Ontario inmates at 'extremely high risk' of death from opioids, Hamilton doctor tells inquest

Incarcerated individuals in Ontario are about 30 times more likely to die of opioid toxicity than people who aren't imprisoned, an emergency room doctor and researcher told the coroner's inquest into six drug-related deaths at the Hamilton-Wentworth Detention Centre. 

Pointing to a study she helped conduct, Dr. Claire Bodkin told the inquest that between 2015 and 2020, 8,460 people in Ontario died from opioid toxicity. About 26 per cent of them were incarcerated at some point during that period.

"That was certainly higher than I expected," Bodkin said, and shows people in provincial jails are at "extremely high risk" of an opioid-related death. 

Bodkin, also a part-time professor, works with organizations including McMaster University, Hamilton Health Sciences and the Hamilton Social Medicine Response Team. She's among about 15 witnesses who were set to testify before the inquest, which began Monday and is examining the deaths of Jason Archer, Paul Debien, Nathaniel Golden, Igor Petrovic, Christopher Johnny Sharp and Robert Soberal.

"Prison health is public health," Bodkin told the inquest at the start of her testimony.

In provincial jails, where the average stay is two to three months, she said, inmates interact with people in the community. They need to receive support in prison and be set up for success when they're discharged, she added.

Upon request from the coroner's office, Bodkin delivered a presentation on opioid deaths of inmates, the complexities of delivering health care in prisons, treatment for people with addictions and preventing overdoses. 

The inquest is mandatory under Ontario law because the men died while incarcerated. Through examining witnesses, analyzing official records and seeking testimony from experts, the jury seeks to determine how the men died and may make non-binding recommendations to prevent similar deaths.

When someone is incarcerated, Bodkin said, the person should have immediate access to opioid agonist therapy, a medical treatment for people dependent on opioids. She said she's currently not aware of any data on how many people in Ontario jails need that treatment. 

Bodkin said there also needs to be back-end work to ensure people discharged from prison know where to access further treatment and their health-care providers can verify when they had their last dose of medication. 

Providing that continuity is "a big challenge," she said, adding that while she knows to call the jail health-care team to verify patients' past treatment, not every doctor does.

Bodkin noted her research shows the risk of death from opioid toxicity is notably high for people released from prison. The study looking at 2015 to 2020 found about 11 per cent of individuals who experienced incarceration and died from opioid toxicity died within two weeks of release.

Early in the week, the jury heard the six men at the centre of the inquest received varying forms of health care, much of it related to drug addiction.

Bodkin said prisoners also have high rates of chronic diseases, childhood trauma and brain injuries, which should all factor into the care they receive.