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Citation
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Marsden J, Stillwell G, Jones H, Cooper A, Eastwood B, Farrell M, Lowden T, Maddalena N, Metcalfe C, Shaw J, Hickman M. Addiction 2017; 112(8): 1408-1418. |
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Abstract
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BACKGROUND AND AIMS: People with opioid use disorder (OUD) in prison face an acute risk of death after release. We estimated whether prison-based opioid substitution treatment (OST) reduces this risk.
DESIGN: Prospective observational cohort study using prison healthcare, national community drug misuse treatment and deaths registers. SETTING: Recruitment at 39 adult prisons in England (32 male; 7 female) accounting for 95% of OST treatment in England during study planning. PARTICIPANTS: Adult prisoners diagnosed with OUD (recruited: September 2010 to August 2013; first release: September 2010; last release: October 2014; follow-up to February 2016; n = 15,141 in the risk set). INTERVENTION AND COMPARATOR At release, participants were classified as OST exposed (n = 8,645) or OST unexposed (n = 6,496). The OST unexposed group did not receive OST, or had been withdrawn, or had a low dose. MEASUREMENTS: Primary outcome: all-cause mortality (ACM) in the first 4 weeks. SECONDARY OUTCOMES: drug-related poisoning (DRP) deaths in the first 4 weeks; ACM and DRP mortality after 4 weeks to 1 year; admission to community drug misuse treatment in the first 4 weeks. Unadjusted and adjusted cox regression models (covariates: sex, age, drug injecting, problem alcohol use, use of benzodiazepines, cocaine, prison transfer and admission to community treatment), tested difference in mortality rates and community treatment uptake.
FINDINGS: In the first 4 weeks after prison release, there were 24 ACM deaths: 6 in the OST exposed group and 18 in the OST unexposed group (mortality rate 0.93 per 100 person years [PY] versus 3.67 per 100 PY; Hazard Ratio [HR] 0.25; 95% Confidence interval [CI] 0.10 to 0.64). There were 18 DRP deaths: OST exposed group mortality rate 0.47 per 100 PY versus 3.06 per 100 PY in the OST unexposed group (HR 0.15; 95% CI 0.04 to 0.53). There was no group difference in mortality risk after the first month. The OST exposed group was more likely to enter drug misuse treatment in the first month post-release (odds ratio 2.47, 95% CI 2.31 to 2.65). The OST mortality protective effect on ACM and DRP mortality risk was not attenuated by demographic, overdose risk factors, prison transfer or community treatment (fully adjusted HR 0.25; 95% CI 0.09 to 0.64 and HR 0.15; 95% CI 0.04 to 0.52, respectively).
CONCLUSIONS: In an English national study, prison-based opioid substitution therapy was associated with a 75% reduction in all-cause mortality and an 85% reduction in fatal drug-related poisoning in the first month after release.
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Language: en |