The Overdose Risk Environment for People Who Inject Drugs Transitioning From Prison to Community in Australia

People who inject drugs (PWID) face disproportionately high rates of drug overdose in the first few weeks post-release from prison, which may be exacerbated by lack of access to healthcare and harm reduction resources. However, little is known about the experiences of PWIDs and the factors that produce the risk of overdose when navigating the critical transition into community. This study aimed to understand the overdose risk environment during transition from prison to community, and what enabling resources are currently being utilized by communities of PWIDs to reduce overdose risk during this transition. A qualitative approach was employed, with semi-structured interviews conducted with 10 PWID who had been incarcerated and experienced an overdose in their lifetime. Data were analysed using thematic analysis through a Risk Environment lens. Participants reported macro-level systemic and structural factors which affected their access to healthcare, including opioid dependence treatment (ODT). At a micro-level, barriers to access often stemmed from stigmatizing interactions with the health workforce. However, peer-led approaches which preference relational care and are focused on building agency were reportedly being used by PWIDs to reduce overdose risk during transition from prison into community. PWIDs suggested naloxone administration and distribution were a key protective factor and critical in mitigating overdose risks post-release, filling current system gaps. Participants suggested enhancing naloxone distribution for PWIDs transitioning out of prison and expanding peer-led education and training in prisons and with service providers involved across all elements of post-release trajectories for PWIDs. The findings underscore the need for systemic changes to improve transitional care for PWIDs. Enhancing capacity for peer-led care, particularly through education and training regarding naloxone administration and distribution, is critical to providing equitable, life-saving care to this priority population.