Researchers have suggested that ex-prisoners could be given psychotropic drugs when they are released from prison after a study showed that they substantially reduce their risk of violent reoffending.
The team says the move may also be a cost-effective risk management strategy and an alternative to offering offenders more expensive psychological programmes when in prison.
Reporting in JAMA
(online, 1 November 2016), the researchers say: “Provision of medication after prison release needs evaluation as a possibly cost-effective crime reduction alternative. Because prisoners with psychiatric disorders benefit from both pharmacological and psychological treatments, research should investigate whether combining therapies improves outcomes.”
The team’s conclusions are based on an analysis of 22,275 ex-offenders with an average age of 38 (of which 92% were male) who were released from Swedish prisons between July 2005 and December 2010.
Analysing population registers, the researchers compared the rates of violent reoffending when ex-offenders were given prescribed drugs compared with periods when drugs were not dispensed.
The prescribed medicines included antipsychotics, antidepressants, psychostimulants and drugs used in the treatment of addictive disorders and epilepsy. The participants were followed up an average 4.6 years after release.
They found that 18.1% of ex-offenders (4,031 individuals) were reconvicted for 5,653 violent crimes during the study period.
The results showed that three classes of psychotropic drugs (antipsychotics, psychostimulants, and drugs used for addictive disorders) were associated with statistically significant hazard ratios (0.58, 0.62, and 0.48, respectively) of violent reoffending. This meant that the provision of psychotropic drugs to released prisoners was associated with lower risk of reoffending.
The researchers also studied the risk of violent reoffending of prisoners who attended prison-based programme of psychological treatments for substance abuse. They found an HR of 0.75, which equated to a risk difference of 23.2 fewer violent re-offences per 1,000 person-years.
“Three classes of psychotropic medications were associated with substantial reductions in violent reoffending. The magnitudes of these associations were as strong as and possibly stronger than those for widely disseminated psychological programs in prison,” the researchers say.
“Owing to the high prevalence of substance use disorders among prisoners and strong links with premature mortality, pharmacological treatments for substance use disorders could have a substantial public health benefit,” they add.
“These findings may have implications for risk management, because prison psychological programmes need appropriate facilities, require sufficiently trained and supervised therapists, and are likely to be relatively expensive.”
Seena Fazel, Wellcome Trust senior researcher at the University of Oxford and member of the research team, says their findings add weight to the argument to rethink the way prison health services are managed.
“[The study suggests] that prison health services need to consider how to improve links [between] prisoners [and]… community health and addiction services on release,” he says. “Many such services do this already but probably not in a consistent way – our study would suggest that it needs to be a key part of release planning.
“It is also about improving identification of psychiatric disorders in prisoners, and then ensuring those with needs are given evidence-based treatments, and then enhancing their adherence on release,” he adds.
Commenting on the study, Katherine Delargy, deputy chief pharmacist at Barnet, Enfield and Haringey Mental Health NHS trust and a member of the College of Mental Health Pharmacy, says: “I think what is needed is to identify and treat mental ill health in the offender/ex-offender population. It is tragic for both individuals and society as a whole that we are not recognising treatable issues such as ADHD in this population.
“This paper shows that pharmacotherapy could be a cost-effective crime reduction strategy. It would be important that the person is involved in the choice of medication and becomes engaged with their own care, rehabilitation and recovery.”
 Chang Z, Lichtenstein P, LÃ¥ngstrÃ¶m N et al. Association between prescription of major psychotropic medications and violent reoffending after prison release. JAMA 2016;316(17):1798-1807. doi: 10.1001/jama.2016.15380