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Stone J, Lim AG, Dore GJ, Borquez A, Geddes L, Gray R, Grebely J, Hajarizadeh B, Iversen J, Maher L, Valerio H, Martin NK, Hickman M, Lloyd AR, Vickerman P. Prison-based interventions are key to achieving HCV elimination among people who inject drugs in New South Wales, Australia: A modelling study. Liver Int 2023; 43:569-579. [PMID: 36305315 PMCID: PMC10308445 DOI: 10.1111/liv.15469] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2022] [Accepted: 10/25/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS People who inject drugs (PWID) experience high incarceration rates which are associated with increased hepatitis C virus (HCV) transmission risk. We assess the importance of prison-based interventions for achieving HCV elimination among PWID in New South Wales (NSW), Australia. METHODS A model of incarceration and HCV transmission among PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from NSW, incorporating elevated HCV acquisition risk among recently released PWID. We projected the contribution of differences in transmission risk during/following incarceration to HCV transmission over 2020-2029. We estimated the past and potential future impact of prison-based opioid agonist therapy (OAT; ~33% coverage) and HCV treatment (1500 treatments in 2019 with 32.9%-83.3% among PWID) on HCV transmission. We estimated the time until HCV incidence reduces by 80% (WHO elimination target) compared to 2016 levels with or without prison-based interventions. RESULTS Over 2020-2029, incarceration will contribute 23.0% (17.9-30.5) of new HCV infections. If prison-based interventions had not been implemented since 2010, HCV incidence in 2020 would have been 29.7% (95% credibility interval: 22.4-36.1) higher. If current prison and community HCV treatment rates continue, there is an 98.8% probability that elimination targets will be achieved by 2030, with this decreasing to 10.1% without current prison-based interventions. CONCLUSIONS Existing prison-based interventions in NSW are critical components of strategies to reduce HCV incidence among PWID. Prison-based interventions are likely to be pivotal for achieving HCV elimination targets among PWID by 2030.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Aaron G. Lim
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Gregory J. Dore
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Annick Borquez
- Division of Infectious Diseases and Global Public HealthUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Louise Geddes
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Richard Gray
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Jason Grebely
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | | | - Jenny Iversen
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Lisa Maher
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Heather Valerio
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public HealthUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of BristolBristolUK
| | - Andrew R. Lloyd
- The Kirby Institute, UNSW SydneyNew South WalesSydneyAustralia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of BristolBristolUK
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Larney S, Madden A, Marshall AD, Martin NK, Treloar C. A gender lens is needed in hepatitis C elimination research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103654. [PMID: 35306279 DOI: 10.1016/j.drugpo.2022.103654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/18/2023]
Abstract
The World Health Organisation has established a goal of eliminating the hepatitis C virus (HCV) as a public health threat by 2030. Considerable effort is being directed towards research to support and enhance HCV treatment uptake among people who inject drugs, but there is a distinct lack of attention given to gender in this work. We argue that a gender lens is needed to make visible the limitations of current HCV elimination research, and support the development of innovative, inclusive approaches to HCV treatment. Partnerships between researchers and people who inject drugs are essential in this work, particularly in the development and evaluation of programs by and for women who inject drugs. Failure to acknowledge the gendered dimensions of HCV elimination risks entrenching gender disparities in access to treatment and cure.
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Affiliation(s)
- Sarah Larney
- Department of Family Medicine and Emergency Medicine, University of Montreal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada.
