Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017

Research Report

SR-18-02

January 2019

PDF

Laura McKendy
Stephanie Biro
&
Leslie Anne Keown
Correctional Service of Canada

Acknowledgements

Special thanks to Shanna Farrell-MacDonald and Claude Girouard for assistance with data pulls, An-Tâm Tremblay, Harold Boudreau, Jonathan Smith, Alka Bhalla, Teresa Merserau, Kimberley Gibner, Terri Scott, Olivia Varsaneux, Maria Hill and Ashley Vachon for subject matter expertise, assistance and editorial support, and Chloe Pedneault, Claudia Sosa and Tara Beauchamp for data coding and research support.

Executive Summary

Key words: prison overdoses; substance misuse; prison drug use; deaths in custody; offender health; opioids

The rise of drug overdose incidents, specifically those involving opioids, is a growing concern for Canadian society (British Columbia Coroners Service Death Review Panel, 2018; Special Advisory Committee on the Epidemic of Opioid Overdoses, 2018; Health Canada, 2017). While numerous reports have documented trends in the community, limited detailed data is available on trends in overdose incidents among custodial populations. This report furthers knowledge on this topic by examining all overdose incidents in federal custody over a five-year period (2012/2013 - 2016/2017), identifying the prevalence and nature of overdose incidents, the circumstances under which overdose incidents occur, the characteristics of offenders who experience overdose incidents, and patterns in the nature of staff and medical responses.

Over the five-year period under examination, 330 incidents were identified for analysis. Most of these overdose incidents were unintentional and non-fatal. More specifically, over three-quarters of cases (77%) were identified as unintentional non-fatal overdose incidents, 15% were intentional non-fatal overdose incidents, and 7% were identified as fatal overdose incidents, either intentional or non-intentional. Overdose incidents have seen a notable increase in the Prairie region; in 2016/2017, 48% (42) of all overdose incidents occurred in this region, compared to 20% (8) in 2012/2013.

In terms of the substances involved in overdose incidents, differences were observed across incident types. Opioids were most common in fatal overdoses and unintentional non-fatal overdose incidents, accounting for 91% and 57% of incidents respectively. Contrastingly, intentional non-fatal overdose incidents seldom involved opioids and most often involved prescription medications (e.g., anticonvulsants, antidepressants, cardiovascular medications), identified in 85% of cases.

Over the five-year period examined, overdose incidents involving opioids increased in raw numbers (from 19 in 2012/2013 to 50 in 2016/2017), with a moderate increase as a percentage of all overdose incidents (from 48% to 57%). Notably, the percentage of those involving fentanyl increased from 3% (1) in 2012/2013, to 26% (23) in 2016/2017. At the same time, the percentage of overdose incidents involving heroin decreased from 25% (10) in 2012/2013, to 13% (11) in 2016/2017. When it came to fatal overdose incidents, fentanyl was the most common substance found, noted in 36% (8) of cases across the five-year period.

While variation exists, certain characteristics were common among offenders who overdosed. They tended to be male (92%), Caucasian (58%) or Indigenous (36%), aged 25-34 (39%), classified as medium security (72%), serving relatively short (under 4 year) sentences (41%), with a major index offence of robbery (31%). Offenders typically had institutional histories riddled with security and discipline incidents, particularly incidents involving drugs, other contraband (excluding tobacco), and disobedience.

Indigenous offenders were involved in 119 (36%) of overdose incidents over the five-year period examined. Indigenous representation was highest in the Pacific region (46%) and was higher among women (52%) relative to men (35%). Overdose incidents involving Indigenous offenders were somewhat less likely to involve opioids compared to incidents involving non-Indigenous offenders (45% versus 56%).

Over the five-year period examined, 21 overdose incidents occurred involving women; all were non-fatal and most (71%) were unintentional. Overdose incidents involving women typically involved prescription medications (86%), while none involved opioids. Overdose incidents involving women were most common in the Ontario and Pacific regions; nine incidents (43% of all cases) occurred in both of these regions. All women involved in overdose incidents had an identified mental health disorder, while 95% (20) had histories of substance abuse.

Overall, overdose incidents tended to occur when offenders were well into their sentence. At the time of incident, offenders had served, on average, 41% of their current sentence, or an average of 4.9 years. The average length of time between the most recent admission date and incident date was 3.2 years. However, variation was observed across incident type; those involved in fatal incidents had served more time (7.8 years) and had been out of the community longer (4.5 years) compared to those involved in non-fatal incidents.

In terms of potential risk factors, offenders involved in overdose incidents often had histories of substance misuse and mental illness. More specifically, 95% of offenders had issues related to drugs, while 54% had issues with alcohol. In 81% of cases, substance misuse was identified as a factor linked to criminal offending. Mental illness was particularly common among those involved in intentional non-fatal overdose incidents; 92% had at least one mental health disorder identified, while 89% had histories of self-injurious/suicidal behaviour.

A disproportionate number of incidents occurred at a single medium security men’s institution in the Prairie region, Drumheller Institution. An institutional-level analysis suggests that the experience of Drumheller is more closely tied to the opioid crisis in the community; over three-quarters (77%) of overdose incidents at Drumheller Institution involved opioids, compared to 47% at all other institutions. Fentanyl was identified in 34% of overdose incidents at Drumheller, compared to 8% at all other institutions. Overall, the number of overdose incidents at Drumheller increased from five incidents in 2012/2013, to 25 in 2016/2017. Despite a higher number of overdose incidents, Drumheller had a smaller percentage of deaths (i.e. 2%) and much higher usage of naloxone. The medication, which can temporarily reverse an opioid overdose, was used in 91% of cases at Drumheller, compared to 34% at all other institutions.

The findings outlined in this report suggest that the community opioid crisis may be paralleled in custodial settings. As this crisis continues to affect the federal offender population, CSC remains committed to efforts to curb prison drug use and reduce the likelihood of overdose incidents. The widespread availability of naloxone in institutions, as well as CSC’s take-home naloxone kit program, Opioid Substitution Treatment (OST) program, substance misuse programs, and the Prison Needle Exchange Program (PNEP), constitute efforts to reduce the potential harms associated with drug use and improve offender health outcomes. This report will further assist in CSC’s goal of achieving safe custodial environments by contributing to knowledge on recent trends surrounding fatal and non-fatal drug overdose incidents in custody.

Introduction

Since 2016, Canada has been in the midst of an opioid crisis. In 2016, there were over 2,800 suspected opioid-related deaths reported in Canada (Health Canada, 2017). In 2017, nearly 4,000 opioid-related deaths were reported in the country, most of which were accidental (Special Advisory Committee on the Epidemic of Opioid Overdoses, 2018). Fentanyl, a substance 50 to 100 times the potency of morphine, is becoming more prominent as a substance in opioid-related deaths, accounting for 55% of such deaths in 2016, up to 72% in 2017. In many cases, fentanyl is hidden in other substances and is unknowingly consumed by drug users (Health Canada, 2017).

Given the connection between substance misuse and criminal offending (Hopley & Brunelle, 2016; Weekes, Thomas, & Graves, 2004), the impact of the opioid crisis may be particularly pronounced among persons involved with the criminal justice system (British Columbia Coroners Service Death Review Panel, 2018). Despite preventive measures (e.g., drug detection technology and drug detector dogs) and deterrent strategies (e.g., random urinalysis testing), illicit substances do make their way into Canadian prisons (Hopley & Brunelle, 2016; van der Meulen, 2017), a dangerous consequence being incidents of overdose.

