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Macdonald C, Macpherson G, Leppan O, Tran LT, Cunningham EB, Hajarizadeh B, Grebely J, Farrell M, Altice FL, Degenhardt L. Interventions to reduce harms related to drug use among people who experience incarceration: systematic review and meta-analysis. Lancet Public Health 2024; 9:e684-e699. [PMID: 39214637 DOI: 10.1016/s2468-2667(24)00160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/26/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. There is a wide range of heterogeneous interventions aimed at reducing these harms in this population. Previous reviews have focused on specific interventions or limited their findings to drug use and recidivism and have not explored interventions delivered after release from prison. Our aim is to examine the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes. METHODS In this systematic review and meta-analysis, we searched Embase, MEDLINE, and PsycINFO databases up until Sept 12, 2023 for studies published from Jan 1, 1980 onwards. All studies evaluating the effectiveness of any intervention on drug use, recidivism outcomes, sexual or injecting risk behaviours, or mortality among people who use psychoactive drugs and who were currently or recently incarcerated were included. Studies without a comparator or measuring only alcohol use were excluded. Data extracted from each study included demographic characteristics, interventions, and comparisons. Pooled odds ratios and risk ratios were calculated using random-effects meta-analyses. FINDINGS We identified 126 eligible studies (47 randomised controlled trials and 79 observational studies) encompassing 18 interventions; receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison (one study; hazard ratio 0·25; 95% CI 0·13-0·48), whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community (two studies; relative risk 0·24; 95% CI 0·15-0·37). Therapeutic community interventions reduced re-arrest at 6-12 months (six studies; odds ratio [OR] 0·72; 95% CI 0·55-0·95) and reincarceration at 24 months (two studies; OR 0·66; 95% CI 0·48-0·96). There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviours and needle and syringe sharing. INTERPRETATION There are effective interventions to reduce mortality and recidivism for people who use drugs who have been incarcerated. Nonetheless, there are also substantial gaps in the research examining the effect of interventions on risk behaviours and mortality during incarceration and a need for randomised designs examining outcomes for people who use drugs after release. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Christel Macdonald
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Georgina Macpherson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Leppan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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Balter DR, Puglisi LB, Dziura J, Fiellin DA, Howell BA. Buprenorphine-naloxone vs. extended-release naltrexone for opioid use disorder in individuals with and without criminal legal involvement: A secondary analysis of the X:BOT randomized controlled trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209438. [PMID: 38857827 PMCID: PMC11300157 DOI: 10.1016/j.josat.2024.209438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/19/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION There is uncertainty about whether criminal legal involvement (CLI) impacts the effectiveness of medications for opioid use disorder (MOUD). We aimed to determine whether CLI modifies the association between buprenorphine-naloxone (BUP-NX) vs. extended-release naltrexone (XR-NTX) and MOUD treatment outcomes. METHODS We conducted a secondary analysis of X:BOT, a 24-week multi-center randomized controlled trial comparing treatment outcomes between BUP-NX (n = 287) and XR-NTX (n = 283) in the general population. We used baseline Additional Severity-Index Lite responses to identify patients with recent CLI (n = 342), defined as active CLI and/or CLI in the past 30 days, and lifetime incarceration (n = 328). We explored recent CLI and lifetime incarceration as potential effect modifiers of BUP-NX vs. XR-NTX effectiveness on relapse, induction, and overdose. We conducted both intention-to-treat and per-protocol analyses for each outcome. RESULTS In intention-to-treat analyses, recent CLI modified the effect of BUP-NX vs. XR-NTX on odds of successful induction (p = 0.03) and hazard of overdose (p = 0.04), but it did not modify the effect on hazard of relapse (p = 0.23). All participants experienced lower odds of successful induction with XR-NTX compared to BUP-NX, but the relative likelihood of successful induction with BUP-NX was lower than XR-NTX among individuals with recent CLI (OR: 0.25, 95 % CI: 0.13-0.47, p < 0.001) compared to those without recent CLI (OR: 0.04, 95 % CI: 0.01-0.19, p < 0.001). Participants with recent CLI experienced similar hazard of overdose with XR-NTX and BUP-NX (HR: 1.12, 95 % CI: 0.42-3.01, p = 0.82), whereas those without recent CLI experienced greater hazard of overdose with XR-NTX compared to BUP-NX (HR: 12.60, 95 % CI: 1.62-98.03, p = 0.02). In per-protocol analyses, recent CLI did not modify the effect of MOUD on hazard of overdose (p = 0.10) or relapse (p = 0.41). Lifetime incarceration did not modify any outcome. CONCLUSIONS Compared to individuals without recent CLI, individuals with recent CLI experienced decreased relative effectiveness of BUP-NX compared to XR-NTX for induction and overdose outcomes. This highlights the importance of considering the impact of recent CLI on opioid use disorder treatment outcomes. Future research should explore the mechanisms through which recent CLI modifies MOUD effectiveness and aim to improve MOUD effectiveness for individuals with recent CLI.
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Affiliation(s)
| | - Lisa B Puglisi
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States of America; Section of General Medicine, Yale School of Medicine, New Haven, CT, United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - David A Fiellin
- Section of General Medicine, Yale School of Medicine, New Haven, CT, United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America
| | - Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States of America; Section of General Medicine, Yale School of Medicine, New Haven, CT, United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America
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Devin J, Lyons S, Murphy L, O’Sullivan M, Lynn E. Factors associated with suicide in people who use drugs: a scoping review. BMC Psychiatry 2023; 23:655. [PMID: 37670233 PMCID: PMC10478413 DOI: 10.1186/s12888-023-05131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Suicide is a significant contributor to global mortality. People who use drugs (PWUD) are at increased risk of death by suicide relative to the general population, but there is a lack of information on associated candidate factors for suicide in this group. The aim of this study was to provide a comprehensive overview of existing evidence on potential factors for death by suicide in PWUD. METHODS A scoping review was conducted according to the Arksey and O'Malley framework. Articles were identified using Medline, CINAHL, PsycINFO, SOCIndex, the Cochrane Database of Systematic Reviews and the Campbell Collaboration Database of Systematic Reviews; supplemented by grey literature, technical reports, and consultation with experts. No limitations were placed on study design. Publications in English from January 2000 to December 2021 were included. Two reviewers independently screened full-text publications for inclusion. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS The initial search identified 12,389 individual publications, of which 53 met the inclusion criteria. The majority (87%) of included publications were primary research, with an uncontrolled, retrospective study design. The most common data sources were drug treatment databases or national death indexes. Eleven potential factors associated with death by suicide among PWUD were identified: sex; mental health conditions; periods of heightened vulnerability; age profile; use of stimulants, cannabis, or new psychoactive substances; specific medical conditions; lack of dual diagnosis service provision; homelessness; incarceration; intravenous drug use; and race or ethnicity. Opioids, followed by cannabis and stimulant drugs were the most prevalent drugs of use in PWUD who died by suicide. A large proportion of evidence was related to opioid use; therefore, more primary research on suicide and explicit risk factors is required. CONCLUSIONS The majority of studies exploring factors associated with death by suicide among PWUD involved descriptive epidemiological data, with limited in-depth analyses of explicit risk factors. To prevent suicide in PWUD, it is important to consider potential risk factors and type of drug use, and to tailor policies and practices accordingly.
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Affiliation(s)
- Joan Devin
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen’s Green, Dublin 2, Ireland
| | - Suzi Lyons
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Lisa Murphy
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Michael O’Sullivan
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Ena Lynn
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
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Santo T. Errors in Data Reported in Meta-Analysis on Opioid Agonist Treatment and Mortality. JAMA Psychiatry 2023; 80:971-972. [PMID: 37466957 DOI: 10.1001/jamapsychiatry.2023.2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
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Marotta P, Hass A, Viera A, Doernberg M, Barbour R, Grau LE, Heimer R. Technical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014-2018. Subst Abuse Treat Prev Policy 2023; 18:43. [PMID: 37420271 PMCID: PMC10329353 DOI: 10.1186/s13011-023-00541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND We investigated the interaction between arrests for technical violations vs. receiving new charges with receiving community-based methadone treatment on time-to reincarceration (TTR) in a cohort of men with opioid use disorder (OUD) released from custody from two Connecticut jails from 2014 to 2018. METHODS Hazard ratios (HR) were estimated for time to reincarceration for technical violations/infractions, misdemeanors only, felonies only, and both misdemeanors and felonies after adjusting for age, race/ethnicity, and receiving methadone treatment during incarceration or in the community following release. Moderation analyses tested the hypotheses that the benefits of receiving methadone in jail or the community on TTR were significantly different for people with only technical violations and infractions compared to misdemeanor and felony charges. RESULTS In the sample of 788 men who were reincarcerated, 29.4% received technical violations with no new charges (n = 232) with the remainder of the sample receiving new charges consisting of 26.9% new misdemeanor charges, 6.5% felony charges, and 37.2% both felony and misdemeanor charges. Compared to men who received new misdemeanor charges, TTR was significantly shorter among those who received technical violations and infractions with no new charges amounting to a 50% increase in TTR (334.5 days, SD = 321.3 vs. 228.1 days, SD = 308.0, p < 0.001; aHR = 1.5, 95% CI = 1.3, 1.8, p < 0.001). TTR of men who resumed methadone and were charged with a new crime was 50% longer than those who resumed methadone and received technical violations/infractions with no new charges. (230.2 days, SD = 340.2 vs. 402.3 days, SD = 231.3; aHR = 1.5, 95%CI = 1.0, 2.2, p = 0.038). CONCLUSIONS Reducing technical violations may enhance the benefits of providing community-based methadone following release from incarceration on extending the time between incarcerations during the vulnerable time post-incarceration and reduce the burden on correctional systems.
