Factors associated with drug use in prison - results from the Norwegian offender mental health and addiction (NorMA) study

Caries and periodontal health status of male inmates: a retrospective study conducted in a French prison

PURPOSE

The purpose of this study is to describe the oral health status of inmates. The secondary aims were to compare recidivists with first-time offenders and also study the impact of psychoactive drugs on the oral health status.

DESIGN/METHODOLOGY/APPROACH

This retrospective study included 120 male inmates from a French prison. Data from the medical and the dental questionnaires and examinations were collected and analyzed.

FINDINGS

The results showed that overall, the inmates had a poor oral health despite their young age. This population was at high risk regarding caries and periodontal diseases due to sedentary behaviors, improper diet, drug, alcohol and tobacco consumption. In total, 93% of inmates had at least one decayed untreated tooth and 95% had periodontal disease. The use of psychoactive drugs seemed strongly related to oral health status degradation. However, the comparison between recidivists and first-time offenders showed few differences.

PRACTICAL IMPLICATIONS

The need for periodontal and dental care is considerable in this population and increased in this environment where risk factors such as addictive behaviors and poor eating habits are common. The impact of psychoactive drugs on oral health should also be taken into consideration.

SOCIAL IMPLICATIONS

Unfortunately, even though strategies for the prevention and management of oral health in prisons have been put in place for some years, the results still seem insufficient.

ORIGINALITY/VALUE

There are still few studies that analyze the impact of this medication on oral health in prisons.

Using nominal group technique to identify perceived barriers and facilitators to improving uptake of the Prison Needle Exchange Program in Canadian federal prisons by correctional officers and healthcare workers

BACKGROUND

Elimination of bloodborne viruses including HIV and hepatitis C virus from prisons requires high coverage of evidence-based interventions that prevent bloodborne virus transmission, including needle and syringe programs. Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake identified by correctional officers and healthcare workers.

METHODS

Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group. We identified the highest-ranking responses (≥10 % of the overall votes) to questions about barriers and facilitators to PNEP uptake.

RESULTS

Between September 2023 and February 2024, 16 focus groups were conducted with 118 participants (n = 51 correctional officers; n = 67 healthcare workers). Among correctional officers, the top perceived barriers were bullying from peers (22 %), fear of being targeted by correctional officers (14 %), and fear of repercussions due to drug use (13 %). The top facilitators were safe injection sites (30 %), provision of wrap-around services (16 %), and education of correctional officers (10 %). Among healthcare workers, the top perceived barriers were lack of confidentiality (16 %), fear of being targeted by correctional officers (12 %), and a long and complex application process (11 %). The top facilitators were education of correctional officers (29 %), delivery of PNEP by an external provider (15 %), automatic approval for participation in the PNEP (13 %), and safe injection sites (12 %).

CONCLUSION

Multiple modifiable barriers and solutions to improving PNEP uptake in Canadian federal prisons were identified by correctional employees. Both participant groups identified the potential for safe injection sites and education to correctional officers as enabling PNEP uptake. These data will inform Canadian efforts to improve engagement and to expand PNEP coverage.

Extent and patterns of drug use in prison in Burkina Faso: findings from a cross-sectional study in central prison of Ouagadougou

PURPOSE

Drug use in prisons remains a public health concern because it is often the place of drug initiation. The purpose of this study was to analyze the drug use in prison in Burkina Faso.

DESIGN/METHODOLOGY/APPROACH

We conducted cross-sectional study in the prison of Ouagadougou. The adult prisoners (male and female) incarcerated for more than one month at the largest prison of Burkina Faso were included in the study. Participants were selected using a systematic random sampling. Data were collected from October 28 to November 26, 2018. The face-to-face interviews were conducted in the prison grounds. Logistic multivariate regression was used to identify factors associated with in prison drug use. All analysis was done using Stata.

FINDINGS

A total of 379 prisoners were included in this study. Approximately one-third inmates (32.71%; n = 124) experienced illicit drug in lifetime. Nearly one-third (28.76%; n = 109) of the prisoners were drug users before incarceration and 11.87% (n = 45) used drug inside the prison, of which 33.33% (n = 15) initiated drug use in the prison. Cannabis was the first drug used by the prisoners (71.11%) followed by tramadol (62.22%), diazepam (13.33%) and cocaine (2.22%). Four prisoners (3.63%) had reported Heroin use before incarceration. Cannabis was mainly smoked. Tramadol, diazepam and amphetamines were swallowed or mixed with food. Cocaine is smoked and snorted. Case of injection of cocaine and heroin was reported before incarceration. Main factors independently associated with drug use in prison is drug use before prison and young age of inmates. Indeed, inmates who had reported drug use before prison had 4.01 time {adjusted odd ratio (AOR: 4.01 [95% CI: 1.91-8.41])} higher odds to use drug in prison.

RESEARCH LIMITATIONS/IMPLICATIONS

To conduct the interviews in the prison grounds could be a limitation due to social desirability bias. Indeed, the prisoners may understate drug use in prison for the fear of likely additional sentence. Availability of biological tests for drug markers might help addressed this bias. Nevertheless, the findings of this study should help to plan effective drug use prevention and care programs for prisoners.

PRACTICAL IMPLICATIONS

The actions must include the implementation of a medical and psychological care in continuum of healthcare system in Burkina Faso. This system should include screening at entry and adequate health and psychological care in prison for drug users for an effective control of drugs use in prison.