Limited research has been conducted on the topic of overdose incidents in custodial settings. Researchers have, however, explored substance use patterns in different prison contexts. While some contradictory findings have been produced Footnote 1, certain factors have been linked to prison drug use. These include: history of drug use (Rowell et al., 2012; Borrill et al., 2003; Baltieri, 2014; Sánchez, Fearn, & Vaughn 2017); age (Rowell-Cunsolo et al., 2016; Baltieri, 2014; Sánchez, Fearn, & Vaughn 2017; Lukasiewicz, 2007); history of prison misconduct (Conner & Tewksbury, 2016; Lukasiewicz, 2007); marital status (Conner & Tewksbury, 2016; Lukasiewicz et al., 2007); history of alcohol use (Borrill et al., 2003); sentence length (Rowell et al., 2012; Andía et al., 2005); length of time served/incarcerated (Health Protection and Research Organization, 2011; Rowell-Cunsolo et al., 2016); race (Borrill et al., 2003); level of education (Borrill et al., 2003; Lukasiewicz, 2007); criminal history (Baltieri, 2014; Lukasiewicz, 2007); history of experiencing/witnessing violence (Borrill et al., 2003); history of unemployment (Borrill et al., 2003); psychotic symptoms (Borrill et al., 2003); separation from parent during childhood (Lukasiewicz, 2007); and gang affiliation (Andía et al., 2005). In terms of motivations for prison drug use, some researchers have found that drugs are consumed to pass the time (Cope, 2003; Gillespie, 2005; Baker, 2015) and to cope with stress (Wheatley, 2007). Of course, many offenders come to correctional facilities with pre-existing substance misuse issues (Weekes, Thomas, & Graves, 2004).

Researchers have also examined overdose incidents following release from custody, during which time offenders are said to be at a heightened risk of drug overdose (Binswanger et al., 2012; Merrall et al., 2010; Krinsky et al., 2009). In the Canadian context, Kinner and colleagues (2012) explored the risk factors associated with non-fatal overdose incidents among recently incarcerated substance users. They found the following variables to be associated with non-fatal overdose incidents: daily use of substances including heroin, benzodiazepines, cocaine and methamphetamine, "binge" drug use, public injection drug use, and a history of non-fatal overdose. They also identified protective factors against non-fatal overdose incidents; these included older age, receipt of methadone treatment, and HIV seropositivity. Other variables that have been linked to overdose incidents among released offenders include: length of incarceration (Winter et al., 2015; Bukten et al., 2017; Binswanger et al., 2011); age (Binswanger et al., 2007); history of unemployment (Winter et al., 2015); history of homelessness (Lim et al., 2012); family history (Winter et al., 2015); drug use history (Winter et al., 2015) and mental health history (Winter et al., 2015).

While minimal research has been conducted on overdose incidents in custody, some exceptions exist. In the American context, Fuh and colleagues (2016) examined overdose incidents requiring outside hospital care in the state of Ohio. Over the three-year period examined, they found that overdose incidents tended to be intentional rather than accidental and most often involved prescription medications, including anticonvulsants (e.g. Phenytoin, Carbamazepine, Divalproex), antidepressants (e.g. Sertraline, Amitriptyline), and cardiovascular medications (e.g. Metoprolol, Lisinopril, Hydrochlorothiazide).

In the Canadian context, initial research conducted by CSC (Weekes & De Moor, 2015) on investigated fatal and non-fatal overdose incidents among federally-incarcerated men between 2011/2012 and 2013/2014 found that opiates, including prescription medications, accounted for over half of incidents, while a mixture of substances was present in a quarter of cases.

CSC has also released findings on fatal drug overdose incidents in the context of its Annual Report on Deaths in Custody. As the 2015/2016 Annual Report (Correctional Service of Canada, 2017) notes, overdose deaths in custody have increased as a proportion of non-natural deaths. The report also notes that fentanyl has become more common in overdose deaths in custody; between 2014/2015 and 2015/2016, fentanyl was identified as a standalone or contributing substance in 69% (9) of fatal overdose incidents. These findings suggest that the community opioid crisis may be paralleled in institutional settings.

The current project seeks to further knowledge on overdose incidents in federal custody. To this end, all fatal and non-fatal overdose incidents between 2012/2013 and 2016/2017 with sufficient information were analyzed, with the goal of identifying the prevalence and nature of overdose incidents, the characteristics of offenders who experience overdoses, the circumstances under which overdose incidents occur, and patterns in the nature of staff and medical responses.

Methodology

For this report, all fatal and non-fatal overdose incidents that occurred between 2012/2013 to 2016/2017 with sufficient information for analysis were included. An overdose was defined as an incident where the consumption of drugs necessitated medical intervention to prevent death and/or serious injury (e.g., administration of naloxone, cardiopulmonary resuscitation, or other type of medical intervention by institutional staff, paramedics, or outside medical personnel)Footnote 2. The purpose of this research is to better understand the nature and scope of overdose incidents, the circumstances surrounding overdose incidents, the profile of offenders involved in fatal and non-fatal overdose incidents, and institutional and medical responses to overdose incidents.

A multi-step approach was taken to identify incidents for inclusion. First, all overdose incidents that were investigated in a Board of Investigation or Local Investigation were identified and included. As per the Corrections and Conditional Release ActFootnote 3, incidents resulting in serious bodily injury are subject to investigation by the Service. To expand the scope of cases beyond those subject to a formal investigation so as to develop a fuller picture of the issue, a data extraction of CSC’s offender database, the Offender Management System (OMS), was conducted to identify all incidents that could be overdose-related. Incident reports labelled as "overdose interrupted", "suspected overdose interrupted", "suicide attempt", "medical emergency", "under the influence" and "other" were extracted and manually screened to identify cases for inclusion.Footnote 4 All cases that met the above-noted definition of an overdose incident were included.

A coding sheet was developed using the insights of previous studies and based on the availability of information relating to the incidents under examination. The data coded relates to: (1) information about the overdose incident (e.g. institution, date, time, suspected and confirmed substances involved, how the substance was obtained, seizure of items, nature of medical intervention, possible precipitating factors and, where applicable, compliance issues and recommendations identified in investigations); and (2) characteristics of the offenders involved in overdose incidents (e.g. age, gender, ethnicity, level of education, previous experience of incarceration, index offence, sentence length, time served at time of incident, security level, criminal history, institutional history, as well as substance abuse, mental health, and physical health histories).

Cases were identified as one of four sub-types of overdose incidents. Unintentional non-fatal overdose incidents were those that did not result in death and no indicators of suicidal intent were present. Intentional non-fatal overdose incidents were those that did not result in death, but an indication of suicidal intent was present (such as a suicide note).Footnote 5 Fatal overdoses were those that resulted in death and may have been intentional or unintentional.Footnote 6 Other types of overdose incidents were those that did not fall in the above three categories, such as accidental overdose caused by an error on the part of healthcare staff (e.g. incorrect medication dosage). While analysis across incident types is presented throughout this report, corresponding tables have not been included due to the possibility of identifying information given low numbers in the "fatal" and "other" categories.

Substances identified in this report include those that were confirmed or suspected in incidents. Confirmed substances were those that were identified in laboratory tests using bodily samples from the offender. Suspected substances were those identified: (1) through tests taken from substances seized from the offender’s cell; (2) in statements provided by the offender involved in the incident and/or; (3) through intelligence-gathering by staff. In 65% of cases, a confirmed substance was not identified in reports, therefore, the suspected substance is noted in a majority of cases. It is important to note that information on suspected substances is not always reliable for various reasons. For example, substances seized from the offender’s cell may not have been the substance consumed by the offender, and offender statements and intelligence information may be inaccurate. The significant reliance on suspected substances in this study raises possible data reliability issues when it comes to substance identification. An area for improvement would lie in establishing new procedures that allow for laboratory testing of drug or bodily samples following overdose incidents.

A total of 330 cases were identified for analysis. Data were collected for each unique offender incidentFootnote 7 using information from investigations, incident reports, and OMS. Cases were entered into survey software and subsequently exported into statistical software (SPSS) for analysis. Frequency distributions were run to determine the variables containing enough information for analysis; further statistical analysis was conducted where appropriate.

Results

Overview of overdose incidents in federal custody, 2012/2013 - 2016/2017

Between 2012/2013 and 2016/2017, 330 overdose incidents were identified for analysis. During this time period, the number of overdose incidents increased from 40 in 2012/2013, to 88 in 2016/2017 (see Table 1). The most common type of incident was unintentional non-fatal overdose, accounting for 77% (254) of cases. Intentional non-fatal overdose incidents accounted for 48 (15%) of cases, while fatal overdoses accounted for 7% (22) of cases. The highest number of fatal overdose incidents occurred in 2015/2016, when seven deaths occurred.

Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017

Figure 1. Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Figure 1. Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017
Incident Type Fiscal Year
2012/2013 2013/2014 2014/2015 2015/2016 2016/2017
Unintentional non-fatal overdose 29 36 60 60 69
Intentional non-fatal overdose 8 7 9 11 13
Fatal overdose 3 2 6 7 4
Other 0 3 0 1 2
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

There was variation across fiscal years in terms of regional differences; overall, however, overdose incidents were most frequent in the Prairie region, where 30% (98) of all incidents occurred, and the Ontario and Pacific regions, whegre 28% (92) and 26% (87) of incidents occurred respectively (see Table 2). Overdose incidents have seen a notable increase in the Prairie region; in 2016/2017, 48% (42) of all incidents in this fiscal year occurred in this region, compared to 20% (8) in 2012/2013 (see Table 3). Drumheller Institution, a medium security men’s institution in the Prairie region, had the highest number of overdose incidents, with 53 cases over the five-year period (see Special Topic on page 23). Ontario had the highest number of fatal overdose incidents. However, as a percentage of all overdose incidents, overdose deaths were most common in the Quebec region (18%). Collins Bay Institution, a men’s multilevel facility in the Ontario region, had the most deaths per institution both in terms of raw numbers (5) and as a percentage of all overdose incidents at the institution (23%).

Overdose Incidents in Federal Custody 2012/2013 - 2016/2017 by Region

Figure 2. Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017 by Region

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Figure 2. Overdose Incidents in Federal Custody, 2012/2013 - 2016/2017 by Region
Incident Type Region
Atlantic Quebec Ontario Prairie Pacific
Unintentional non-fatal overdose 12 18 64 85 75
Intentional non-fatal overdose 6 10 18 7 7
Fatal overdose 1 6 9 4 2
Other 0 0 1 2 3
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.


Federal Institutions with 15 or more Overdose Incidents between 2012/2013 and 2016/2017

Figure 3. Federal Institutions with 15 or more Overdose Incidents, 2012/2013 - 2016/2017

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Figure 3. Federal Institutions with 15 or more Overdose Incidents, 2012/2013 - 2016/2017
Incident Type Federal Institution
Bowden Institution Collins Bay Institution Drumheller Institution Mission Institution Mountain Institution Warkworth Institution
Unintentional non-fatal overdose 11 17 51 15 21 11
Intentional non-fatal overdose 2 0 1 0 3 2
Fatal overdose 1 5 1 2 0 2
Other 1 0 0 0 0 1
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Incident details of overdose incidents in federal custody, 2012/2013 - 2016/2017

In the five-year period under examination, opioids were the most common substance identified in overdose incidents, suspected or confirmed as either a standalone or a contributing substance in 52% of cases (see Table 4). The most common substances Footnote 8 confirmed or suspected in overdose incidents were heroin (15%), fentanyl (12%) and methadone (11%). Prescription medicationsFootnote 9 (e.g., antidepressants, anticonvulsants and cardiovascular medications) were the second most common type of substance involved in overdose incidents, suspected or confirmed in 39% of cases. Examples of suspected or confirmed medications involved in overdose incidents include Hydrochlorothiazide (19), Carbamazepine (19), Gabapentin (16) and Amitriptyline (13). Stimulants (e.g., cocaine, amphetamines, methamphetamines, ecstasy) were suspected or confirmed in 11% of cases.

What are opioids?

When medically prescribed, opioids are intended to treat pain. When abused, opioids are a dangerous substance.

In 2017, there were 3,987 opioid-related deaths in Canada*

Opioids include substances such codeine, fentanyl, heroin, morphine, oxycodone, hydromorphone and methadone.

*Source: Public Health Agency of Canada (2017)

Over the five-year period, the most common substances involved in overdose incidents underwent change (see Table 4). Overdose incidents involving opioids increased in raw numbers (from 19 in 2012/2013 to 50 in 2016/2017), with a moderate increase as a percentage of all overdose incidents (from 48% to 57%). The percentage of those involving fentanyl increased from 3% (1) in 2012/2013, to 26% (23) in 2016/2017. At the same time, the percentage of overdose incidents involving heroin decreased from 25% (10) in 2012/2013, to 13% (11) in 2016/2017. Overdose incidents involving prescription medications increased in raw numbers but decreased as a percentage of all overdoses, from 50% (20) in 2012/2013 to 31% (27) in 2016/2017.

Opioids were most commonly involved in fatal overdose incidents, identified in 91% (20) of cases, followed by unintentional non-fatal overdose incidents (57%). However, non-fatal intentional overdose incidents seldom involved opioids; rather, prescription medications were most common, identified in 85% of cases (compared to 32% of unintentional non-fatal overdose incidents and 27% of overdose death incidents). Examples of substances involved in intentional non-fatal overdose incidents include Acetaminophen (Tylenol) (11%), Amitriptyline (11%), and insulin (11%).

Most (79%) overdose incidents occurred in the offender’s cell, with 13% occurring in an administrative segregation unit cell (see Table 4). Offenders were typically discovered by staff members. There was considerable variation as to when overdose incidents occurred; however, incidents were most common on Thursdays (when around 20% of overdose incidents occurred), in the month of June (14%), and in the afternoon periodFootnote 10 (33%). Fatal overdose incidents were considerably more likely than non-fatal incidents to occur in the middle of the nightFootnote 11 (i.e. 27% versus 6%).

Substances Involved in Overdose Incidents*

Figure 4. Substances Involved in Overdose Incidents

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

*Substances identified include those that were confirmed through laboratory test results from samples taken from the offender or substances otherwise suspected (e.g. based on tests of seized substances, offender statements and/or intelligence information).

Figure 4. Substances Involved in Overdose Incidents
Incident Type Substances Involved (%)*
Opioid
(e.g. heroin, fentanyl, methadone, morphine, oxycodone, codeine, hydrocodone)
Stimulant
(e.g. cocaine, crack cocaine, amphetamine, methamphetamine, ecstasy)
Other prescription medications
(e.g. anticonvulsants, psychotropics, cardiovascular, medications)
Other
(e.g. depressants hallucinogens, synthetic cannabinoids)
Unintentional non-fatal overdose 57 12 32 12
Intentional non-fatal overdose 4 6 85 2
Fatal overdose 91 14 27 5

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

*Substances identified include those that were confirmed through laboratory test results from samples taken from the offender or substances otherwise suspected (e.g. based on tests of seized substances, offender statements and/or intelligence information)

Opioids were involved in 50% of non-fatal overdose incidents and 91% of fatal overdoses.

This image depicts Carfentanil (seized at Grande Cache Institution).
Source: Preventive Security and Intelligence Division, CSC.

Image 1. Carfentanil (seized at Grande Cache Institution).

Source: Preventive Security and Intelligence Division, CSC.

In terms of the medical response, cardiopulmonary resuscitation (CPR) was provided in 17% of cases, an automated external defibrillator (AED) was employed in 12% of cases, and naloxone was given in 43% of cases (see Tables 6 and 7). Naloxone was most often administered by CSC medical personnel only (45%). In a majority of cases, an ambulance was called (86%) and external medical attention at a hospital was provided (91%). Internal medical attention provided by institutional healthcare staff was provided in 60% of cases. In terms of measures taken following the incident, 26% of offenders were transferred to another institution, 12% had a change to their offender security level (OSL), and 32% received institutional charges.

Use of Naloxone in Overdose Incidents by Fiscal Year

Figure 5. Use of Naloxone in Overdose Incidents by Fiscal Year

Figure 5. Use of Naloxone in Overdose Incidents by Fiscal Year
Use of Naloxone
Fiscal Year 2012/2013 18
Fiscal Year 2013/2014 25
Fiscal Year 2014/2015 28
Fiscal Year 2015/2016 23
Fiscal Year 2016/2017 49

This image depicts Narcan™ nasal spray (demonstration model).