| | - Annie Madden
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Alison D Marshall
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA; School of Population Health Sciences, University of Bristol, UK
| | - Carla Treloar
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; Social Policy Research Centre, UNSW Sydney, Australia
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Gjersing L, Bretteville-Jensen AL. Characteristics and risk of incarceration among "hard-to-reach" people who use drugs: A five-year prospective cohort study combining self-reports and registry data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103288. [PMID: 34004380 DOI: 10.1016/j.drugpo.2021.103288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Incarcerations are associated with an increased risk of morbidity and mortality among people who use drugs (PWUD). In a sample of 884 PWUD, we examine and estimate the risk of incarcerations (i.e., number, duration, and most serious offense). METHODS In this prospective cohort study, PWUD were recruited from street- and low-threshold services in seven Norwegian cities in 2013 (Sept-Nov), and followed through the Correctional Service Registry until 20.12.2018. The risk of incarceration during follow-up was examined with multivariable logistic (no incarceration vs. at least one) and multinomial regression models ("no incarcerations", vs. "1″, "≥2″), while accounting for gender, age, homelessness/shelter use, opioid substitution treatment, illegal income sources, injecting behaviours, previous incarcerations, and recruitment city. RESULTS During follow-up, there were in total 662 incarceration episodes, and 44.7% of the participants were incarcerated at least once. Overall, 37.5% of those incarcerated had at least one episode due to a drug offense. The average incarceration duration was 65.2 days with 3.5% of the episodes lasting ≥one year. Gender (male), homelessness/shelter use, illegal income sources, injecting stimulants, and previous incarcerations increased the odds of incarceration, while older age decreased the odds. Gender (male), younger age, self-reported theft or theft and dealing, injecting stimulants or heroin and stimulants and previous incarcerations increased the risk of multiple incarcerations. CONCLUSION In a five-year prospective study of PWUD, incarcerations were common, and short-term sentences and recidivism were the norm. This is of concern as incarcerations add to an already elevated morbidity and mortality risk in this population.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway
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Treloar C, Schroeder S, Lafferty L, Marshall A, Drysdale K, Higgs P, Baldry E, Stoove M, Dietze P. Structural competency in the post-prison period for people who inject drugs: A qualitative case study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103261. [PMID: 33990057 DOI: 10.1016/j.drugpo.2021.103261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Access to services is key to successful community (re-)integration following release from prison. But many people experience disengagement from services, including people who inject drugs (PWID). We use a case study approach and the notion of structural competency to examine influences on access to services among a group of PWID recently released from prison. METHODS This qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia). INCLUSION CRITERIA aged 18+; lifetime history of injecting drug use; incarcerated for > three months and released from custody < 12 months previously. From 48 participants, five case studies were selected as emblematic of the complex and intersecting factors occurring at the time participants missed an appointment at a service. RESULTS Numerous, concurrent, and interdependent structural influences in participants' lives coincided with their difficulty accessing and maintaining contact with services and resulted in missed appointments. The key factors involved in the cases presented here include policies around opioid agonist treatment, inadequate, unsuitable and unsafe housing, the management of mental health and side effects of treatment, the lack of social support or estrangement from family, and economic hardship. The support available from service workers to navigate these structural issues was inconsistent. One dissenting case is examined in which missing appointments is anticipated and accommodated. CONCLUSIONS A case study approach enabled a holistic and in-depth examination of upstream structural elements that intersect with limited social and economic resources to exacerbate the challenges of community re-entry. These results highlight structural issues that have a disproportionate impact on the choices and opportunities for PWID. The incorporation of a structural competency framework in design of services and in staff training could support person-centred and coordinated service provision that take into account PWID's experiences post-release to overcome structural barriers to service engagement.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia.
| | - Sophia Schroeder
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Lise Lafferty
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Alison Marshall
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Mark Stoove
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
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James DB, Lee KSK, Patrao T, Courtney RJ, Conigrave KM, Shakeshaft A. Understanding the client characteristics of Aboriginal residential alcohol and other drug rehabilitation services in New South Wales, Australia. Addict Sci Clin Pract 2020; 15:27. [PMID: 32727625 PMCID: PMC7388208 DOI: 10.1186/s13722-020-00193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aboriginal alcohol and other drug residential rehabilitation (residential rehabilitation) services have been providing treatment in Australia of over 50 years. However, there are no studies in Australia or internationally that document characteristics of clients attending Indigenous residential rehabilitation services worldwide. This is the first multi-site paper to describe key client characteristics of six Indigenous (hereafter Aboriginal Australians as the term recommended by the Aboriginal Health and Medical Research Council of New South Wales) residential rehabilitation services in Australia. METHODS All recorded client admissions between 1 January 2011 to 31 December 2016 were considered from six operating services in the Australian state of New South Wales. Data collected were classified into categories based on demographics, treatment utilisation, substance use, mental health and quality of life characteristics. Means, median and percentages were calculated (where appropriate). RESULTS There were 2645 admissions across the six services in the study period, with an average of 440 admissions per year across all services. Participants were aged between 26 to 35 years, with fewest participants aged 46 +. Program length ranged from 12 to 52 weeks (mean of 12 weeks). The completion rates and length of stay for each service ranged from less than two to more than 12 weeks. The principal drug of choice was alcohol and amphetamines in half of the services. Not all services used them, but a range of tools were used to measure treatment, substance use and mental health or quality of life outcomes. CONCLUSION This study is the first internationally to describe the key features of multiple Aboriginal residential rehabilitation services. The variation in tools used to collect client data made it difficult to compare client characteristics across services. Future research could explore predictors of treatment completion, identify opportunities for standardisation in client assessments and validate cultural approaches of care. These efforts would need to be guided by Aboriginal leadership in each service.
