The scale of drug and alcohol misuse in the criminal justice system is significant and both directly and indirectly leads to deaths in custody. It impacts those in custody and the staff who are asked to provide for their care. When individuals are released into the community, support is often not available or accessed. These concerns are occurring against the backdrop of a rising number of drug deaths in England and Wales.

This report highlights the need for a whole-systems approach to tackling substance misuse and aiding support and recovery. It also advocates for greater use of harm-reduction initiatives and the use of mechanisms to help ensure recommendations made following a death can be shared with the relevant people. All work in this area must retain the prevention of avoidable deaths as its key driver.