Citation

Larney S, Gisev N, Farrell M, Dobbins T, Burns L, Gibson A, Kimber J, Degenhardt L. BMJ Open 2014; 4(4): e004666.

Affiliation

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Copyright

(Copyright © 2014, BMJ Publishing Group)

DOI

10.1136/bmjopen-2013-004666

PMID

24694626

Abstract

OBJECTIVES: To describe deaths in prison among opioid-dependent people, and examine associations between receipt of opioid substitution therapy (OST) and risk of death in prison.

DESIGN: Retrospective cohort study. SETTING: Adult prisons in New South Wales (NSW), Australia. PARTICIPANTS: 16 715 opioid-dependent people who were received to prison between 2000 and 2012. INTERVENTIONS: Opioid substitution therapy. PRIMARY OUTCOME MEASURES: Natural and unnatural (suicide, drug-induced, violent and other injury) deaths in prison.

RESULTS: Cohort members were in prison for 30 998 person-years (PY), during which time there were 51 deaths. The all-cause crude mortality rate (CMR) in prison was 1.6/1000 PY (95% CI 1.2 to 2.2/1000 PY), and the unnatural death CMR was 1.1/1000 PY (95% CI 0.8 to 1.6/1000 PY). Compared to time out of OST, the hazard of all-cause death was 74% lower while in OST (adjusted HR (AHR): 0.26; 95% CI 0.13 to 0.50), and the hazard of unnatural death was 87% lower while in OST (AHR: 0.13; 95% CI 0.05 to 0.35). The all-cause and unnatural death CMRs during the first 4 weeks of incarceration were 6.6/1000 PY (95% CI 3.8 to 10.6/1000 PY) and 5.5/1000 PY (95% CI 2.9 to 9.4/1000 PY), respectively. Compared to periods not in OST, the hazard of all-cause death during the first 4 weeks of incarceration was 94% lower while in OST (AHR: 0.06; 95% CI 0.01 to 0.48), and the hazard of unnatural death was 93% lower while in OST (AHR: 0.07; 95% CI 0.01 to 0.53).

CONCLUSIONS: Mortality of opioid-dependent prisoners was significantly lower while in receipt of OST.

Language: en