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Based on content analysis of all Prison and Probation Ombudsman \u2018other non\u2010natural\u2019 fatal incident investigation reports, descriptive statistics were generated. Qualitative analysis explored the circumstances surrounding deaths and key risk factors. Most deaths were of men, whose mean age was 39 years. Drug toxicity was the main factor in causing death, exacerbated by underlying physical health conditions and risk\u2010taking behaviours. A variety of substances were involved. New psychoactive substances became more important over time. A high proportion had recorded histories of substance use and mental illness. During this period, the prison system was under considerable stress creating dangerous environments for drug\u2010related harm. This study highlights the process of complex interaction between substances used, individual characteristics, situational features and the wider environment in explaining drug\u2010related deaths in prisons. Implications for policy and practice are discussed.<\/jats:p>","DOI":"10.1002\/jcop.22989","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T08:30:13Z","timestamp":1672907413000},"page":"1056-1077","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The risk matrix: Drug\u2010related deaths in prisons in England and Wales, 2015\u20132020"],"prefix":"10.1002","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2567-4218","authenticated-orcid":false,"given":"Karen","family":"Duke","sequence":"first","affiliation":[{"name":"Drug and Alcohol Research Centre Middlesex University London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Gleeson","sequence":"additional","affiliation":[{"name":"Drug and Alcohol Research Centre Middlesex University London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"MacGregor","sequence":"additional","affiliation":[{"name":"Drug and Alcohol Research Centre Middlesex University London UK"},{"name":"London School of Hygiene and Tropical Medicine University of London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betsy","family":"Thom","sequence":"additional","affiliation":[{"name":"Drug and Alcohol Research Centre Middlesex University London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Advisory Council on the Misuse of Drugs (ACMD). 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