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Affiliation(s)
- Phillip Marotta
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO USA
| | - Alissa Hass
- Indiana University School of Medicine, Bloomington, USA
| | - Adam Viera
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Molly Doernberg
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Russell Barbour
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Lauretta E. Grau
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Robert Heimer
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
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Marshall AD, Schroeder SE, Lafferty L, Drysdale K, Baldry E, Stoové M, Dietze P, Higgs P, Treloar C. Perceived access to opioid agonist treatment in prison among people with a history of injection drug use: A qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209066. [PMID: 37156422 DOI: 10.1016/j.josat.2023.209066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Opioid agonist treatment (OAT) is associated with a reduced likelihood of hepatitis C incidence, nonfatal overdose, and (re)incarceration among people who inject drugs (PWID), yet factors underpinning decisions to access OAT in prison and postrelease are not well understood. The aim of the qualitative study was to explore the perspectives of OAT access while in prison among PWID recently released from prison in Australia. METHODS Eligible participants enrolled in the SuperMix cohort (n = 1303) were invited to take part in a semi-structured interview in Victoria, Australia. Inclusion criteria were informed consent, aged ≥18 years, history of injection drug use, incarcerated for ≥3 months, and released from custody <12 months. The study team analysed data via a candidacy framework to account for macro-structural influences. RESULTS Among 48 participants (33 male; ten Aboriginal), most injected drugs in the prior month (n = 41), with heroin most frequently injected (n = 33) and nearly half (n = 23) were currently on OAT (primarily methadone). Most participants described the navigation and permeability of OAT services in prison as convoluted. If not on OAT pre-entry, prison policies often restricted access, leaving participants to withdraw in cells. In turn, some participants commenced OAT postrelease to ensure OAT continuity of care if reincarcerated. Other participants who experienced delayed access to OAT in prison stated no need to initiate while in prison or postrelease as they were now "clean". Last, implementation of OAT delivery in prison (e.g., lack of confidentiality) frequently led to changes in OAT type to avoid peer violence (pressure to divert OAT). CONCLUSION Findings draw attention to simplistic notions of OAT accessibility in prisons, illuminating how structural determinants influence choice in PWID decision-making. Suboptimal access and acceptability of OAT delivery in prisons will continue to place PWID at risk of harm postrelease (e.g., overdose).
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Sophia E Schroeder
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Mark Stoové
- 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
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Hartung DM, McCracken CM, Nguyen T, Kempany K, Waddell EN. Fatal and nonfatal opioid overdose risk following release from prison: A retrospective cohort study using linked administrative data. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208971. [PMID: 36821990 DOI: 10.1016/j.josat.2023.208971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/08/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Among individuals who are released from prison, opioid overdose is a leading cause of death with a risk more than ten-fold the general population. Although the epidemiology of opioid-related fatalities has been described, few studies have characterized both fatal and nonfatal opioid-related poisonings. The objective of this study was to estimate risk of fatal and nonfatal opioid overdose among adults released from prison. METHODS The study estimated fatal and nonfatal opioid overdose rates using linked corrections, Medicaid, hospital discharge, and vital statistics from the state of Oregon from 2014 to 2018. Multivariable proportional hazards models identified demographic and prison-related factors associated with overdose. RESULTS Between 2014 and 2017, 18,258 individuals were released from prison. A majority of individuals were male (87 %) and ages 26 to 64 (83 %). Two-thirds had a documented substance use disorder treatment need and 20 % demonstrated mental health treatment need. Following prison release, 579 opioid overdose events occurred; 65 (11 %) were fatal. The rate of opioid overdose was 1085.7 per 100,000 person-years (PY). Rates were highest in the first two weeks (2286.7 per 100,000 PY), among women (1582.9 per 100,000 PY), and those with mental health (1624.3 per 100,000 PY) or substance use disorder treatment needs (1382.6 per 100,100 PY). Only mental health (adjusted hazard ratio [aHR] 1.54, 95 % CI 1.24 to 1.90) and substance use need (aHR 2.59; 95 % CI 2.01 to 3.34) remained significant in multivariable models. CONCLUSIONS The rate of opioid overdose is markedly elevated after prison release, particularly in the first two weeks. In women, the higher rate of opioid overdose is mediated by a greater mental health burden.
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Affiliation(s)
- Daniel M Hartung
- College of Pharmacy, Oregon State University, Portland, OR, United States of America.
| | - Caitlin M McCracken
- College of Pharmacy, Oregon State University, Portland, OR, United States of America
| | - Thuan Nguyen
- OHSU-Portland State University School Public Health, Oregon Health & Science University, Portland, OR, United States of America
| | - Katherine Kempany
- Oregon Department of Corrections, Salem, OR, United States of America
| | - Elizabeth Needham Waddell
- OHSU-Portland State University School Public Health, Oregon Health & Science University, Portland, OR, United States of America
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Health and correctional staff acceptability of depot buprenorphine in NSW prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103978. [PMID: 36870227 DOI: 10.1016/j.drugpo.2023.103978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Provision of opioid agonist treatment (OAT) in custodial settings is resource-intensive and may be associated with diversion, non-medical use, and violence. A clinical trial of a new OAT, depot buprenorphine (the UNLOC-T study), provided the opportunity to obtain health and correctional staff perspectives regarding this treatment prior to widespread roll-out. METHODS Sixteen focus groups with 52 participants were conducted, including 44 health staff (nurses, nurse practitioners, doctors, and operational staff) and eight correctional staff. RESULTS Key challenges to providing OAT identified as potentially being addressed by depot buprenorphine included 1) patient access, 2) OAT program capacity, 3) treatment administration procedures, 4) medication diversion and other safety issues and, 5) impact on other service delivery. CONCLUSIONS The introduction of depot buprenorphine into correctional settings was considered to have the potential to increase safety for patients, improve staff / patient relations and advance patient health outcomes via expanded treatment coverage and efficiencies gained through enhanced health service delivery. Support was almost universal from both correctional and health staff participating in this study. These findings build on emerging research regarding the positive impact of more flexible OAT programs and could be used to engage support for the implementation of depot buprenorphine from staff in other secure settings.
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Whaley S, Bandara S, Taylor K, Krawczyk N. Expanding buprenorphine in U.S. jails: One county's response to addressing the fears of diversion. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208944. [PMID: 36880899 DOI: 10.1016/j.josat.2022.208944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/16/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The overdose crisis continues to be a major public health emergency in the United States. While effective medications for opioid use disorder (MOUD), such as buprenorphine, have ample scientific evidence to their effectiveness, they are underutilized in the United States and particularly in criminal justice settings. One rationale against the expansion of MOUD in carceral settings cited by jail, prison, and even Drug Enforcement Administration leaders is the potential for diversion of these medications. However, currently little data exist to support this claim. Instead, successful examples from early expansion states could help to change attitudes and calm misconceptions around diversion fears. RESULTS In this commentary, we discuss the experience of one county jail that successfully expanded buprenorphine treatment and did not suffer significant impacts related to diversion. Instead, the jail found that their holistic and compassionate approach to buprenorphine treatment improved conditions both for incarcerated individuals and jail staff. CONCLUSION Amid a changing policy landscape and a federal commitment to increase access to effective treatments in criminal justice settings, lessons can be learned from jails and prisons that have already or are working toward expansion of MOUD in their facilities. Ideally, these anecdotal examples, in addition to data, will help to encourage more facilities to incorporate buprenorphine into their opioid use disorder treatment strategies.
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Affiliation(s)
- Sara Whaley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Taylor
- Camden County Department of Corrections, Camden, NJ, USA
| | - Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Franchetti G, Thierauf-Emberger A, Franz A, Thoma V, Auwärter V, Huppertz LM. Detection of methadone and buprenorphine in urine samples from inmates of German prisons. Front Psychiatry 2023; 14:1139370. [PMID: 36926464 PMCID: PMC10011066 DOI: 10.3389/fpsyt.2023.1139370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/02/2023] [Indexed: 03/04/2023] Open
Abstract
The use of non-prescribed opioid substitution drugs is a serious public health problem, involving general population as well as vulnerable populations such as prisoners. The estimation of the prevalence of opioid substitution drug misuse in prisoners is crucial to suggest strategies to contrast this phenomenon and reduce the associated morbidity and mortality. The present study aimed to provide an objective estimation of the prevalence of illicit use of methadone and buprenorphine in two German prisons. Urine samples were collected from inmates of Freiburg and Offenburg prisons at random times and tested for the detection of methadone, buprenorphine and their metabolites. Analyses were performed by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. In total 678 inmates participated in this study. The participation rate was about 60% of all permanent inmates. Of the 675 samples suitable for the analysis, 70 samples (10.4%) tested positive for methadone, 70 samples (10.4%) for buprenorphine, and 4 samples (0.6%) for both drugs. At least 100 samples (14.8%) were not associated with reported prescribed-opioid substitution treatment (OST). Buprenorphine was the most common illicitly used drug. In one of the prisons, buprenorphine was brought in from the outside. The present cross-sectional experimental study was able to provide reliable information regarding the illicit use of opioid substitution drugs in prisons.