Image 2. Narcan™ nasal spray (demonstration model)

Naloxone use in CSC

Naloxone is a harm reduction intervention used for the prevention of opioid overdose deaths and is a standard of care for temporarily reversing opioid overdoses. The intent of managing an opioid emergency with naloxone is to move the continuum of care forward prior to the arrival of emergency medical services. Previously, naloxone was only accessible by CSC medical staff in the form of injectable naloxone. In fall of 2016, CSC acquired the nasal spray version of naloxone (Narcan™) to be stored in the Correctional Manager’s office for use by correctional officers. Narcan™ nasal spray is also now available for use by nurses in addition to the injectable version.

Special Topic: The opioid crisis in federal institutions

Opioid Overdoses Incidents in Federal Custody*

Figure 6. Opioid Overdose Incidents in Federal Custody

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

*Substances identified include those that were confirmed through laboratory test results from samples taken from the offender or substances otherwise suspected (e.g. based on tests of seized substances, offender statements and/or intelligence information).

Figure 6. Opioid Overdose Incidents in Federal Custody
Opioid Type Fiscal Year
2012/2013 2013/2014 2014/2015 2015/2016 2016/2017
Fentanyl 1 3 1 12 23
Heroin 10 12 0 15 11
Methadone 5 9 0 10 12
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes. *Substances identified include those that were confirmed through laboratory test results from samples taken from the offender or substances otherwise suspected (e.g. based on tests of seized substances, offender statements and/or intelligence information).


This image depicts Heroin mixed with fentanyl (seized at Drumheller Institution). 
Source: Preventive Security and Intelligence Division, CSC.

Image 3. Heroin mixed with fentanyl (seized at Drumheller Institution).

Source: Preventive Security and Intelligence Division, CSC.

Compliance issues and recommendations outlined in investigations of overdose incidents in federal custody, 2012/2013 - 2016/2017

Institutional and staff compliance issuesFootnote 12 related to overdose incidents were analyzed for cases with a completed formal investigation, which represented 40% (132) of cases. The most common compliance issue in relation to overdose incidents related to documentation and reporting (e.g. completion of necessary forms), noted in 58% of cases that had an investigation. Other compliance issues related to security patrols (e.g., timing and quality), staff response to the overdose emergency, and searches (before or following the incident). Overdose deaths had the highest number of compliance issues; common issues of non-compliance related to documentation and reporting protocol (noted in 64% of cases), searches (noted in 23% of cases), staff response (noted in 46% of cases), security patrols/checks (noted in 59% of cases), availability and/or use of proper equipment (noted in 27% of cases), and management of evidence and/or incident scene (noted in 18% of cases). Recommendations outlined in investigations were also most common in relation to incidents involving death; the most common recommendation related to security policies and procedures (noted in 32% of cases).

Compliance Issues Identified in Investigations

Figure 7. Compliance Issues Identified in Investigations

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Figure 7. Compliance Issues Identified in Investigations
Compliance Issues Identified in Investigations
Support to offenders 2
Staff levels 2
Nursing spot checks 3
Aboriginal Social History not properly considered 6
Support to staff 6
Management of evidence/crime scene 8
Communication between staff and/or agencies 10
Urine screens 10
Staff certifications 12
Drug interdiction/management strategy 13
Offender not charged 16
Equipment (availability or proper use) 16
Medication practices by health services 17
Searches 30
Staff response to incident 33
Security patrols 34
Documentation/Reporting 77
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Profile of offenders involved in overdose incidents in federal custody, 2012/2013 - 2016/2017

Profile of Offenders Involved in Overdose Incidents

Unintentional non-fatal incidents

  • Average age = 35
  • 93% male
  • 73% medium security offenders
  • Most common index offence: robbery
  • Served an average of 4.7 years (43% of their sentence)

Intentional non-fatal incidents

  • Average age = 38
  • 85% male
  • 60% medium security offenders
  • Most common index offence: homicide
  • Served an average of 5.1 years (35% of their sentence)

Fatal incidents

  • Average age = 39
  • 100% male
  • 73% medium security offenders
  • Most common index offence: robbery
  • Served an average 7.8 years (46% of their sentence)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Incarcerated offenders involved in overdose incidents tended to be male (92%), Caucasian (58%) or Indigenous (36%), aged 25-34 (39%), serving relatively short (under 4 year) sentences (41%) for robbery (31%; see Tables 12-15). A majority of offenders (60%) had less than a high school education. Offenders tended to be classified as medium security (72%) with scores of low on institutional adjustment (64%) and medium on security riskFootnote 13 (67%). Slightly more than half (54%) of offenders were serving their first federal sentence.

In terms of regional variation, incarcerated offenders involved in overdose incidents were youngest in the Prairie region, with an average age of 31, and oldest in the Quebec region, with an average age of 42. Indigenous representation was highest in the Pacific region (46%) and lowest in the Quebec region (18%).

Offenders who overdosed in custody had served an average of 4.9 years at the time of the incident. However, those involved in fatal incidents had served more time compared to those involved in non-fatal incidents. More specifically, the average length of time served was 4.7 years for offenders involved in unintentional non-fatal overdose incidents, 5.1 years for those involved in intentional non-fatal overdose incidents, and 7.8 years for those who died by overdose. Regional variation was also evident; those in the Pacific region had served, on average, the most time (7.6 years) at the time of the incident, while those in the Prairie region had served the least amount of time (2.9 years; see Table 15).

The length of time between the offender’s most recent admission dateFootnote 14 and the overdose incident was an average of 3.2 years. However, those involved in fatal overdose incidents had been in custody longer (i.e. an average of 4.5 years, compared to 4.2 years for intentional non-fatal overdose incidents and 3 years for unintentional non-fatal overdose incidents). Comparing across regions, those in the Prairie region overdosed sooner following admission, with an average of 1.5 years between the most recent admission date and incident date, followed by those in Ontario (2.5 years), and those in the Atlantic region (3.8 years; see Table 15). For offenders in the Quebec and Pacific regions, there was an average of 5.3 and 5 years respectively in between the most recent date of admission and the incident date. Overall, offenders involved in overdose incidents had served on average 41% of their total sentenceFootnote 15 .

Criminal profile of offenders involved in overdose incidents in federal custody, 2012/2013 - 2016/2017

In terms of the criminal profile of incarcerated offenders involved in overdose incidents in federal custody, just under quarter (23%) had affiliations with Security Threat Groups (STGs), 69% had been in trouble with the law as a youth offender, while 87% had previous adult criminal histories prior to their index offence(s) (see Table 16). In relation to drug offending, 22% were currently serving time for at least one drug-related offence, while 46% had previous drug-related convictions. For 81% of offenders involved in an overdose incident, substance misuse was identified as a factor linked to criminal offending.

Substance misuse was most often identified as a criminogenic factor among offenders involved in unintentional overdose interrupted incidents (84%) compared to those involved in intentional non-fatal overdose incidents (68%) and overdose deaths (68%). Across regions, a link between substance misuse and criminal offending was most prevalent among offenders in the Prairie region, identified in 89% of cases, and least common among those in the Quebec region, identified in 53% of cases (see Table 17).

Institutional history of offenders involved in overdose incidents in federal custody, 2012/2013 - 2016/2017

Drug tests in year prior to incident

21% of offenders tested positive for illicit substances.

Of these:

  • 40% tested positive for opioids
  • 41% tested positive for stimulants
  • 50% tested positive for cannabis

The institutional histories of offenders prior to the overdose incident were examined. In general, most offenders had completed institutional programming (84%) and had previously been institutionally employed (88%; see Table 18). However, offenders often had histories of institutional security and/or disciplinary issues, including incidents related to drugsFootnote 16 (71%), other contrabandFootnote 17(77%), disobedienceFootnote 18 (63%), as well as compatibility issues with other inmates (76%) and staff (56%), while the vast majority (83%) of offenders had histories of administrative segregation. In 21% of cases, the offender had tested positive for illicit substancesFootnote 19 in the year prior to the incident, while in 18% of cases, the offender had refused a urinalysis test. In cases of positive drug test results, common substances identified included cannabis, stimulants and opioids.

