We have studied deaths occurring after release from prison in the Canton of Geneva during the period 1982-86. The mortality rate during the first year after release was about 5 deaths/1000 person years, a rate over four times the age-adjusted rate in the general population. The majority of deaths were due to overdose by opiate drugs among young, frequently imprisoned drug abusers, and occurred within the first few weeks after release. Likely risk factors include loss of tolerance to opiates while in prison, and psychological and social stresses following release.

During one year we sought medical historical data for all medico-legal autopsies with toxicological analysis (n = 51); the same procedure was applied to a control group of autopsies without toxicological analysis. Historical data was available in 70 cases (69%), the proportion being significantly higher among cases where the cause of death was poisoning (84%) than in the non-poisoning cases (48%). In the poisoning cases information was more often available from the emergency service, the psychiatric service and the prison medical service. Autopsy observations revealed a higher proportion of prior pathology than the medical history. But in a minority of cases, potentially significant prior illnesses were shown by the medical history and not at the autopsy (for example, in cases of advanced decomposition and in cases with no pathological lesions: idiopathic epilepsy; HIV infection). Historical data was judged to make some contribution to the conclusions concerning the cause of death in 71% of the cases of poisoning. The most important single contribution was the assessment of dependence status among drug or alcohol abusing subjects.

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