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Affiliation(s)
- Giorgia Franchetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Padova, Italy.,Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Annette Thierauf-Emberger
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Anette Franz
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Vanessa Thoma
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Laura M Huppertz
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
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Curtis M, Dietze P, Wilkinson AL, Agius PA, Stewart AC, Cossar RD, Butler T, Walker S, Kirwan A, Winter RJ, Stoové M. Discontinuation of opioid agonist treatment following release from prison in a cohort of men who injected drugs prior to imprisonment in Victoria, Australia: A discrete-time survival analysis. Drug Alcohol Depend 2023; 242:109730. [PMID: 36516552 DOI: 10.1016/j.drugalcdep.2022.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Retention in opioid agonist treatment (OAT) following release from prison is associated with improved outcomes, however factors associated with post-release OAT discontinuation in Australia are poorly understood. We examined post-release OAT discontinuation in a cohort of men who engaged in approximately monthly injecting drug use (IDU) prior to imprisonment in Victoria, Australia. METHODS Longitudinal data were used to calculate incidence of first-event post-release OAT discontinuation among men released from prison receiving OAT, and single-event discrete-time survival methods were used to estimate associations with post-release OAT discontinuation. RESULTS Among 110 participants, 55 OAT discontinuations were observed in the two years post-release, an overall crude incidence rate (IR) of 46 per 100 person-years (PY) (95 % confidence interval [95 %CI]: 36-60 per 100PY). Incidence was greatest between release from prison and first follow-up (IR: 84 per 100PY, 95 %CI: 62-116 per 100PY). Initiating OAT during index imprisonment (versus transitioning from community OAT; adjusted hazard rate [AHR]: 2.17, 95 %CI: 1.14-4.13) and identifying as Aboriginal and/or Torres Strait Islander (AHR: 4.95, 95 %CI: 2.00-12.25) were associated with an increased hazard of OAT discontinuation. CONCLUSION In a cohort of men with recent histories of IDU released from prison receiving OAT, half reported OAT discontinuation within two years of release from prison, with incidence of discontinuation greatest soon after prison-release. Targeted support for men who initiate OAT during episodes of imprisonment and Aboriginal and/or Torres Strait Islander peoples is necessary to reduce incidence of OAT discontinuation among people at greatest risk of discontinuation.
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Affiliation(s)
- Michael Curtis
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia.
| | - Paul Dietze
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Anna L Wilkinson
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul A Agius
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ashleigh C Stewart
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Forensic Medicine, Monash University, VIC, Australia; Victorian Institute of Forensic Medicine, Melbourne, VIC, Australia
| | - Reece D Cossar
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- Justice Health Research Program, School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Shelley Walker
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Amy Kirwan
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Rebecca J Winter
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
| | - Mark Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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12
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Ling R, White B, Roberts J, Cretikos M, Howard MV, Haber PS, Lintzeris N, Reeves P, Dunlop AJ, Searles A. Depot buprenorphine as an opioid agonist therapy in New South Wales correctional centres: a costing model. BMC Health Serv Res 2022; 22:1326. [PMID: 36348369 PMCID: PMC9644557 DOI: 10.1186/s12913-022-08687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In 2019 daily liquid methadone and sublingual buprenorphine-naloxone were primary opioid agonist treatments for correctional centres in New South Wales, Australia. However, both had significant potential for diversion to other patients, and their daily administration was resource intensive. An alternative treatment in the form of subcutaneous depot buprenorphine became a viable option following a safety trial in 2020 - the UNLOC-T study. Depot preparation demonstrated advantages over current treatments as more difficult to divert and requiring fewer administrations. This paper reports the results of economic modelling of staffing costs in medication administration comparing depot buprenorphine, methadone, and sublingual buprenorphine provision in UNLOC-T trial facilities. METHODS The costing study adopted a micro-costing approach involving the synthesis of cost data from the UNLOC-T clinical trial as well as data collected from Justice Health and Forensic Mental Health Network records. Labour and materials data were collected during site observations and interviews. Costs were calculated from two payer perspectives: a) the New South Wales (state) government which funds custodial and health services; and b) the Australian Commonwealth government, which pays for medications. The analysis compared the monthly-per-patient cost for each of the three medications in trial-site facilities during July 2019. This was followed by simulation of depot buprenorphine implementation across the study population. Costs associated with medical assessment and reviews were excluded. RESULTS The monthly-per-patient New South Wales government service costs of depot buprenorphine, methadone and sublingual buprenorphine were: $151, $379 and $1,529 respectively while Commonwealth government medication costs were $434, $80 and $525. The implementation simulation found that service costs of depot buprenorphine declined as patients transitioned from weekly to monthly administration. Costs of treatment using the other medications increased as patient numbers decreased alongside fixed costs. At 12 months, monthly-per-patient service costs for depot buprenorphine, methadone and sublingual buprenorphine-which would be completely phased out by month 13-were $92, $530 and $2,162 respectively. CONCLUSIONS Depot buprenorphine was consistently the least costly of the treatment options. Future modelling could allow for dynamic patient populations and downstream impacts for participants and the state health system. TRIAL REGISTRATION ACTRN12618000942257 . Registered 4 June 2018.
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Affiliation(s)
- R Ling
- Hunter Medical Research Institute, University of Newcastle, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Newcastle, Australia.
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - B White
- Drug and Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia
- Drug Health Services, Edith Collins Translational Research Centre, Sydney Local Health District, Camperdown, NSW, Australia
- Speciality of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - J Roberts
- Drug and Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Malabar, NSW, Australia
| | - M Cretikos
- Centre for Population Health, NSW Ministry of Health, St Leonards, NSW, Australia
| | - M V Howard
- Corrective Services New South Wales, Sydney NSW, Australia
| | - P S Haber
- Drug and Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia
- Drug Health Services, Edith Collins Translational Research Centre, Sydney Local Health District, Camperdown, NSW, Australia
- Speciality of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - N Lintzeris
- Drug and Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia
- Speciality of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills, NSW, Australia
| | - P Reeves
- Hunter Medical Research Institute, University of Newcastle, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Newcastle, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - A J Dunlop
- Hunter Medical Research Institute, University of Newcastle, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Newcastle, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - A Searles
- Hunter Medical Research Institute, University of Newcastle, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Newcastle, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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13
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Stijelja S, Mishara BL. Preventing suicidal and self-Injurious behavior in correctional facilities: A systematic literature review and meta-analysis. EClinicalMedicine 2022; 51:101560. [PMID: 35898320 PMCID: PMC9309412 DOI: 10.1016/j.eclinm.2022.101560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Rates of suicide and self-harm are elevated in carceral institutions. Inmates are a vulnerable group since they are exposed to multiple risk factors. This paper critically reviews empirical research on programs to prevent suicidal and self-harmful behaviors in correctional facilities and summarizes effect sizes across studies. METHODS We searched PsychINFO, PubMed, IEEEXPLORE and the CRISE Documentation Centre Database to identify relevant articles published before June 2022. Inclusion criteria were: peer-reviewed and with outcome data on effectiveness of prevention activities. Two reviewers independently assessed 905 articles to determine inclusion eligibility. Quality was assessed by two independent reviewers using the Quality Assessment Tool for Quantitative Studies. Meta-analyses using random-effect models were used to pool effect sizes for each outcome. This review was conducted in accordance with PRISMA guidelines. FINDINGS Twenty-four of the 905 articles, published between 1980 and 2022, were included. Studies were frequently conducted in the United States (n=13; 54%) and used varying study designs; most frequently pre-post with no control group (n=9; 38%). Sample sizes and interventions varied considerably. Most were of moderate quality (n=21; 88%). On average, prevention programs in correctional facilities were effective in decreasing suicide deaths (pooled rate ratio of 0·35 [95% CI 0·23 to 0·55; p<0·001]; I2=68·01%), incidents of self-harm (pooled Hedges'g of -0·54 (95% CI: -1·03 to -0·05; p=0·031]; I2=81·34%), and suicidal ideation (pooled Hedges'g of -0·39 [95% CI: -0·65 to -0·14; p=0·003]; I2=47·09%). INTERPRETATION Prevention activities are effective in reducing suicide death, self-harm and suicidal ideation in correctional settings. Multicomponent programs, which include several preventive activities, seem to be most effective in reducing suicide deaths. Future evaluation studies should control for confounding variables by including control groups, having larger samples and limiting attrition. Standards for suicide prevention in jails and prisons should be included in National suicide prevention strategies. FUNDING None.
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Affiliation(s)
- Stefan Stijelja
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Brian L. Mishara
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Corresponding author at: CRISE-UQAM, C.P. 8888, Succ. Centre-ville, Montréal, Québec H3C 3P8, Canada.
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Scott R, Aboud A, O'Gorman T. Long-acting injectable buprenorphine - 'best practice' opioid agonist therapy for Australian prisoners. Australas Psychiatry 2022; 30:498-502. [PMID: 34852654 DOI: 10.1177/10398562211059086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To consider opioid agonist therapy in prisons. CONCLUSIONS Given the substantial risks of substance misuse by prisoners, long-acting injectable buprenorphine should be adopted as 'best practice' treatment in Australian prison populations.