Those involved in overdose deaths were more likely to have institutional incidents relating to drugs (86%), other contraband (91%), and disobedience (82%), while those involved in intentional non-fatal overdose incidents were more likely to have faced issues with other inmates (85%) and have been suspended from work or programming (53%). Positive urinalysis tests and urinalysis test refusals were more common among offenders involved in unintentional non-fatal overdose incidents (26% and 21% respectively), and least common among those involved in non-fatal intentional incidents (2% in both cases).

Offender Institutional Incidents Prior to Overdose

Figure 8. Offender Institutional Incidents Prior to Overdose

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

*Drug-related issues include drug possession, consumption and distribution.

**Other contraband refers to possession of non-authorized items excluding drugs, such as brew (prison-made alcohol) and weapons.

Figure 8. Offender Institutional Incidents Prior to Overdose
Institutional Incidents Prior to Overdose Incident Type
Fatal Intentional non-fatal Unintentional non-fatal
Positive urinalysis test (in year prior) 14% 2% 26%
Cause disturbance 18% 9% 15%
Unlawfully at large/Escape 23% 13% 34%
Refusal to attend work/Programming 23% 17% 9%
Jeopardize security 32% 21% 17%
Suspension from work/programming 32% 53% 47%
Property-related 41% 40% 30%
Tobacco 41% 36% 29%
Issues with staff 55% 60% 56%
Issues with inmates 68% 85% 75%
Disobey order/rule 82% 55% 63%
Drugs* 86% 40% 75%
Other contraband** 91% 57% 80%

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

*Drug-related issues include drug possession, consumption and distribution.

**Other contraband refers to possession of non-authorized items excluding drugs, such as brew (prison-made alcohol) and weapons.

Special Topic: Overdose incidents at women’s institutions

Mental health information of offenders involved in overdose incidents in federal custody, 2012/2013 - 2016/2017

Of offenders involved in intentional overdose incidents:

92% had at least one mental health disorder
89% had a history of self-injurious/suicidal behaviour

The majority of incarcerated offenders (70%) involved in overdose incidents in custody had at least one mental health condition identified, with the most common types being mood disorders (40%) followed by anxiety disorders (31%) and neurocognitive/neurodevelopmental conditions (30%; see Table 19). Nearly half (46%) of offenders involved in overdose incidents had previously engaged in self-injurious/suicidal behaviours. The vast majority (97%) of offenders involved in overdose incidents had histories of substance misuse; 95% with drugs and 54% with alcohol.

Offenders involved in intentional non-fatal overdose incidents were considerably more likely to have at least one mental health disorder (92%) relative to those involved in unintentional non-fatal overdose incidents (67%) and overdose deaths (55%). Likewise, a history of self-injurious/suicidal behaviour was more prevalent among offenders involved in intentional non-fatal overdose incidents, noted in 89% of cases, relative to those involved in unintentional non-fatal overdose incidents (40%) and overdose deaths (32%). In terms of regional differences, those in the Quebec and Atlantic regions were the most likely to have histories of self-injurious/suicidal behaviour, with 68% of offenders in both regions having such histories identified, while those in the Prairie region were the least likely to have such histories (37%).

Special Topic: Overdose incidents among Indigenous offenders

  • Between 2012/2013 and 2016/2017, there were 119 overdose incidents involving Indigenous offenders, accounting for 36% of all overdose incidents.
  • Indigenous representation was highest in the category of unintentional non-fatal overdose (40%).
  • Indigenous representation was greatest in the Pacific region (46%).
  • Indigenous offenders were somewhat more likely than non-Indigenous offenders to have at least one mental health disorder (75% versus 67%).
  • Indigenous offenders were less likely than non-Indigenous offenders to overdose on opioids (45% versus 56%).
  • Overdose incidents involving Indigenous offenders were less likely to be classified as involving serious bodily injury compared to incidents involving non-Indigenous offenders (35% versus 48%).

Overdose Incidents by Indigenous Status

Figure 9. Overdose Incidents Involving Indigenous and Non-Indigenous Offenders

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Figure 9. Overdose Incidents Involving Indigenous and Non-Indigenous Offenders
Region Indigenous Status
Indigenous Non-Indigenous
Atlantic 4 15
Quebec 6 28
Ontario 33 59
Prairie 36 62
Pacific 40 47
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes.

Special Topic: Overdose incidents at Drumheller Institution

  • Between 2012/2013 and 2016/2017, 53 overdose incidents occurred at Drumheller Institution, a men’s medium security institution in the Prairie region.
  • Most overdose incidents at Drumheller were non-fatal and unintentional; 96% of incidents fell under this category, compared to 73% of incidents at all other institutions.
  • The majority of overdose incidents at Drumheller involved opioids (77%), significantly higher than at all other institutions (47%).
  • Fentanyl was suspected or confirmed in 34% of overdose incidents at Drumheller, compared to 8% at all other institutions.
  • Stimulants were identified in 21% of overdose incidents at Drumheller, compared to 9% at all other institutions.
  • Overdose incidents involving prescription medications were identified in only 4% of cases at Drumheller, much lower than at all other institutions (46%).
Special topic : Overdose incidents at Drumheller Institution
Overdose incidents Profile of offenders
96% were non-fatal and unintentional Average age = 30.6
23% occurred in segregation 26% Indigenous
77% involved opioids 40% were serving time for drug-related offences
34% involved fentanyl 40% had positive drug test(s) results in the year prior
23% involved heroin Served an average of 2.9 years (51% of their sentence)
91% involved the use of naloxone 76% were first time federal offenders
This image depicts Fentanyl (seized at Drumheller Institution).
Source: Preventive Security and Intelligence Division, CSC.

Image 4. Fentanyl (seized at Drumheller Institution).

Source: Preventive Security and Intelligence Division, CSC.

Discussion

CSC continues to pursue various measures intended to prevent incidents of overdose in custody. Drug prevention and detection strategies - such as the use of ion scanners, urinalysis testing and drug detection dogs - are a component of curbing prison drug use. Harm reduction measures are also central to improving offender health outcomes; such measures include access to opiate substitution therapy for those with opioid use disorder (Cheverie, MacSwain, Farrell MacDonald, & Johnson 2014), the availability of naloxone to both medical and non-medical staff working in CSC institutions, as well as the availability of correctional programming and support targeting substance misuse (Ternes, Doherty, & Matheson 2014; Doherty, Ternes, & Matheson, 2014; Kunic & Varis, 2009).

Additionally, CSC has implemented a national project to provide offenders leaving custody with take-home naloxone kits to reduce the likelihood of overdose following release, when drug tolerance may be lower due to periods of abstinence while incarcerated. Such kits include two ampoules of naloxone injection (0.4mg/mL), two retractable Vanish Point Syringes, alcohol swabs, two pairs of nitrile gloves, a rescue breathing barrier device, as well as instructions provided by Health Canada outlining how to respond to an overdose and how to use naloxone (Pant & Severn, 2018).

In June 2018, CSC launched a Prison Needle Exchange Program (PNEP) to help reduce the spread of blood-borne infectious diseases. The initial sites selected for the program were Grand Valley Institution for Women in Kitchener, Ontario and Atlantic Institution in Renous, New Brunswick. The program will be rolled out at all federal institutions beginning in January of 2019.

To more quickly and accurately identify the substances involved in potential overdose incidents, CSC’s Preventive Security Intelligence Branch commenced the Critical Drug Analysis Process (CDAP) in July of 2018 in partnership with Health Canada’s Drug Analysis Services (DAS). Previously, no standardized approach was in place for drug testing of seized substances, and results for drug samples could take several months. The CDAP will make use of new technology in forensic drug analysis (nuclear magnetic resonance spectroscopy), document information on both the composition and purity of drug samples, and ensure results are provided to sites within 24 hours of sample submission. Under the CDAP, seized substances that are believed to have caused on overdose or staff exposure are sent to DAS for analysis. In addition to bearing operational utility, the CDAP will help CSC better identify trends and improve data reliability regarding substances involved in overdose incidents and staff exposure.

