The thirteen participants in this analysis that self-disclosed a history of incarceration included six women and seven men, and the mean age was 35 (range 26–55). Participants described their ethnicity as Indigenous (38%), Caucasian (38%), mixed Indigenous and Caucasian (15%), and other (8%). Participants reported past use of a variety of substances, including opioids (heroin, fentanyl and carfentanyl, and prescription opiates), cocaine, methamphetamines, MDMA, psychedelics, cannabis and alcohol. Five participants reported drug use in the last 3 months, four in the past 6 months, and four within the last 3 years.
The perspectives that participants shared regarding the impact of involvement with the criminal justice system on their drug use and perceived risk of overdose revealed three broad thematic relationships: (1) incarceration was associated with harms and was perceived to increase risk of overdose following release (the majority of participants); (2) incarceration was perceived to have limited impact on substance use and overdose risk (some participants); (3) incarceration was associated with a perceived reduction of substance use and overdose risk (a minority of participants). Responses were situated within differing systemic environments and involved individualized and sometimes conflicting interpretations and experiences.
Theme 1: Incarceration was associated with harms and perceived to increase risk of overdose following release
The majority of participants identified and described several harms associated with incarceration that increased risk of overdose following release. Participants commonly described the harms of forced withdrawal upon entering corrections facilities. For example, one participant (Male, 38, Caucasian) described the experience:
When I was incarcerated in the last few years and I was addicted to opiates, it was absolute hell going in there, they did not give me any sort of methadone, suboxone. I just sat in there and went through full-blown withdrawals...
Another participant (Male, 27, Caucasian) also asserted that he felt that withdrawal was the only option they had upon entering prison:
It’s just forcibly stopping you from it. It’s not a decision, it’s more that you have to.
Notably, participants and peer researchers identified differences between federal and provincial correctional institutions, generally describing more robust harm reduction and treatment options available in federal facilities.
Other participants illustrated how incarceration increased their risk of overdose upon release from corrections. Participants explained that incarceration reduced their tolerance and was also related to changes in their drug supply. For instance:
“When I haven’t done drugs in so long, I do have a higher risk of overdosing. Doing too much. Or getting something that’s tainted.” –(Female, 26, Caucasian & Indigenous)
One participant described a combination of motive, expectations and a lack of harm reduction information, highlighting that often individuals use similar amounts as they were before they were incarcerated, causing them to overdose:
“I think getting clean, and then going out and relapsing and using the same amount you would use before. I think that’s why a lot of people are dying, because their tolerance is way down. Especially guys getting out of jail or getting out of treatment and wanting to use right away. They’re used to a certain amount, and when they go out and relapse that amount, thinking that it’s going to be fine.” – (Male, 31, Indigenous)
The association between decreased tolerance following incarceration and increased risk of overdose was shared by many participants; however, other participants described ongoing access to substances during incarceration and viewed incarceration as having a limited effect on their substance use.
Theme 2: Incarceration was perceived to have limited impact on substance use and overdose risk
Some participants described a pattern of entering and exiting correctional facilities over time, with these periods of incarcerations’ having little impact on their drug use and behaviours. One participant (Female, 27, Indigenous) described her criminal justice system experience:
When I was a youth I got into quite a bit of trouble, but I didn’t start going to jail until I was 18. I was constantly in and out. It was because I was wired to heroin and crystal meth, and it led me to do things that normal, sober people don’t do.
Peer analysis emphasized the differences in length of sentencing between provincial and federal institutions, with shorter, cyclical patterns of incarceration appearing more often in provincial institutions.
Another participant (Female, 32, Caucasian) described how although her drug use ceased during incarceration, it had limited longer-term impact upon release:
Well, it cleaned me up. The second I got out, I remember leaving the Chilliwack courthouse, the first stop I went was to a family friend, an older gentleman, he used to be a neighbour when I lived in Abbotsford. I followed and would always bum money off of him. My first stop was him, and my second stop was the dealer’s.
Additionally, several participants noted that—while access was more difficult—the widespread availability of drugs in federal facilities allowed them to continue their use while incarcerated. For instance, one participant (Female, 30, Caucasian) explained:
It was consistent. I had drugs all the time…Well it was less, but still there. I’ve done heroin in jail, but only because I brought it with me, and I had a large amount. Me and my roommate were good to go for a couple months…It’s very easy access.
Another participant (Male, 53, Caucasian) described that although financial barriers exist, drugs were still prevalent in the correctional setting:
It’s there if you can afford it. Probably 5–7 times more expensive than it is on the street. If you can afford it, it’s available, even in prison.
One participant (Male, 27, Caucasian) described his experience that substances were much less readily available in the provincial institution he was incarcerated in:
You can get weed in jail, you can sometimes get smokes in jail, but anything else you it’s really hard to get in. Especially since I was only in provincial jail. If I was to go to federal, I’d probably find anything at anytime.
This was supported by another participant (Male, 31, Indigenous) who described his experience in a federal institution:
I went to federal. There’s a lot of drugs in there. When I got that federal sentence, I was at a point where I hit my bottom.
While participants reported varying access to substances according to institutional policies and individual circumstances, these participants did not have to go through withdrawal and could resume similar substance use patterns on release. While the majority of interview participants reported negative or minimal impacts of incarceration, a small minority of participants reported that incarceration reduced their substance use which decreased their risk of future overdose.
Theme 3: Incarceration was associated with a perceived reduction of substance use and overdose risk
A minority of participants described a perceived reduction of drug use as a result of incarceration. This was mostly related to opportunities for detoxification and/or treatment. For example, one participant (Female, 32, Caucasian) stated:
I really don’t think I wouldn’t have been able to detox if I could have left. The whole detoxing off of drugs was good because I was literally locked in a box. I had gone to detox a couple times before, when I got to that really rough part, I was gone with all my bags.
While forced withdrawal—particularly in provincial facilities—was experienced detrimentally by some participants, the interviews revealed that it can also be experienced as positive, although possibly by fewer people.
Another few participants described the benefit of harm reduction initiatives such as OAT. A perceived difference in access to OAT and harm reduction was identified in federal versus provincial settings:
“I spent my whole time in prison clean. I got onto methadone…When I got in there. They put me on suboxone till they put me on methadone…It did help me. The federal system, they have really good programming. While as the provincial system, they don’t really have programming… I’ve spent lots of time in provincial…It used to be easy to get on suboxone and methadone and all that stuff. I feel now it’s harder.” - Male, 31, Indigenous
Perceptions of how incarceration influences substance use and risk of overdose varied and at times conflicted; uniformly, however, the differences in policies and environments between correctional institutions played a definitive role.