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Affiliation(s)
- Russ Scott
- Prison Mental Health Service, Brisbane, Queensland, Australia
| | - Andrew Aboud
- Prison Mental Health Service, Brisbane, Queensland, Australia
| | - Thomas O'Gorman
- Metro North Mental Health Alcohol and Drug Service, Brisbane, Queensland, Australia
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15
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Chaillon A, Bharat C, Stone J, Jones N, Degenhardt L, Larney S, Farrell M, Vickerman P, Hickman M, Martin NK, Bórquez A. Modeling the population-level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia. Addiction 2022; 117:1338-1352. [PMID: 34729841 PMCID: PMC9299987 DOI: 10.1111/add.15736] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The individual-level effectiveness of opioid agonist treatment (OAT) in reducing mortality is well established, but there is less evidence on population-level benefits. We use modeling informed with linked data from the OAT program in New South Wales (NSW), Australia, to estimate the impact of OAT provision in the community and prisons on mortality and the impact of eliminating excess mortality during OAT initiation/discontinuation. DESIGN Dynamic modeling. SETTING AND PARTICIPANTS A cohort of 49 359 individuals who ever received OAT in NSW from 2001 to 2018. MEASUREMENTS Receipt of OAT was represented through five stages: (i) first month on OAT, (ii) short (1-9 months) and (iii) longer (9+ months) duration on OAT, (iv) first month following OAT discontinuation and (v) rest of time following OAT discontinuation. Incarceration was represented as four strata: (i) never or not incarcerated in the past year, (ii) currently incarcerated, (iii) released from prison within the past month and (iv) released from prison 1-12 months ago. The model incorporated elevated mortality post-release from prison and OAT impact on reducing mortality and incarceration. FINDINGS Among the cohort, mortality was 0.9 per 100 person-years, OAT coverage and retention remained high (> 50%, 1.74 years/episode). During 2001-20, we estimate that OAT provision reduced overdose and other cause mortality among the cohort by 52.8% [95% credible interval (CrI) = 49.4-56.9%] and 26.6% (95% CrI =22.1-30.5%), respectively. We estimate 1.2 deaths averted and 9.7 life-years gained per 100 person-years on OAT. Prison OAT with post-release OAT-linkage accounted for 12.4% (95% CrI = 11.5-13.5%) of all deaths averted by the OAT program, primarily through preventing deaths in the first month post-release. Preventing elevated mortality during OAT initiation and discontinuation could have averted up to 1.4% (95% CrI = 0.8-2.0%) and 3.0% (95% CrI = 2.1-5.3%) of deaths, respectively. CONCLUSION The community and prison opioid agonist treatment program in New South Wales, Australia appears to have substantially reduced population-level overdose and all-cause mortality in the past 20 years, partially due to high retention.
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Affiliation(s)
- Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicola Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) and Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.,National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
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16
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A National Study of Suicidal Ideation and Suicide Attempt Among Incarcerated People in Iran. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00773-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Dunlop AJ, White B, Roberts J, Cretikos M, Attalla D, Ling R, Searles A, Mackson J, Doyle MF, McEntyre E, Attia J, Oldmeadow C, Howard MV, Murrell T, Haber PS, Lintzeris N. Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings. Addiction 2022; 117:382-391. [PMID: 34184798 PMCID: PMC9291502 DOI: 10.1111/add.15627] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody. DESIGN Open-label, non-randomized trial. SETTING Correctional centres in New South Wales, Australia. PARTICIPANTS Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm. INTERVENTION AND COMPARATOR Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. MEASUREMENTS Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16. FINDINGS Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P < 0.0001). CONCLUSIONS This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.
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Affiliation(s)
- Adrian J. Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health DistrictNewcastleNSWAustralia,School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanNSWAustralia,Drug and Alcohol Clinical Research and Improvement NetworkNSWAustralia
| | - Bethany White
- Drug and Alcohol Clinical Research and Improvement NetworkNSWAustralia,Edith Collins Translational Research Centre, Drug Health Services, Sydney Local Health DistrictCamperdownNSWAustralia,Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
| | - Jillian Roberts
- Drug and Alcohol Clinical Research and Improvement NetworkNSWAustralia,Justice Health and Forensic Mental Health NetworkMalabarNSWAustralia
| | | | - Dena Attalla
- Justice Health and Forensic Mental Health NetworkMalabarNSWAustralia
| | - Rod Ling
- Hunter Medical Research InstituteUniversity of NewcastleNewcastleNSWAustralia
| | - Andrew Searles
- Hunter Medical Research InstituteUniversity of NewcastleNewcastleNSWAustralia
| | - Judith Mackson
- Chief Pharmacist Unit, Legal and Regulatory Services Branch, NSW Ministry of HealthNSWAustralia
| | - Michael F. Doyle
- Edith Collins Translational Research Centre, Drug Health Services, Sydney Local Health DistrictCamperdownNSWAustralia,Centre of Research Excellence Indigenous Health and Alcohol, Central Clinical SchoolUniversity of SydneyCamperdownNSWAustralia
| | | | - John Attia
- School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanNSWAustralia,Hunter Medical Research InstituteUniversity of NewcastleNewcastleNSWAustralia,John Hunter Hospital, Hunter New England Local Health DistrictNew Lambton HeightsNSWAustralia
| | | | | | - Terry Murrell
- Corrective Services New South WalesSydneyNSWAustralia
| | - Paul Steven Haber
- Drug and Alcohol Clinical Research and Improvement NetworkNSWAustralia,Edith Collins Translational Research Centre, Drug Health Services, Sydney Local Health DistrictCamperdownNSWAustralia,Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
| | - Nicholas Lintzeris
- Drug and Alcohol Clinical Research and Improvement NetworkNSWAustralia,Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia,Drug and Alcohol ServicesSouth Eastern Sydney Local Health District, Surry HillsNSWAustralia
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Santo T, Clark B, Hickman M, Grebely J, Campbell G, Sordo L, Chen A, Tran LT, Bharat C, Padmanathan P, Cousins G, Dupouy J, Kelty E, Muga R, Nosyk B, Min J, Pavarin R, Farrell M, Degenhardt L. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:979-993. [PMID: 34076676 PMCID: PMC8173472 DOI: 10.1001/jamapsychiatry.2021.0976] [Citation(s) in RCA: 258] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/01/2021] [Indexed: 12/11/2022]
Abstract
Importance Mortality among people with opioid dependence is higher than that of the general population. Opioid agonist treatment (OAT) is an effective treatment for opioid dependence; however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality. Objective To estimate the association of time receiving OAT with mortality. Data Sources The Embase, MEDLINE, and PsycINFO databases were searched through February 18, 2020, including clinical trial registries and previous Cochrane reviews. Study Selection All observational studies that collected data on all-cause or cause-specific mortality among people with opioid dependence while receiving and not receiving OAT were included. Randomized clinical trials (RCTs) were also included. Data Extraction and Synthesis This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data on study, participant, and treatment characteristics were extracted; person-years, all-cause mortality, and cause-specific mortality were calculated. Crude mortality rates and rate ratios (RRs) were pooled using random-effects meta-analyses. Main Outcomes and Measures Overall all-cause and cause-specific mortality both by setting and by participant characteristics. Methadone and buprenorphine OAT were evaluated specifically. Results Fifteen RCTs including 3852 participants and 36 primary cohort studies including 749 634 participants were analyzed. Among the cohort studies, the rate of all-cause mortality during OAT was more than half of the rate seen during time out of OAT (RR, 0.47; 95% CI, 0.42-0.53). This association was consistent regardless of patient sex, age, geographic location, HIV status, and hepatitis C virus status and whether drugs were taken through injection. Associations were not different for methadone (RR, 0.47; 95% CI, 0.41-0.54) vs buprenorphine (RR, 0.34; 95% CI, 0.26-0.45). There was lower risk of suicide (RR, 0.48; 95% CI, 0.37-0.61), cancer (RR, 0.72; 95% CI, 0.52-0.98), drug-related (RR, 0.41; 95% CI, 0.33-0.52), alcohol-related (RR, 0.59; 95% CI, 0.49-0.72), and cardiovascular-related (RR, 0.69; 95% CI, 0.60-0.79) mortality during OAT. In the first 4 weeks of methadone treatment, rates of all-cause mortality and drug-related poisoning were almost double the rates during the remainder of OAT (RR, 2.01; 95% CI, 1.55-5.09) but not for buprenorphine (RR, 0.58; 95% CI, 0.18-1.85). All-cause mortality was 6 times higher in the 4 weeks after OAT cessation (RR, 6.01; 95% CI, 4.32-8.36), remaining double the rate for the remainder of time not receiving OAT (RR, 1.81; 95% CI, 1.50-2.18). Opioid agonist treatment was associated with a lower risk of mortality during incarceration (RR, 0.06; 95% CI, 0.01-0.46) and after release from incarceration (RR, 0.09; 95% CI, 0.02-0.56). Conclusions and Relevance This systematic review and meta-analysis found that OAT was associated with lower rates of mortality. However, access to OAT remains limited, and coverage of OAT remains low. Work to improve access globally may have important population-level benefits.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
| | - Brodie Clark
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
| | - Matt Hickman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jason Grebely
- Kirby Institute, University of New South Wales, Sydney, Sydney, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
- University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Luis Sordo
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Aileen Chen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
| | | | - Grainne Cousins
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Julie Dupouy
- University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France
- Inserm UMR1027, University of Toulouse III, Faculty of Medicine, Toulouse, France
| | - Erin Kelty
- The School of Population & Global Health, The University of Western Australia, Perth, Australia
| | - Roberto Muga
- Department of Internal Medicine, Germans Trias i Pujol-IGTP University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jeong Min
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Raimondo Pavarin
- Epidemiological Monitoring Center on Addiction, Azienda Unità Sanitaria Locale Bologna, Mental Health Dipartimento Salute Mentale – Dipendenze Patologiche, Bologna, Italy
- Italian Society on Addiction, Milan, Italy
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Sydney, Australia
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Barocas JA. It's Not Them, It's Us: Hepatitis C Reinfection Following Successful Treatment Among People Who Inject Drugs. Clin Infect Dis 2021; 72:1401-1403. [PMID: 32166311 DOI: 10.1093/cid/ciaa258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
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Kaplowitz E, Truong AQ, Macmadu A, Peterson M, Brinkley-Rubinstein L, Potter N, Green TC, Clarke JG, Rich JD. Fentanyl-related overdose during incarceration: a comprehensive review. HEALTH & JUSTICE 2021; 9:13. [PMID: 34013442 PMCID: PMC8133055 DOI: 10.1186/s40352-021-00138-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/05/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration. METHODS We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021. RESULTS Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country. CONCLUSIONS Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives.