The findings outlined in this report will help inform subsequent efforts to reduce the likelihood of overdose incidents in custody and improve health outcomes by providing information on the nature and scope of overdose incidents, the profile of offenders involved in overdose incidents, and the circumstances under which overdose incidents occur.

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Appendix -Tables

Table 1
Type of incident by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Incident Type Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
Unintentional Overdose Interrupted 29 36 60 60 69 254 (77%)
Intentional Overdose Interrupted 8 7 9 11 13 48 (15%)
Death 3 2 6 7 4 22 (7%)
Other - 3 - 1 2 6 (2%)
Total 40 48 75 79 88 330 (100%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 2
Type of incident by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Incident Type Region Totals
Atlantic Quebec Ontario Prairie Pacific
Unintentional Overdose Interrupted 12 18 64 85 75 254 (77%)
Intentional Overdose Interrupted 6 10 18 7 7 48 (15%)
Death 1 6 9 4 2 22 (7%)
Other - - 1 2 3 6 (2%)
Total 19 34 92 98 87 330 (100%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 3
Overdose incidents by region and fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Region Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
Atlantic 2 2 6 2 7 19 (6%)
Quebec 5 8 9 5 7 34 (10%)
Ontario 10 14 32 24 12 92 (28%)
Prairie 8 9 19 20 42 98 (30%)
Pacific 15 15 9 28 20 87 (26%)
Total 40 48 75 79 88 330 (100%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 4
Incident details by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Detail Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
Occurred in segregation 8 7 8 7 12 42 (13%)
Location of incident
Cell 37 36 50 65 71 259 (79%)
Other 2 12 19 13 15 61 (19%)
Not specified 1 - 6 1 2 10 (3%)
Time of incident
12:00 AM - 06:00 AM 2 2 6 10 3 23 (7%)
6:01 AM - 12:00 PM 15 17 16 18 27 93 (28%)
12:01 PM - 6:00 PM 13 11 24 31 31 110 (33%)
6:01 PM - 11:59 PM 10 18 29 20 27 104 (32%)
Day of week
Sunday 6 6 10 10 11 43 (13%)
Monday 5 4 9 10 14 42 (13%)
Tuesday 2 9 6 12 5 34 (10%)
Wednesday 7 8 10 16 12 53 (16%)
Thursday 7 11 15 10 23 66 (20%)
Friday 8 5 14 11 12 50 (15%)
Saturday 5 5 11 10 11 42 (13%)
Discovered by (all that apply)
Staff 28 37 50 63 70 248 (75%)
Other offender(s) 11 11 17 10 16 65 (20%)
Not specified 1 1 8 6 4 20 (6%)
Substance involved (all that apply) a
Opioid b 19 25 39 39 50 172 (52%)
Fentanyl 1 3 1 12 23 40 (12%)
Heroin 10 12 - 15 11 48 (15%)
Methadone 5 9 - 10 12 36 (11%)
Stimulant 4 8 5 9 10 36 (11%)
Prescription medication 20 17 31 33 27 128 (39%)
THC 2 4 6 6 5 23 (7%)
Hallucinogen - - - 1 - 1 (<1%)
Depressant - 3 1 - 4 8 (2%)
Unsure 2 3 6 10 13 34 (10%)
Source of substance (all that apply)
Own medication 14 8 16 21 13 72 (22%)
Other offender(s) 5 9 17 23 16 70 (21%)
Visitor 1 1 - 2 - 4 (1%)
Other 1 5 1 2 2 11 (3%)
Unsure 19 26 45 35 59 184 (56%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

aSubstances identified include those that were confirmed through tests administered to the offender or otherwise suspected (e.g. based on tests of seized substances, intelligence information). All substances identified are included; column totals may therefore exceed the total number of cases.

bOnly the three most common opioid substances are identified in this table.

Table 5
Incident details by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Detail Region Totals
Atlantic Quebec Ontario Prairie Pacific
Occurred in segregation 3 5 11 17 6 42 (13%)
Location of incident
Cell 16 30 70 76 67 259 (79%)
Other 3 3 19 17 19 61 (19%)
Not specified 0 1 3 5 1 10 (3%)
Time of incident
12:00 AM - 06:00 AM 1 6 3 9 4 23 (7%)
6:01 AM - 12:00 PM 5 12 29 31 16 93 (28%)
12:01 PM - 6:00 PM 4 9 29 33 35 110 (33%)
6:01 PM - 11:59 PM 9 7 31 25 32 104 (32%)
Day of week
Sunday 2 3 14 19 5 43 (13%)
Monday 2 8 11 11 10 42 (13%)
Tuesday 1 3 12 7 11 34 (10%)
Wednesday 3 3 10 19 18 53 (16%)
Thursday 6 11 16 21 12 66 (20%)
Friday 3 1 12 13 21 50 (15%)
Saturday 2 5 17 8 10 42 (13%)
Discovered by (all that apply)
Staff 14 24 74 65 71 248 (75%)
Other offender(s) 5 10 12 24 14 65 (20%)
Not specified 1 - 6 10 3 20 (6%)
Substance involved (all that apply) a
Opioid b 6 17 44 61 44 172 (52%)
Fentanyl - 4 3 22 11 40 (12%)
Heroin - 6 12 17 13 48 (15%)
Methadone 4 2 4 6 20 36 (11%)
Stimulant 3 - 5 15 13 36 (11%)
Prescription medication 10 14 49 24 31 128 (39%)
THC - 3 4 14 2 23 (7%)
Hallucinogen - - - - 1 1 (<1%)
Depressant 2 - 3 1 2 8 (2%)
Unsure 3 2 7 10 12 34 (10%)
Source of substance (all that apply)
Own medication 7 10 31 8 16 72 (22%)
Other offender(s) 6 7 19 14 24 70 (21%)
Visitor - - 1 - 3 4 (1%)
Other 1 - 1 3 6 11 (3%)
Unsure 5 20 46 72 41 184 (56%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

aSubstances identified include those that were confirmed through tests administered to the offender or otherwise suspected (e.g. based on tests of seized substances, intelligence information). All substances identified are included; column totals may therefore exceed the total number of cases.

bOnly the three most common opioid substances are identified in this table.

