Misuse Database</p><p>Descriptive Statistics for characteristics at First SDMD Registration by Registration Era, SDMD Cohort, Scotland, 1996–2010.</p

Drugs-related Death Rates Soon After Hospital-discharge Within 28 and 90 Days After Hospital-discharge by Duration of Hospital-stay and Main Discharge-diagnosis Versus Ever-IDU and Reported Misuse of Alcohol, SDMD Cohort, Scotland, 1996–2010.

<p>Abbreviations: DRD, drugs-related death; SDMD, Scottish Drugs Misuse Database; Pys, Person-years; CI, Confidence Interval; IDU, Injecting Drug User</p><p>^a All diagnoses not included in specified groups</p><p>^b Diagnoses related to drug misuse, (a) Poisonings by drugs, medicaments & biological substances and (b) Mental & behavioral disorders due to psychoactive substance</p><p>^c All mental and behavioral disorders, excluding those due to psychoactive substances</p><p>Drugs-related Death Rates Soon After Hospital-discharge Within 28 and 90 Days After Hospital-discharge by Duration of Hospital-stay and Main Discharge-diagnosis Versus Ever-IDU and Reported Misuse of Alcohol, SDMD Cohort, Scotland, 1996–2010.</p