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Affiliation(s)
- Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA.
| | - Ashley Q Truong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandria Macmadu
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Meghan Peterson
- Division of General Internal Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Lauren Brinkley-Rubinstein
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Traci C Green
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA
- The Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA
- Department of Emergency Medicine , Brown School of Medicine , RI, Providence, USA
| | | | - Josiah D Rich
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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21
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Vail W, Faro E, Watnick D, Giftos J, Fox AD. Does incarceration influence patients' goals for opioid use disorder treatment? A qualitative study of buprenorphine treatment in jail. Drug Alcohol Depend 2021; 222:108529. [PMID: 33810909 PMCID: PMC10044474 DOI: 10.1016/j.drugalcdep.2021.108529] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Correctional facilities increasingly offer medications for opioid use disorder (OUD), including buprenorphine. Nevertheless, retention in treatment post-incarceration is suboptimal and overdose mortality remains high. Our objectives were to understand how incarcerated patients viewed buprenorphine treatment and identify modifiable factors that influenced treatment continuation post-release. METHODS We conducted semi-structured interviews with 22 men receiving buprenorphine treatment in an urban jail. Interviews were audio recorded, professionally transcribed, and analyzed using a grounded-theory approach. Team members constructed preliminary case memos from transcripts, and then interactively discussed themes within respective memos. We established participant 'typologies' by consensus. RESULTS Distinct typologies emerged based on participants' post-release treatment goals: (1) those who viewed buprenorphine treatment as a cure for OUD; (2) those who thought buprenorphine would help manage opioid-related problems; and (3) those who did not desire OUD treatment. Participants also described common social structural barriers to treatment continuation and community re-integration. Participants reported that post-release housing instability, unemployment, and negative interactions with parole contributed to opioid use relapse and re-incarceration. CONCLUSION Participants had different goals for post-release buprenorphine treatment continuation, but their prior experiences suggested that social structural issues would complicate these plans. Incarceration can intensify marginalization, which when combined with heightened legal supervision, reinforced cycles of release, relapse, and re-incarceration. Participants valued buprenorphine treatment, but other structural and policy changes will be necessary to reduce incarceration-related inequities in opioid overdose mortality.
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Affiliation(s)
- William Vail
- Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, United States; Correctional Health Services, NYC Health + Hospitals, United States.
| | - Elissa Faro
- Department of Pediatrics, Montefiore Medical Center-Albert Einstein College of Medicine, United States
| | - Dana Watnick
- Department of Pediatrics, Montefiore Medical Center-Albert Einstein College of Medicine, United States
| | - Jonathan Giftos
- Correctional Health Services, NYC Health + Hospitals, United States
| | - Aaron D Fox
- Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, United States
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22
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Stone J, Degenhardt L, Grebely J, Larney S, Altice FL, Smyrnov P, Rahimi-Movaghar A, Alavi M, Young AM, Havens JR, Miller WC, Hickman M, Vickerman P. Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis. Lancet Psychiatry 2021; 8:301-309. [PMID: 33640039 PMCID: PMC8255389 DOI: 10.1016/s2215-0366(20)30538-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). METHODS We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020-40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4-11%; prison 0-40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4-14 months to 2 years; and scaling up prison-based OAT. OUTCOMES Drug-related harms contributed differentially to mortality across settings: overdose contributed 27-47% (range of median projections) of preventable drug-related deaths over 2020-40, suicide 6-17%, injury 3-17%, HIV 0-59%, and HCV 2-18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12-24% of preventable drug-related deaths, including 13-22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27-51% of preventable drug-related deaths. INTERPRETATION OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. FUNDING UK National Institute for Health Research, US National Institute on Drug Abuse.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Département de Médecine Famille et de Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alavi
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - April M Young
- Center on Drug and Alcohol Research, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Jennifer R Havens
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William C Miller
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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23
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Stone J, Fraser H, Young AM, Havens JR, Vickerman P. Modeling the role of incarceration in HCV transmission and prevention amongst people who inject drugs in rural Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 88:102707. [PMID: 32151496 PMCID: PMC7483428 DOI: 10.1016/j.drugpo.2020.102707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND People who inject drugs (PWID) experience high incarceration rates, with current/recent incarceration being associated with increased hepatitis C virus (HCV) transmission. We assess the contribution of incarceration to HCV transmission amongst PWID in Perry County (PC), Kentucky, USA, and the impact of scaling-up community and in-prison opioid substitution therapy (OST), including the potential for reducing incarceration. METHODS A dynamic model of incarceration and HCV transmission amongst PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from PC, incorporating an empirically estimated 2.8-fold (95%CI: 1.36-5.77) elevated HCV acquisition risk amongst currently incarcerated or recently released (<6 months) PWID compared to other PWID. We projected the percentage of new HCV infections that would be prevented among PWID over 2020-2030 if incarceration no longer elevated HCV transmission risk, if needle and syringe programmes (NSP) and OST are scaled-up, and/or if drug use was decriminalized (incarceration/reincarceration rates are halved) with 50% of PWID that would have been imprisoned being diverted onto OST. We assume OST reduces reincarceration by 10-42%. RESULTS Over 2020-2030, removing the effect of incarceration on HCV transmission could prevent 42.7% (95% credibility interval: 15.0-67.4%) of new HCV infections amongst PWID. Conversely, scaling-up community OST and NSP to 50% coverage could prevent 28.5% (20.0-37.4%) of new infections, with this increasing to 32.7% (24.5-41.2%) if PWID are retained on OST upon incarceration, 36.4% (27.7-44.9%) if PWID initiate OST in prison, and 45.3% (35.9-54.1%) if PWID are retained on OST upon release. decriminalization (with diversion to OST) could further increase this impact, preventing 56.8% (45.3-64.5%) of new infections. The impact of these OST interventions decreases by 2.1-28.6% if OST does not reduce incarceration. CONCLUSION Incarceration is likely to be an important contributor to HCV transmission amongst PWID in PC. Prison-based OST could be an important intervention for reducing this risk.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
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24
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Initiation of Medications for Opioid Use Disorder Shortly Before Release From Prison to Promote Treatment Retention: Strong Evidence but Compromised Policy. J Addict Med 2020; 15:525-526. [PMID: 33298751 DOI: 10.1097/adm.0000000000000788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Infective endocarditis in intravenous drug users. Trends Cardiovasc Med 2020; 30:491-497. [DOI: 10.1016/j.tcm.2019.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
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26
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Bird SM. Fatal accident inquiries into 83 deaths in Scottish prison custody: 2010-2013. BJPsych Open 2020; 6:e132. [PMID: 33121556 PMCID: PMC7745234 DOI: 10.1192/bjo.2020.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The only non-legal reference in Lord Cullen's Review of fatal accident inquiry (FAI) Legislation in Scotland (2009) was my audit of FAIs into 97 deaths in prison custody in Scotland, 1999-2003: recommending that waiting time from prisoner death to end of FAI should be less than 1 year for 90% of FAIs, and epidemiological rules for FAIs to have a written determination versus formal findings. AIMS Audit of FAIs into 83 deaths in Scottish prison custody in the period 2010-2013. METHOD Assessement of waiting times from prisoner death to end of FAI; dissemination of written determinations; self-inflicted death rate per 1000 prisoner-years; cause of natural deaths; and yellow card submissions. Detailed cross-checking was nec37essary between Scottish Prison Service and courts' websites and the Scottish Fatalities Investigation Unit. RESULTS Of 83 FAIs into deaths in Scottish prison custody, 2010-2013, 37 (45%) were long-awaited (ongoing >2 years after the prisoner's death); 16 (19%, 95% CI 11-28%) beyond 3 years. Of 37 long-awaited FAIs, 27 made written determinations but only 12 of these (44%) were published. Self-inflicted deaths numbered 36: 1.1 per 1000 prisoner-years (95% CI 0.75-1.48). Of 47 deaths from natural causes, cardiovascular disease accounted for 23 (49%, 95% CI 34-63%); liver disease was implicated in 10 of 47. To support pharmacovigilance, submissions were made to Medicines and Healthcare Regulatory Agency for eight deaths (10%, 95% CI 4-19%). CONCLUSIONS FAIs into prisoner deaths in Scotland are too long-awaited given that four (5%) identified precautions that could have prevented death.