Table 6
Further incident details by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Detail Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
Serious bodily injury?
No 12 7 14 17 26 76 (23%)
Yes 22 30 34 32 25 143 (43%)
Not specified 6 11 27 30 37 111 (34%)
Medical response
CPR was used 6 5 13 14 17 55 (17%)
AED was used 4 4 9 11 11 39 (12%)
Naloxone was used 18 25 28 23 49 143 (43%)
Ambulance called 34 40 63 71 74 282 (86%)
Internal medical care 26 28 49 51 45 199 (60%)
External medical care 35 43 72 74 75 299 (91%)
Time spent in hospital
24 hours or less 23 33 46 49 59 210 (64%)
Over 1 day - less than 1 week 7 7 18 19 15 66 (20%)
1 week or more 3 1 3 3 1 11 (3%)
Not specified/applicable 7 7 8 8 13 43 (13%)
Disciplinary measures
Offender transferred 12 16 21 16 22 87 (26%)
Security level changed 5 7 6 9 12 39 (12%)
Institutional charges 10 16 18 26 36 106 (32%)
Investigatory response
BOI 22 18 16 31 16 103 (31%)
Local 2 5 6 13 3 29 (9%)
In progress - - - - 7 7 (2%)
None 16 25 53 35 62 191 (58%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 7
Further incident details by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Detail Region Totals
Atlantic Quebec Ontario Prairie Pacific
Serious bodily injury?
No 3 8 18 26 21 76 (23%)
Yes 8 16 39 53 27 143 (43%)
Not specified 8 10 35 19 39 111 (34%)
Medical response
CPR was used 1 8 12 22 12 55 (17%)
AED was used 1 8 12 13 5 39 (12%)
Naloxone was used 5 15 31 56 36 143 (43%)
Ambulance called 16 32 76 83 75 282 (86%)
Internal medical care 8 23 51 65 52 199 (60%)
External medical care 18 30 85 85 81 299 (91%)
Time spent in hospital
24 hours or less 13 13 57 60 67 210 (64%)
Over 1 day - less than 1 week 3 9 21 20 13 66 (20%)
1 week or more 2 3 4 2 - 11 (3%)
Not specified/applicable 1 9 10 16 7 43 (13%)
Disciplinary measures
Offender transferred 7 11 22 30 17 87 (26%)
Security level changed - 2 6 17 14 39 (12%)
Institutional charges 10 16 18 26 36 106 (32%)
Investigatory response
BOI 4 16 33 30 20 103 (31%)
Local 2 4 11 5 7 29 (9%)
In progress - - - 6 1 7 (2%)
None 13 14 48 57 59 191 (58%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 8
Compliance issues by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Compliance issue Fiscal Year Totals (% of investigated cases) Totals (% of all cases)
12/13 13/14 14/15 15/16 16/17
Staff levels 1 1 - - - 2 (2%) 2 (1%)
Searches 4 6 11 4 5 30 (23%) 30 (9%)
Documentation and reporting 18 16 17 16 10 77 (58%) 77 (23%)
Staff certifications 4 2 1 3 2 12 (9%) 12 (4%)
Staff response 6 11 4 7 5 33 (25%) 33 (10%)
Security patrols 8 8 5 11 2 34 (12%) 34 (10%)
Availability/use of equipment 5 1 2 6 2 16 (12%) 16 (5%)
Medication administration 2 4 2 6 3 17 (13%) 17 (5%)
Nursing spot checks 1 - 1 1 - 3 (2%) 3 (1%)
Urine screens 1 1 - 6 2 10 (8%) 10 (3%)
Support to staff 1 2 1 1 1 6 (5%) 6 (2%)
Aboriginal Social History not properly considered 2 2 - 1 1 6 (5%) 6 (2%)
Communication between staff members and/or agencies 2 1 - 1 6 10 (8%) 10 (3%)
Drug interdiction/management strategy - 2 - 1 10 13 (10%) 13 (4%)
Management of evidence/ crime scene - 5 - 1 2 8 (6%) 8 (2%)
Offender not charged 1 - - 5 10 16 (12%) 16 (5%)
Total completed investigationsa 24 23 22 44 19 132 (100%) 132 (40%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

aThis refers to the number of completed investigations as of July 01, 2018; seven additional cases in 2016/2017 remained under investigation at the time of analysis.

Table 9
Recommendations by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Recommendation Fiscal Year Totals (% of investigated cases) Totals (% of all cases)
12/13 13/14 14/15 15/16 16/17
Visiting policies/procedures 2 1 1 5 - 9 (7%) 9 (3%)
Medication policies/procedures 3 3 5 5 2 18 (14%) 18 (6%)
Staff training 2 - 1 - 4 7 (5%) 7 (2%)
Security policies/procedures 3 6 6 4 - 19 (14%) 19 (6%)
Total completed investigationsa 24 23 22 44 19 132 (100%) 132 (40%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

aThis refers to the number of completed investigations as of July 01, 2018; seven additional cases in 2016/2017 remained under investigation at the time of analysis.

Table 10
Compliance issues by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Compliance issue Region Totals (% of investigated cases) Totals (% of all cases)
Atlantic Quebec Ontario Prairie Pacific
Staff levels - - 1 1 - 2 (2%) 2 (1%)
Searches - 1 18 7 4 30 (23%) 30 (9%)
Documentation and reporting 3 9 38 14 13 77 (58%) 77 (23%)
Staff certifications 1 3 5 2 1 12 (9%) 12 (4%)
Staff response 2 11 11 3 6 33 (25%) 33 (10%)
Security patrols 2 11 11 10 - 34 (12%) 34 (10%)
Availability/use of equipment - 3 9 2 2 16 (12%) 16 (5%)
Medication administration 1 3 5 1 7 17 (13%) 17 (5%)
Nursing spot checks 1 - 1 - 1 3 (2%) 3 (1%)
Urine screens 1 1 2 5 1 10 (8%) 10 (3%)
Support to staff - 2 2 1 1 6 (5%) 6 (2%)
Aboriginal Social History not properly considered - - 3 2 1 6 (5%) 6 (2%)
Communication between staff members and/or agencies - 2 2 4 2 10 (8%) 10 (3%)
Drug interdiction/ management strategy - - 1 12 - 13 (10%) 13 (4%)
Management of evidence/ crime scene - 5 - 2 1 8 (6%) 8 (2%)
Offender not charged - - 1 15 - 16 (12%) 16 (5%)
Total completed investigationsa 24 23 22 44 19 132 (100%) 132 (40%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

aThis refers to the number of completed investigations as of July 01, 2018; seven additional cases in 2016/2017 remained under investigation at the time of analysis.

Table 11
Recommendations by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Recommendation Region Totals (% of investigated cases) Totals (% of all cases)
Atlantic Quebec Ontario Prairie Pacific
Visiting policies/procedures - - 4 4 1 9 (7%) 9 (3%)
Medication policies/procedures - 3 7 2 6 18 (14%) 18 (6%)
Staff training - 2 1 4 - 7 (5%) 7 (2%)
Security policies/procedures - 7 10 1 1 19 (14%) 19 (6%)
Total completed investigations 19 34 92 98 87 132 (100%) 132 (40%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