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Affiliation(s)
- Douglas B James
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia.
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - Tania Patrao
- School of Public Health, University of Queensland, St Lucia, QLD, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney Local Health District, Camperdown, NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia
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Sullivan E, Ward S, Zeki R, Wayland S, Sherwood J, Wang A, Worner F, Kendall S, Brown J, Chang S. Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program. BMJ Open 2019; 9:e030546. [PMID: 31345984 PMCID: PMC6661568 DOI: 10.1136/bmjopen-2019-030546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described. METHODS AND ANALYSIS Population-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the 'time-to' health-related outcomes after adjusting for potential confounders. ETHICS AND DISSEMINATION Ethical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Ethics Committee, the Corrective Services NSW Ethics Committee and the University of Technology Sydney Human Research Ethics Committee.
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Affiliation(s)
- Elizabeth Sullivan
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Clinical Business Unit, Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Stephen Ward
- Clinical Business Unit, Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Reem Zeki
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sarah Wayland
- Faculty of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Juanita Sherwood
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Faye Worner
- WAMINDA South Coast Women’s Health & Welfare Aboriginal Corporation, Nowra, New South Wales, Australia
| | - Sacha Kendall
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - James Brown
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sungwon Chang
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Larney S, Zador D, Sindicich N, Dolan K. A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia. Drug Alcohol Rev 2016; 36:305-310. [DOI: 10.1111/dar.12442] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/29/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Deborah Zador
- Drug and Alcohol Services; Justice Health and Forensic Mental Health Network; Sydney Australia
| | - Natasha Sindicich
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Kate Dolan
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
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Larney S, Cama E, Nelson E, Larance B, Degenhardt L. A cross-sectional study of correlates of imprisonment in opioid-dependent men and women in New South Wales, Australia. Drug Alcohol Rev 2015; 35:686-692. [PMID: 26711174 DOI: 10.1111/dar.12357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/16/2015] [Accepted: 09/22/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND AIMS Involvement in the criminal justice system is common among opioid-dependent people. This study aimed to determine prevalence and adolescent-onset correlates of adult imprisonment among opioid-dependent men and women in New South Wales, Australia. DESIGN AND METHODS Participants were recruited from opioid substitution therapy clinics and completed a face-to-face, structured interview. Data were collected on demographic characteristics, family history, substance dependence and psychiatric disorders. Adolescent-onset correlates of adult incarceration (including interactions with gender) were examined using logistic regression. RESULTS Opioid-dependent men were significantly more likely than opioid-dependent women to report adult imprisonment (66% vs 40%; P < 0.001). In a multivariable logistic regression model, older age, male gender, having completed high school education only, having dependent children or living independently prior to age 18 years, a history of juvenile detention and adolescent-onset opioid dependence were all significantly associated with increased odds of adult imprisonment. Adolescent-onset depression was associated with a halving of odds of adult imprisonment. The only variable for which we observed an interaction with gender was juvenile detention, which had a significantly greater impact on the odds of imprisonment for men than women. DISCUSSION AND CONCLUSIONS More than half of this sample of opioid dependent adults had a history of imprisonment. Variables that are associated with imprisonment in the general population, such as childhood maltreatment, were not important in predicting imprisonment in this sample. Further study is required to understand the interaction between sex and juvenile detention in predicting adult imprisonment. [Larney S, Cama E, Nelson E, Larance B, Degenhardt L. A cross-sectional study of correlates of imprisonment in opioid-dependent men and women in New South Wales, Australia. Drug Alcohol Rev 2016;35:686-692].