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Affiliation(s)
- Sheila M. Bird
- Cambridge University's MRC Biostatistics Unit, UK; and Edinburgh University's College of Medicine and Veterinary Medicine, UK
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27
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Bernard CL, Rao IJ, Robison KK, Brandeau ML. Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis. PLoS Med 2020; 17:e1003239. [PMID: 33048929 PMCID: PMC7553283 DOI: 10.1371/journal.pmed.1003239] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cycles of incarceration, drug abuse, and poverty undermine ongoing public health efforts to reduce overdose deaths and the spread of infectious disease in vulnerable populations. Jail diversion programs aim to divert low-level drug offenders toward community care resources, avoiding criminal justice costs and disruptions in treatment for HIV, hepatitis C virus (HCV), and drug abuse. We sought to assess the health benefits and cost-effectiveness of a jail diversion program for low-level drug offenders. METHODS AND FINDINGS We developed a microsimulation model, calibrated to King County, Washington, that captured the spread of HIV and HCV infections and incarceration and treatment systems as well as preexisting interventions such as needle and syringe programs and opiate agonist therapy. We considered an adult population of people who inject drugs (PWID), people who use drugs but do not inject (PWUD), men who have sex with men, and lower-risk heterosexuals. We projected discounted lifetime costs and quality-adjusted life years (QALYs) over a 10-year time horizon with and without a jail diversion program and calculated resulting incremental cost-effectiveness ratios (ICERs) from the health system and societal perspectives. We also tracked HIV and HCV infections, overdose deaths, and jail population size. Over 10 years, the program was estimated to reduce HIV and HCV incidence by 3.4% (95% CI 2.7%-4.0%) and 3.3% (95% CI 3.1%-3.4%), respectively, overdose deaths among PWID by 10.0% (95% CI 9.8%-10.8%), and jail population size by 6.3% (95% CI 5.9%-6.7%). When considering healthcare costs only, the program cost $25,500/QALY gained (95% CI $12,600-$48,600). Including savings from reduced incarceration (societal perspective) improved the ICER to $6,200/QALY gained (95% CI, cost-saving $24,300). Sensitivity analysis indicated that cost-effectiveness depends on diversion program participants accessing community programs such as needle and syringe programs, treatment for substance use disorder, and HIV and HCV treatment, as well as diversion program cost. A limitation of the analysis is data availability, as fewer data are available for diversion programs than for more established interventions aimed at people with substance use disorder. Additionally, like any model of a complex system, our model relies on simplifying assumptions: For example, we simplified pathways in the healthcare and criminal justice systems, modeled an average efficacy for substance use disorder treatment, and did not include costs associated with homelessness, unemployment, and breakdown in family structure. CONCLUSIONS We found that diversion programs for low-level drug offenders are likely to be cost-effective, generating savings in the criminal justice system while only moderately increasing healthcare costs. Such programs can reduce incarceration and its associated costs, and also avert overdose deaths and improve quality of life for PWID, PWUD, and the broader population (through reduced HIV and HCV transmission).
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Affiliation(s)
- Cora L. Bernard
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
| | - Isabelle J. Rao
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
| | - Konner K. Robison
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
- * E-mail:
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28
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Bukten A, Lund IO, Kinner SA, Rognli EB, Havnes IA, Muller AE, Stavseth MR. Factors associated with drug use in prison - results from the Norwegian offender mental health and addiction (NorMA) study. HEALTH & JUSTICE 2020; 8:10. [PMID: 32399643 PMCID: PMC7218530 DOI: 10.1186/s40352-020-00112-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/01/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Remarkably little is known about drug use during imprisonment, including whether it represents a continuation of pre-incarceration drug use, or whether prison is also a setting for drug use initiation. This paper aims to describe drug use among people in prison in Norway and investigate risk factors associated with in-prison drug use. METHODS We used data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of 1499 individuals in Norwegian prisons. Respondents reported on drug use (narcotics and non-prescribed medications) both before and during imprisonment. We used multivariate logistic regression to investigate the associations between drug use in prison and demographics, previous drug use, mental health, and criminal activity. RESULTS Sixty-five percent of respondents reported lifetime drug use, and about 50% reported daily use of drugs during the 6 months before incarceration. Thirty-five percent reported ever using drugs in prison, but initiation of drug used during incarceration was uncommon. In a multivariate model, factors independently associated with drug use in prison included lifetime number of drugs used (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI] 1.12-1.23; p < 0.001), daily drug use in the 6 months before imprisonment (aOR = 7.12; 95%CI 3.99-12.70; p < 0.001), and being intoxicated while committing the crime related to current imprisonment (aOR = 2.13; 95%CI 1.13-4.03; p = 0.020). CONCLUSIONS In-prison drug use is independently associated with high-risk drug use before imprisonment. To reduce drug use in prison, correctional services must systematically screen for pre-prison drug use and offer effective drug treatment for those in need.
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Affiliation(s)
- Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, 0407, Oslo, Norway.
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway.
| | | | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Public Health, University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
- Mater Research Institute-UQ, University of Queensland, Brisbane, Australia
| | - Eline Borger Rognli
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | | | | | - Marianne Riksheim Stavseth
- Norwegian Centre for Addiction Research, University of Oslo, Kirkveien 166, 0407, Oslo, Norway
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
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29
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Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM Perspect 2020; 2020:202004b. [PMID: 35291732 PMCID: PMC8916813 DOI: 10.31478/202004b] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.
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Affiliation(s)
| | - N Jia Ahmad
- Johns Hopkins Bloomberg School of Public Health
| | - Jenny Wen
- Johns Hopkins University School of Medicine
| | - Joshua Sharfstein Sharfstein
- Johns Hopkins Bloomberg School of Public Health; and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
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30
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Böhmer K, Schecke H, Render I, Scherbaum N. Implementation of opioid maintenance treatment in prisons in North Rhine-Westphalia, Germany - a top down approach. Subst Abuse Treat Prev Policy 2020; 15:21. [PMID: 32156295 PMCID: PMC7065365 DOI: 10.1186/s13011-020-00262-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid Maintenance Treatment (OMT) is a well-evaluated treatment of opioid use disorder (OUD). Especially, under the condition of imprisonment, OMT is a preventive measure regarding infectious diseases such as hepatitis C. However, only a minority of prisoners with OUD are currently in OMT in numerous countries. In 2009, the Ministry of Justice of the federal state of North Rhine-Westphalia (NRW), Germany, launched the process of implementing OMT in prisons with various elements (e.g. development of recommendations regarding the treatment of prisoners with OUD, monitoring the number of prisoners in OMT, education of prison doctors). In the recommendations OMT was defined as the gold standard of treatment of OUD. METHODS To assess the effectiveness of the implementation strategy a survey on the prevalence of OMT in prisons in NRW was carried out twice a year by the Ministry of Justice between 2008 and 2016. Participants were prisoners in NRW, Germany. The diagnosis of OUD at admission to prison and the treatment state on survey dates was measured. RESULTS The number of prisoners in NRW dropped from 17,301 in 2008 to 16,432 in 2016. In the same period, the number of prisoners with OUD (mainly males) dropped from 4201 persons to 3650 persons and the number of prisoners in OMT increased from 139 persons (3.3%) to 1415 (38.7%) persons. DISCUSSION Currently, the percentage of prisoners with OUD in OMT in NRW is almost reaching the treatment rate outside prisons in Germany (45-50%). However, after release from prison there is still a high risk for a discontinuation of OMT. CONCLUSIONS Overall, the top-down approach of implementing OMT in prisons in the federal state of NRW was effective.
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Affiliation(s)
- Kathrin Böhmer
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45 147, Essen, Germany.
| | - Henrike Schecke
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45 147, Essen, Germany
| | - Irmgard Render
- Ministry of Justice of North-Rhine Westphalia, Düsseldorf, Germany
| | - Norbert Scherbaum
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45 147, Essen, Germany
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31
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Barocas JA, Morgan JR, Wang J, McLoone D, Wurcel A, Stein MD. Outcomes Associated With Medications for Opioid Use Disorder Among Persons Hospitalized for Infective Endocarditis. Clin Infect Dis 2020; 72:472-478. [PMID: 31960025 PMCID: PMC7850516 DOI: 10.1093/cid/ciaa062] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/17/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Endocarditis, once predominately found in older adults, is increasingly common among younger persons who inject drugs. Untreated opioid use disorder (OUD) complicates endocarditis management. We aimed to determine if rates of overdose and rehospitalization differ between persons with OUD with endocarditis who are initiated on medications for OUD (MOUDs) within 30 days of hospital discharge and those who are not. METHODS We performed a retrospective cohort study using a large commercial health insurance claims database of persons ≥18 years between July 1, 2010, and June 30, 2016. Primary outcomes included opioid-related overdoses and 1-year all-cause rehospitalization. We calculated incidence rates for the primary outcomes and developed Cox hazards models to predict time from discharge to each primary outcome as a function of receipt of MOUDs. RESULTS The cohort included 768 individuals (mean age 39 years, 51% male). Only 5.7% of people received MOUDs in the 30 days following hospitalization. The opioid-related overdose rate among those who did receive MOUDs in the 30 days following hospitalization was lower than among those who did not (5.8 per 100 person-years [95% confidence interval [CI], 5.1-6.4] vs 7.3 per 100-person years [95% CI, 7.1-7.5], respectively). The rate of 1-year rehospitalization among those who received MOUDs was also lower than those who did not (162.0 per 100 person-years [95% CI, 157.4-166.6] vs 255.4 per 100 person-years [95% CI, 254.0-256.8], respectively). In the Cox hazards models, the receipt of MOUDs was not associated with either of the outcomes. CONCLUSIONS MOUD receipt following endocarditis may improve important health-related outcomes in commercially insured persons with OUD.
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Affiliation(s)
- Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA,Boston University School of Medicine, Boston, Massachusetts, USA,Correspondence: J. A. Barocas, Boston University Medical Campus, 801 Massachusetts Ave, 2nd Fl, Boston, MA 02131 ()
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jianing Wang
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dylan McLoone
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alysse Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine Tufts Medical Center, Boston, Massachusetts, USA,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michael D Stein
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
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Buadze A, Baggio S, Schleifer R, Aeberhard E, Wolff H, Schneeberger A, Liebrenz M. The Accessibility of Opioid Agonist Treatment and Its Forced Discontinuation in Swiss Prisons-Attitudes, Perceptions and Experiences of Defense Lawyers in Dealing With Detained Persons Using Opioids. Front Psychiatry 2020; 11:395. [PMID: 32477183 PMCID: PMC7240251 DOI: 10.3389/fpsyt.2020.00395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opioid agonist treatment (OAT) is an important pillar in the treatment of individuals using opioids and its continuation during imprisonment is recommended. Despite this knowledge access to and continuation of OAT is still limited in many countries. The forced discontinuation during pre-trial detention can cause severe withdrawal symptoms, which in turn may significantly impair the defendant's ability to exercise granted procedural participation rights. Furthermore, it can be argued that forced discontinuation of a desired treatment represents a form of a compulsory intervention. AIMS The present study was developed against the backdrop of a recent ruling by the European Court of Human Rights (Wenner vs. Germany). It intended to examine how defense lawyers dealing with detained persons using opioids view and assess the accessibility of OAT in pre-trial detention as well as during imprisonment in different parts of Switzerland. METHODS Using a qualitative approach, we interviewed 11 defense lawyers from three different cantons of Switzerland with multiple years of experience in providing legal representation to more than 220 defendants using heroin. The interviews were analyzed with QSR NVIVO 11 for Windows. A qualitative content analysis approach was used to evaluate findings. RESULTS Defenders who had been exposed to the opioid crisis during the course of their legal career had adopted a positive attitude towards OAT and associated it with a stabilizing influence on their clients, an improvement in criminal prognosis, and a reduction in recidivism. They were generally of the opinion that access to OAT had improved, however identified a considerable variance in different penitentiaries, which were mediated by attitudes of staff and authorities. Based on the assessments of the defense lawyers, it can be estimated that the initiation of OAT especially during pre-trial detention is challenging. The predominant aim of OAT in a variety of Swiss prisons still seems to focus on a discontinuation, mediated by a forced reduction of medication. Some of the interventions reported are not in line with the principle of equivalence and strongly contrast the recommendations of the Council of Europe.