Table 12
Profile of offenders involved in overdose incidents by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Characteristic Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
Age
18-24 4 5 12 17 8 46 (14%)
25-34 9 19 28 31 42 129 (39%)
35-44 18 14 21 12 21 86 (26%)
45-54 5 8 7 12 13 45 (14%)
55+ 4 2 7 7 4 24 (7%)
Ethnicity
Caucasian 24 28 39 50 50 191 (58%)
Indigenous 15 14 33 23 34 119 (36%)
Other 1 6 3 6 4 20 (6%)
Level of education
Less than high school 28 24 48 46 52 198 (60%)
High school 9 20 22 27 29 107 (32%)
More than high school 2 3 5 4 7 21 (6%)
Not indicated 1 1 - 2 - 4 (1%)
Security level
Minimum 1 4 2 2 2 11 (3%)
Medium 28 29 57 51 71 236 (72%)
Maximum 11 10 10 24 13 68 (21%)
Not yet determined - 5 6 2 2 15 (5%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 13
Profile of offenders involved in overdose incidents by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Characteristic Region Totals
Atlantic Quebec Ontario Prairie Pacific
Age
18-24 4 1 11 20 10 46 (14%)
25-34 7 9 39 51 23 129 (39%)
35-44 3 13 24 21 25 86 (26%)
45-54 5 5 13 6 16 45 (14%)
55+ - 6 5 - 13 24 (7%)
Ethnicity
Caucasian 14 25 52 59 41 191 (58%)
Indigenous 4 6 33 36 40 119 (36%)
Other 1 3 7 3 6 20 (6%)
Level of education
Less than high school 10 20 60 60 48 198 (60%)
High school 7 8 24 33 35 107 (32%)
More than high school 2 4 6 5 4 21 (6%)
Not indicated - 2 2 - - 4 (1%)
Security level
Minimum - 2 3 1 5 11 (3%)
Medium 12 17 67 77 63 236 (72%)
Maximum 5 15 19 15 14 68 (21%)
Not yet determined 2 - 3 5 5 15 (5%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 14
Sentence information for offenders involved in overdose incidents by fiscal year for overdose incidents in federal custody, 2012/2013 - 2016/2017
Sentence information Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
First time federal offender 16 30 39 41 52 178 (54%)
Sentence length
2 - less than 4 years 16 18 38 29 33 134 (41%)
4 - less than 6 years 3 9 11 17 21 61 (19%)
6 - less than 10 years 6 11 3 18 16 54 (16%)
Over 10 years 5 2 4 5 7 23 (7%)
Indeterminate 10 8 19 10 11 58 (18%)
Major index offence
Homicide-related 10 10 18 11 20 69 (21%)
Sexual 5 6 2 4 6 23 (7%)
Assault 3 5 12 6 7 33 (10%)
Robbery 13 13 22 30 23 101 (31%)
Other violent 4 6 3 9 6 28 (9%)
Property 2 4 5 5 6 22 (7%)
Drug 2 2 8 9 9 30 (9%)
Other non-violent 1 2 5 5 10 23 (7%)
Other - - - - 1 1 (<1%)
Time served
0 - 60 days - 5 3 2 2 12 (4%)
61 - 90 days - 1 4 1 - 6 (2%)
91 days - 1 year 7 6 22 19 16 70 (21%)
Over 1 year - 2 years 8 9 11 13 19 60 (18%)
Over 2 years - 5 years 11 13 14 28 30 96 (29%)
Over 5 years - 10 years 2 9 10 10 13 44 (13%)
Over 10 years 12 5 11 6 8 42 (13%)
Time between most recent admission and incident
0 - 60 days 4 7 11 9 11 42 (13%)
61 - 90 days 4 3 5 4 2 18 (6%)
91 days - 1 year 8 14 30 29 22 103 (31%)
Over 1 year - 2 years 6 8 9 13 20 56 (17%)
Over 2 years - 5 years 7 7 4 13 18 49 (15%)
Over 5 years - 10 years 2 4 8 7 10 31 (9%)
Over 10 years 8 5 8 3 5 29 (9%)
Not indicated 1 - - 1 - 2 (1%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 15
Sentence information for offenders involved in overdose incidents by region for overdose incidents in federal custody, 2012/2013 - 2016/2017
Sentence information Region Totals
Atlantic Quebec Ontario Prairie Pacific
First time federal offender 10 14 49 60 45 178 (54%)
Sentence length
2 - less than 4 years 8 7 42 55 22 133 (41%)
4 - less than 6 years 2 10 12 17 20 61 (19%)
6 - less than 10 years 3 5 17 16 13 54 (16%)
Over 10 years 3 1 4 6 9 23 (7%)
Indeterminate 3 11 17 4 23 58 (18%)
Major index offence
Homicide-related 5 10 23 7 24 69 (21%)
Sexual - 2 8 3 10 23 (7%)
Assault 3 3 11 13 3 33 (10%)
Robbery 5 9 28 29 30 101 (31%)
Other violent 2 3 8 10 5 28 (9%)
Property 1 1 6 10 4 22 (7%)
Drug 1 3 7 15 4 30 (9%)
Other non-violent 1 3 1 11 7 23 (7%)
Other 1 - - - - 1 (<1%)
Time served
0 - 60 days 1 - 2 4 5 12 (4%)
61 - 90 days 1 - 3 2 - 6 (2%)
91 days - 1 year 6 9 25 21 9 70 (21%)
Over 1 year - 2 years 1 4 17 24 14 60 (18%)
Over 2 years - 5 years 2 9 23 35 27 96 (29%)
Over 5 years - 10 years 4 7 14 10 9 44 (13%)
Over 10 years 4 5 8 2 23 42 (13%)
Time between most recent admission and incident
0 - 60 days 3 2 7 18 12 42 (13%)
61 - 90 days 1 1 4 8 4 18 (6%)
91 days - 1 year 9 11 33 32 18 103 (31%)
Over 1 year - 2 years 1 3 18 22 12 56 (17%)
Over 2 years - 5 years 1 6 16 12 14 49 (15%)
Over 5 years - 10 years 2 6 10 5 8 31 (9%)
Over 10 years 2 5 4 1 17 29 (9%)
Not indicated - - - - 2 2 (1%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 16
Criminal profile of offenders involved in overdose incidents in federal custody by fiscal year, 2012/2013 - 2016/2017
Criminal factor Fiscal Year Totals
12/13 13/14 14/15 15/16 16/17
Security threat group (STG) affiliation 12 8 13 20 22 75 (23%)
Young offender record 27 29 56 56 59 227 (69%)
Prior adult record 35 44 65 67 77 288 (87%)
Offending tied to substance misuse 31 39 65 59 72 266 (81%)
Current Offences (all that apply)
Property 18 16 30 26 26 116 (35%)
Homicide-related 10 10 18 11 20 69 (21%)
Assault 10 16 23 25 18 92 (28%)
Sexual 5 6 4 6 6 27 (8%)
Robbery 17 15 30 32 26 120 (36%)
Drug 8 7 14 21 21 71 (22%)
Other non-violent 15 22 47 39 37 160 (49%)
Other violent 10 11 23 29 34 107 (32%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 17
Criminal profile of offenders involved in overdose incidents in federal custody by region, 2012/2013 - 2016/2017
Criminal factor Region Totals
Atlantic Quebec Ontario Prairie Pacific
Young offender record 12 17 69 72 57 227 (69%)
Prior adult record 17 32 78 83 78 288 (87%)
Offending tied to substance misuse 15 18 71 87 75 266 (81%)
Current Offences (all that apply)
Property 7 11 31 36 31 116 (35%)
Homicide-related 6 10 23 6 24 69 (21%)
Assault 6 12 31 24 19 92 (28%)
Sexual - 2 10 4 11 27 (8%)
Robbery 7 13 33 32 35 120 (36%)
Drug 4 9 13 31 14 71 (22%)
Other non-violent 10 14 47 58 31 160 (49%)
Other violent 5 12 28 39 23 107 (32%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
Table 18
Institutional history by region for offenders involved in overdose incidents in federal custody, 2012/2013 - 2016/2017
Factor Region Totals
Atlantic Quebec Ontario Prairie Pacific
Completed programming 13 23 76 86 80 278 (84%)
Previously held job 15 30 77 88 80 290 (88%)
Institutional incidents related to
Drugsa 12 24 61 69 69 235 (71%)
Tobaccob 7 15 20 25 37 104 (32%)
Other contraband 15 28 65 78 69 255 (77%)
Issues with inmates 17 26 71 69 68 251 (76%)
Issues with staff 12 22 48 44 59 185 (56%)
Suspension from work/programming 10 19 35 48 42 154 (47%)
Refusal to attend work/programming - 17 4 10 6 37 (11%)
UAL/Escape 4 10 20 30 35 99 (30%)
Disobediencec 12 29 49 52 67 209 (63%)
Property-related 6 16 30 24 29 105 (32%)
Jeopardize security 3 11 18 17 12 61 (19%)
Cause disturbance 2 6 20 6 11 45 (14%)
Positive urinalysis in year prior 2 4 14 30 20 70 (21%)
Refused urinalysis in year prior 2 3 18 19 18 60 (18%)
History of segregation 18 32 76 73 75 274 (83%)

Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.

aDrug-related issues include drug possession, consumption and distribution.

bOther types of contraband include unauthorized items excluding drugs and tobacco, such as ‘brew’ (prison-made alcohol) and weapons.

cIncidents of disobedience include cases where the offender was institutionally charged for disobeying a written rule or order.

Table 19
Mental health information by region for offenders involved in overdose incidents in federal custody, 2012/2013 - 2016/2017
Factor Region Totals
Atlantic Quebec Ontario Prairie Pacific
At least one mental health disorder identified 15 28 61 67 59 230 (70%)
Mental health disorder(s) identified
Mood disorder 11 15 39 43 23 131 (40%)
Psychotic disorder 3 6 13 9 9 40 (12%)
Anxiety disorder 10 9 27 32 25 103 (31%)
Personality disorder 6 20 22 18 20 86 (26%)
Neurocognitive/ neurodevelopmental 8 6 30 27 28 99 (30%)
Other 2 1 13 8 8 32 (10%)
History of self-harm / suicide 13 23 41 36 40 153(46%)
History of substance abuse 17 32 87 98 86 320 (97%)
Alcohol 9 13 50 55 51 178 (54%)
Drugs 17 30 85 98 82 312 (95%)
Opiates 8 17 43 48 49 165 (50%)
Stimulants 9 19 56 70 56 210 (64%)
Cannabis 10 21 47 70 53 201 (61%)
Hallucinogens 2 7 6 11 12 38 (12%)
Depressants/downers 1 2 7 10 4 24 (7%)
Note: Results are accurate as of July 01, 2018. Subsequent investigations or reviews may result in changes to this table.
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