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Alpert Medical School, Brown University, Providence, USA
| | - Elena Cama
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Elliot Nelson
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Department of Global Health, School of Public Health, University of Washington, Seattle, USA.,Murdoch Children's Research Institute, Melbourne, Australia
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Gisev N, Gibson A, Larney S, Kimber J, Williams M, Clifford A, Doyle M, Burns L, Butler T, Weatherburn DJ, Degenhardt L. Offending, custody and opioid substitution therapy treatment utilisation among opioid-dependent people in contact with the criminal justice system: comparison of Indigenous and non-Indigenous Australians. BMC Public Health 2014; 14:920. [PMID: 25192713 PMCID: PMC4168057 DOI: 10.1186/1471-2458-14-920] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/29/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although Indigenous Australians are over-represented among heroin users, there has been no study examining offending, time in custody, and opioid substitution therapy (OST) treatment utilisation among Indigenous opioid-dependent (including heroin) people at the population level, nor comparing these to non-Indigenous opioid-dependent people. The aims of this study were to compare the nature and types of charges, time in custody and OST treatment utilisation between opioid-dependent Indigenous and non-Indigenous Australians in contact with the criminal justice system. METHODS This was a population-based, retrospective data linkage study using records of OST entrants in New South Wales, Australia (1985-2010), court appearances (1993-2011) and custody episodes (2000-2012). Charge rates per 100 person-years were compared between Indigenous and non-Indigenous Australians by sex, age and calendar year. Statistical comparisons were made for variables describing the cumulative time and percentage of follow-up time spent in custody, as well as characteristics of OST initiation and overall OST treatment utilisation. RESULTS Of the 34,962 people in the cohort, 6,830 (19.5%) were Indigenous and 28,132 (80.5%) non-Indigenous. Among the 6,830 Indigenous people, 4,615 (67.6%) were male and 2,215 (32.4%) female. The median number of charges per person against Indigenous people (25, IQR 31) was significantly greater than non-Indigenous people (9, IQR 16) (p < 0.001). Overall, Indigenous people were charged with 33.2% of the total number of charges against the cohort and 44.0% of all violent offences. The median percentage of follow-up time that Indigenous males and females spent in custody was twice that of non-Indigenous males (21.7% vs. 10.1%, p < 0.001) and females (6.0% vs. 2.9%, p < 0.001). The percentage of Indigenous people who first commenced OST in prison (30.2%) was three times that of non-Indigenous people (11.2%) (p < 0.001). Indigenous males spent less time in OST compared to non-Indigenous males (median percentage of follow-up time in treatment: 40.5% vs. 43.1%, p < 0.001). CONCLUSIONS Compared to non-Indigenous opioid-dependent people, Indigenous opioid-dependent people in contact with the criminal justice system are charged with a greater number of offences, spend longer in custody and commonly initiate OST in prison. Hence, contact with the criminal justice system provides an important opportunity to engage Indigenous people in OST.
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Affiliation(s)
- Natasa Gisev
- />National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales Australia
| | - Amy Gibson
- />Centre for Health Research, University of Western Sydney, Sydney, New South Wales Australia
| | - Sarah Larney
- />National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales Australia
- />Alpert Medical School, Brown University, Providence, Rhode Island USA
| | - Jo Kimber
- />National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales Australia
| | - Megan Williams
- />School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales Australia
| | - Anton Clifford
- />School of Population Health, University of Queensland, Brisbane, Queensland Australia
| | - Michael Doyle
- />The Kirby Institute, UNSW Australia, Sydney, New South Wales Australia
| | - Lucy Burns
- />National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales Australia
| | - Tony Butler
- />The Kirby Institute, UNSW Australia, Sydney, New South Wales Australia
| | - Don J Weatherburn
- />New South Wales Bureau of Crime Statistics and Research (BOCSAR), Sydney, NSW Australia
| | - Louisa Degenhardt
- />National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales Australia
- />School of Population and Global Health, The University of Melbourne, Melbourne, Victoria Australia
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10
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Larney S, Gisev N, Farrell M, Dobbins T, Burns L, Gibson A, Kimber J, Degenhardt L. Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study. BMJ Open 2014; 4:e004666. [PMID: 24694626 PMCID: PMC3987723 DOI: 10.1136/bmjopen-2013-004666] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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.
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Alpert Medical School, Brown University, Providence, USA
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Timothy Dobbins
- School of Public Health, University of Sydney, Sydney, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Amy Gibson
- Centre for Health Research, University of Western Sydney, Sydney, Australia
| | - Jo Kimber
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Centre for Health Policy, Programs and Economics, University of Melbourne, Melbourne, Australia
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