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Affiliation(s)
- Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Baggio
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.,Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Office of Corrections, Canton of Zurich, Zurich, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Eveline Aeberhard
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Andres Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Psychiatrische Dienste Graubuenden, Chur, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review. PLoS Med 2019; 16:e1003002. [PMID: 31891578 PMCID: PMC6938347 DOI: 10.1371/journal.pmed.1003002] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration. METHODS AND FINDINGS We systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273-131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27-960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15-1,557) and 44 (range 27-382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36-55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research. CONCLUSIONS In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.
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Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis. Mol Psychiatry 2019; 24:1868-1883. [PMID: 29934549 DOI: 10.1038/s41380-018-0094-5] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/27/2018] [Accepted: 04/18/2018] [Indexed: 11/08/2022]
Abstract
Opioid use disorder (OUD) is associated with a high risk of premature death. Medication-assisted treatment (MAT) is the primary treatment for opioid dependence. We comprehensively assessed the effects of different MAT-related characteristics on mortality among those with OUD by a systematic review and meta-analysis. The all-cause and overdose crude mortality rates (CMRs) and relative risks (RRs) by treatment status, different type, period, and dose of medication, and retention time were pooled using random effects, subgroup analysis, and meta-regression. Thirty cohort studies involving 370,611 participants (1,378,815 person-years) were eligible in the meta-analysis. From 21 studies, the pooled all-cause CMRs were 0.92 per 100 person-years (95% CI: 0.79-1.04) while receiving MAT, 1.69 (1.47-1.91) after cessation, and 4.89 (3.54-6.23) for untreated period. Based on 16 studies, the pooled overdose CMRs were 0.24 (0.20-0.28) while receiving MAT, 0.68 (0.55-0.80) after cessation of MAT, and 2.43 (1.72-3.15) for untreated period. Compared with patients receiving MAT, untreated participants had higher risk of all-cause mortality (RR 2.56 [95% CI: 1.72-3.80]) and overdose mortality (8.10 [4.48-14.66]), and discharged participants had higher risk of all-cause death (2.33 [2.02-2.67]) and overdose death (3.09 [2.37-4.01]). The all-cause CMRs during and after opioid substitution treatment with methadone or buprenorphine were 0.93 (0.76-1.10) and 1.79 (1.47-2.10), and corresponding estimate for antagonist naltrexone treatment were 0.26 (0-0.59) and 1.97 (0-5.18), respectively. Retention in MAT of over 1-year was associated with a lower mortality rate than that with retention ≤1 year (1.62, 1.31-1.93 vs. 5.31, -0.09-10.71). Improved coverage and adherence to MAT and post-treatment follow-up are crucial to reduce the mortality. Long-acting naltrexone showed positive advantage on prevention of premature death among persons with OUD.
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Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, Bruneau J, Altice FL, Henderson G, Rahimi-Movaghar A, Larney S. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet 2019; 394:1560-1579. [PMID: 31657732 PMCID: PMC7068135 DOI: 10.1016/s0140-6736(19)32229-9] [Citation(s) in RCA: 411] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022]
Abstract
We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville, Montreal, QC, Canada
| | | | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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Russolillo A, Moniruzzaman A, Somers JM. Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada. PLoS Med 2018; 15:e1002625. [PMID: 30063699 PMCID: PMC6067717 DOI: 10.1371/journal.pmed.1002625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with criminal histories have high rates of opioid dependence and mortality. Excess mortality is largely attributable to overdose deaths. Methadone maintenance treatment (MMT) is one of the best evidence-based opioid substitution treatments (OSTs), but there is uncertainty about whether methadone treatment reduces the risk of mortality among convicted offenders over extended follow-up periods. The objective of this study was to investigate the association between adherence to MMT and overdose fatality as well as other causes of mortality. METHODS AND FINDINGS We conducted a retrospective cohort study involving linked population-level administrative data among individuals in British Columbia (BC), Canada with a history of conviction and who filled a methadone prescription between January 1, 1998 and March 31, 2015. Participants were followed from the date of first-dispensed methadone prescription until censoring (date of death or March 31, 2015). Methadone was divided into medicated (methadone was dispensed) and nonmedicated (methadone was not dispensed) periods and analysed as a time-varying exposure. Hazard ratios (HRs) with 95% CIs were estimated using multivariable Cox regression to examine mortality during the study period. All-cause and cause-specific mortality rates were compared during medicated and nonmedicated methadone periods. Participants (n = 14,530) had a mean age of 34.5 years, were 71.4% male, and had a median follow-up of 6.9 years. A total of 1,275 participants died during the observation period. The overall all-cause mortality rate was 11.2 per 1,000 person-years (PYs). Participants were significantly less likely to die from both nonexternal (adjusted HR [AHR] 0.27 [95% CI 0.23-0.33]) and external (AHR 0.41 [95% CI 0.33-0.51]) causes during medicated periods, independent of sociodemographic, criminological, and health-related factors. Death due to infectious diseases was 5 times lower (AHR 0.20 [95% CI 0.13-0.30]), and accidental poisoning (overdose) deaths were nearly 3 times lower (AHR 0.39 [95% CI 0.30-0.50]) during medicated periods. A competing risk regression demonstrated a similar pattern of results. The use of a Canadian offender population may limit generalizability of results. Furthermore, our observation period represents community-based methadone prescribing and may omit prescriptions administered during hospital separations. Therefore, the magnitude of the protective effects of methadone from nonexternal causes of death should be interpreted with caution. CONCLUSIONS Adherence to methadone was associated with significantly lower rates of death in a population-level cohort of Canadian convicted offenders. Achieving higher rates of adherence may reduce overdose deaths and other causes of mortality among offenders and similarly marginalized populations. Our findings warrant examination in other study centres in response to the crisis of opiate-involved deaths.
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Affiliation(s)
- Angela Russolillo
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julian M. Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Brinkley-Rubinstein L, McKenzie M, Macmadu A, Larney S, Zaller N, Dauria E, Rich J. A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release. Drug Alcohol Depend 2018; 184:57-63. [PMID: 29402680 PMCID: PMC10445765 DOI: 10.1016/j.drugalcdep.2017.11.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
Recently, incarcerated individuals are at increased risk of opioid overdose. Methadone maintenance treatment (MMT) is an effective way to address opioid use disorder and prevent overdose; however, few jails and prisons in the United States initiate or continue people who are incarcerated on MMT. In the current study, the 12 month outcomes of a randomized control trial in which individuals were provided MMT while incarcerated at the Rhode Island Department of Corrections (RIDOC) are assessed. An as-treated analysis included a total of 179 participants-128 who were, and 51 who were not, dosed with methadone the day before they were released from the RIDOC. The results of this study demonstrate that 12 months post-release individuals who received continued access to MMT while incarcerated were less likely to report using heroin and engaging in injection drug use in the past 30 days. In addition, they reported fewer non-fatal overdoses and were more likely to be continuously engaged in treatment in the 12-month follow-up period compared to individuals who were not receiving methadone immediately prior to release. These findings indicate that providing incarcerated individuals continued access to MMT has a sustained, long-term impact on many opioid-related outcomes post-release.
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Affiliation(s)
| | - Michelle McKenzie
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nickolas Zaller
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Emily Dauria
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Josiah Rich
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, United States
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Pricolo A, Nielsen S. Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’ over-the-counter medicine. Drug Alcohol Rev 2017; 37:450-453. [DOI: 10.1111/dar.12547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Suzanne Nielsen
- National Drug and Alcohol Centre; University of New South Wales; Sydney Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
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Darke S, Larney S, Farrell M. Yes, people can die from opiate withdrawal. Addiction 2017; 112:199-200. [PMID: 27514508 DOI: 10.1111/add.13512] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, 2052, New South Wales, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, 2052, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, 2052, New South Wales, Australia
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Resumption of injecting drug use following release from prison in Australia. Drug Alcohol Depend 2016; 168:104-111. [PMID: 27635997 DOI: 10.1016/j.drugalcdep.2016.08.640] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Ex-prisoners with a history of injecting drug use (IDU) experience disproportionate drug-related harm. Rapid resumption of substance use following prison release is common and evidenced in high rates of overdose mortality. However, few studies have documented the rate of IDU resumption following prison release or identified risk factors for relapse. METHODS Structured interviews were conducted with 533 adults with a history of IDU in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post-release. Incidence of self-reported IDU resumption was calculated overall and for each follow-up interval. Risk factors associated with time to resumption of IDU were estimated using discrete-time survival analysis. RESULTS IDU resumption was reported by 41% of participants during a median of 98days of follow-up (IQR=94-121), an overall crude incidence of 1.06 per person-year. The highest rate was observed in the first month (23%; crude incidence 2.24 per person-year). In adjusted discrete-time survival analyses, being unemployed at the previous interview (AHR=1.59; 95%CI:1.10-2.30), shorter incarceration (≤90days vs. >365days; AHR=2.20; 95%CI:1.33-3.65), and IDU during the index incarceration (AHR=2.80; 95%CI:1.92-4.09) were significantly associated with time to IDU resumption; parole was protective (AHR=0.66; 95%CI:0.47-0.92). CONCLUSIONS Evidence-based efforts to prevent IDU in prison and IDU resumption after release are important for both prisoner and public health. Enhancing opportunities for employment and capitalising on the short-term benefits of parole for ex-prisoners may delay resumption of IDU after release from prison. These strategies should complement rather than replace harm reduction efforts for this high-risk population.
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Marzano L, Hawton K, Rivlin A, Smith EN, Piper M, Fazel S. Prevention of Suicidal Behavior in Prisons. CRISIS 2016; 37:323-334. [PMID: 27278569 PMCID: PMC5120691 DOI: 10.1027/0227-5910/a000394] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/09/2016] [Accepted: 01/09/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. AIMS To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. METHOD We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000-2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. RESULTS We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). CONCLUSION Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.
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Affiliation(s)
- Lisa Marzano
- Department of Psychology, Middlesex University, London, UK
| | - Keith Hawton
- Centre for Suicide Research, University of
Oxford, UK
| | | | | | - Mary Piper
- Health and Justice, Health and Wellbeing Directorate, Public Health England, London, UK
| | - Seena Fazel
- Centre for Suicide Research, University of
Oxford, UK
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Larney S, Lai W, Dolan K, Zador D. Monitoring a Prison Opioid Treatment Program Over a Period of Change to Clinical Governance Arrangements, 2007-2013. J Subst Abuse Treat 2016; 70:58-63. [PMID: 27692189 DOI: 10.1016/j.jsat.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/17/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Opioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody. METHOD Data from the NSW prison OST program were obtained for the calendar years 2007-2013. Outcomes were analyzed quarterly using log binomial segmented regression. RESULTS 8577 people were treated with OST in NSW correctional centers, 2007-2013. Over the entire study period, patients were retained in OST until release in 82% of treatment episodes; a prescription for OST was able to be arranged prior to release in 90% of releases; and patients presented to a community clinic within 48 hours of release in 94% of releases with prescriptions. Following the introduction of the changes to clinical governance, there was a significant increasing trend in retention in OST until release, and in provision of an OST prescription at release. There was an initial increase, followed by a decreasing trend, in presentation to a community clinic within 48 hours of release. DISCUSSION This large prison-based OST program has high rates of retention in treatment and continuity of care as patients transition from custody to the community. Strengthened clinical governance arrangements were associated with increased retention in treatment until release and increased provision of an OST prescription at release, but did not improve clinic attendance following release from custody.
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia.
| | - Wilson Lai
- Drug and Alcohol Service, Justice Health and Forensic Mental Health Network, PO, Box 150 Matraville NSW, 2036, Australia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia
| | - Deborah Zador
- Drug and Alcohol Service, Justice Health and Forensic Mental Health Network, PO, Box 150 Matraville NSW, 2036, Australia
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44
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Mohlman MK, Tanzman B, Finison K, Pinette M, Jones C. Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont. J Subst Abuse Treat 2016; 67:9-14. [PMID: 27296656 DOI: 10.1016/j.jsat.2016.05.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 11/26/2022]
Abstract
In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions.
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Affiliation(s)
- Mary Kate Mohlman
- Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA.
| | - Beth Tanzman
- Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA
| | - Karl Finison
- Onpoint Health Data, 254 Commercial Street, Suite 257, Portland, ME 04101, USA
| | - Melanie Pinette
- Onpoint Health Data, 254 Commercial Street, Suite 257, Portland, ME 04101, USA
| | - Craig Jones
- Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA
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45
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Kourounis G, Richards BDW, Kyprianou E, Symeonidou E, Malliori MM, Samartzis L. Opioid substitution therapy: Lowering the treatment thresholds. Drug Alcohol Depend 2016; 161:1-8. [PMID: 26832931 DOI: 10.1016/j.drugalcdep.2015.12.021] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of "treatment thresholds", and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes. METHOD We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015. RESULTS Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs. CONCLUSION Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.
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Affiliation(s)
- Georgios Kourounis
- St George's University of London, Medical School at the University of Nicosia, Agiou Nikolaou Street 93, Engomi, 2408 Nicosia, Cyprus; Department of Addiction Psychiatry, Athalassa Psychiatric Hospital, Cyprus Mental Health Services, Leoforos Lemesou 199/2, 1452 Nicosia, Cyprus
| | - Brian David Wensley Richards
- St George's University of London, Medical School at the University of Nicosia, Agiou Nikolaou Street 93, Engomi, 2408 Nicosia, Cyprus; Department of Addiction Psychiatry, Athalassa Psychiatric Hospital, Cyprus Mental Health Services, Leoforos Lemesou 199/2, 1452 Nicosia, Cyprus
| | - Evdokia Kyprianou
- Cyprus Anti-Drugs Council, Leoforos Lemesou 130, City Home 81, 2015 Strovolos, Cyprus
| | - Eva Symeonidou
- Cyprus Anti-Drugs Council, Leoforos Lemesou 130, City Home 81, 2015 Strovolos, Cyprus
| | - Minerva-Melpomeni Malliori
- Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 72, 74, Vassil. Sophias Avenue, 11528 Athens, Greece
| | - Lampros Samartzis
- St George's University of London, Medical School at the University of Nicosia, Agiou Nikolaou Street 93, Engomi, 2408 Nicosia, Cyprus; Department of Addiction Psychiatry, Athalassa Psychiatric Hospital, Cyprus Mental Health Services, Leoforos Lemesou 199/2, 1452 Nicosia, Cyprus.
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Larney S, Degenhardt L, Farrell M. Response to Bird et al.: The importance of post-release engagement in treatment in estimating impacts on post-release deaths. Addiction 2016; 111:560-1. [PMID: 26589456 DOI: 10.1111/add.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia. .,Alpert Medical School, Brown University, Providence, RI, USA .
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - M Farrell
- 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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48
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Gisev N, Shanahan M, Weatherburn DJ, Mattick RP, Larney S, Burns L, Degenhardt L. A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence. Addiction 2015. [PMID: 26212260 DOI: 10.1111/add.13073] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Although opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6 months post-release. DESIGN Population-based, retrospective data linkage study using records of OST entrants (1985-2010), charges and court appearances (1993-2011), prison episodes (2000-11) and death notifications (1985-2011). SETTING New South Wales, Australia. PARTICIPANTS A cohort of 16,073 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011. INTERVENTION OST treatment compared to no OST treatment at prison release. MEASUREMENTS Mortality and costs (treatment, criminal justice system-court, penalties, prison-and the social costs of crime) were evaluated at 6 months post-release. Analyses included propensity score matching, bootstrapping and regression. FINDINGS A total of 13,468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14,356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500. CONCLUSION Opioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6 months of release.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Don J Weatherburn
- New South Wales Bureau of Crime Statistics and Research (BOCSAR), Sydney, New South Wales, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Australia, 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
| | - Lucy Burns
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, 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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49
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Bird SM, Fischbacher CM, Graham L, Fraser A. Impact of opioid substitution therapy for Scotland's prisoners on drug-related deaths soon after prisoner release. Addiction 2015; 110:1617-24. [PMID: 25940815 PMCID: PMC4744745 DOI: 10.1111/add.12969] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/13/2015] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drug-related deaths (DRD) within 14 days after prison release. DESIGN Linkage of Scotland's prisoner database with death registrations to compare periods before (1996-2002) and after (2003-07) prison-based OST was introduced. SETTING All Scottish prisons. PARTICIPANTS People released from prison between 1 January 1996 and 8 October 2007 following an imprisonment of at least 14 days and at least 14 weeks after the preceding qualifying release. MEASUREMENTS Risk of DRD in the 12 weeks following release; percentage of these DRDs which occurred during the first 14 days. FINDINGS Before prison-based OST (1996-2002), 305 DRDs occurred in the 12 weeks after 80 200 qualifying releases, 3.8 per 1000 releases [95% confidence interval (CI) = 3.4-4.2]; of these, 175 (57%) occurred in the first 14 days. After the introduction of prison-based OST (2003-07), 154 DRDs occurred in the 12 weeks after 70 317 qualifying releases, a significantly reduced rate of 2.2 per 1000 releases (95% CI = 1.8-2.5). However, there was no change in the proportion which occurred in the first 14 days, either for all DRDs (87: 56%) or for opioid-related DRDs. CONCLUSIONS Following the introduction of a prison-based opioid substitution therapy (OST) policy in Scotland, the rate of drug-related deaths in the 12 weeks following release fell by two-fifths. However, the proportion of deaths that occurred in the first 14 days did not change appreciably, suggesting that in-prison OST does not reduce early deaths after release.
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50
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White N, Ali R, Larance B, Zador D, Mattick RP, Degenhardt L. The extramedical use and diversion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine-naloxone film. Drug Alcohol Rev 2015; 35:76-82. [DOI: 10.1111/dar.12317] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Nancy White
- Discipline of Pharmacology; School of Medical Sciences; University of Adelaide; Adelaide Australia
| | - Robert Ali
- Discipline of Pharmacology; School of Medical Sciences; University of Adelaide; Adelaide Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Deborah Zador
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Richard P. Mattick
- 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
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