SOCIAL IMPLICATIONS

Most of these drug users in prison have a low level of education and are unemployed. Education activities and training on occupational activities to prepare drug users for a successful social reintegration less dependent on drugs is essential. This study can be a basis to explore more possibilities and find out what is available to help those with substance use disorder, manage these cases in prison and prevent relapse on release.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study is the first study on drug use in prison in Burkina Faso. It indicates that the repressive strategy against drug use seems ineffective because former users continue their consumption inside and also new users are initiated to use drugs in prison.

Cardiovascular risk assessment of people living in prison in the Northern region of Ghana

PURPOSE

The health of people living in prisons (PLP) frequently remains marginalised in national development discourse, particularly in resource-constrained settings like Ghana. This study aims to determine the prevalence of cardiovascular disease (CVD) risk factors among PLP at a prison facility in the Northern Region of Ghana.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study involving 134 male persons in prison, aged 18-79 years, was conducted to assess their dietary habits, tobacco use, alcohol consumption, sleep behaviour and physical activity practices. Serum lipid profile, fasting blood glucose (FBG), blood pressure (BP) and body mass indices of participants were also measured.

FINDINGS

Almost half (48.1%) of the participants had abnormal lipid levels. Those with FBG in the diabetes range (= 7.0 mmol/l) constituted 3.9%, while 16.7% were in the impaired FBG range (6.1-6.9 mmol/l). Participants with BP within the pre-hypertension range were 54.5%. The majority of participants (92%) had a low daily intake of fruits and vegetables. Few participants were active smokers (5%) and alcohol users (2%). The average sleep duration at night among the participants was 5.54 ± 2.07 h. The majority (74%) of the participants were sedentary. About a quarter of the participants (24.6%) had overweight/obesity.

ORIGINALITY/VALUE

This study highlights the CVD risks among PLP. Findings suggest the need for targeted interventions, such as dietary and lifestyle modification strategies, regular physical activity and routine screening for diabetes, dyslipidaemia and hypertension. These interventions within the prison space could significantly improve the cardiovascular health of PLP in resource-limited settings.

Factors associated with drug use in prison: A systematic review of quantitative and qualitative evidence

BACKGROUND

About a third of people use drugs during their incarceration, which is associated with multiple adverse health and criminal justice outcomes. Many studies have examined factors associated with in-prison drug use, but this evidence has not yet been systematically reviewed. We aimed to systematically review and synthesise the evidence on factors related to drug use in prison.

METHODS

Three databases (PubMed, PsycINFO and Embase) were systematically searched as well as grey literature, for quantitative, qualitative and mixed-methods studies examining factors related to drug use inside prison. We excluded studies that did not explicitly measure in prison drug use or only measured alcohol and/or tobacco use. Study quality was assessed using the Newcastle Ottawa Scale (NOS) for quantitative studies and Critical Appraisal Skills Programme (CASP) for qualitative studies. The review was prospectively registered on PROSPERO (CRD42021295898).

RESULTS

Fifty-four studies met the inclusion criteria, reporting data on 26,399 people in prison. Most studies were of low or moderate-quality, and all used self-report to assess drug use. In quantitative studies, studies found that previous criminal justice involvement, poor prison conditions, pre-prison drug use and psychiatric diagnosis were positively associated with drug use in prison. In qualitative studies, reasons for drug use were closely linked to the prison environment lacking purposeful activity and the social context of the prison whereby drug use was seen as acceptable, necessary for cohesion and pressurised.

CONCLUSION

In the first systematic review of factors associated with drug use in prison, key modifiable risk factors identified from quantitative and qualitative studies were psychiatric morbidity and poor prison conditions. Non-modifiable factors included previous drug use and criminal history linked to substance use. Our findings indicate an opportunity to intervene and improve the prison environment to reduce drug use and associated adverse outcomes.

Synthetic cannabinoid use in an adult male prison in the UK

INTRODUCTION

Synthetic cannabinoids (i.e. Spice) are a major public health problem in UK prisons, however, research in this area is limited. Here we aimed to draw comparisons between people with and without experience of using synthetic cannabinoids in prison, to characterise the features of, and motivations for use within this setting and evaluate support for different treatment interventions.

METHOD

Questionnaires were administered to 122 people in a category-B prison for adult males in England between July 2022 and March 2023. Participants were asked questions related to their sociodemographic and custodial characteristics, use of synthetic cannabinoids (and other drugs) inside and outside of prison and psychological distress was measured via the Brief Symptom Inventory (BSI-18). Those that had ever used synthetic cannabinoids in prison completed additional questions related to features of use, motivations for use and support for various interventions.

RESULTS

In total 46.7 % (n = 57) of participants reported use of synthetic cannabinoids in prison and this group experienced significantly greater levels of psychological distress compared to those reporting no use (mean (± standard deviation) BSI-18 scores = 23.7 (±16.7) vs 12.8 (±13.6), p < 0.001). Participants mostly reported using paper-based preparations (77.4 %) and use via e-cigarettes (75.9 %). The most strongly endorsed motivations for use included to alleviate boredom (91.1 % strongly agree/agree), to make the sentence pass faster (89.3 % strongly agree/agree) and to cope with stress (80.4 % strongly agree/agree). The interventions that received most support were strategies to better manage time and medication to manage withdrawal.

CONCLUSIONS

The use of synthetic cannabinoids in UK prisons typically involves the use of paper-based preparations via e-cigarettes, and use is associated with greater levels of psychological distress. Motivations for use were mostly pragmatic (e.g. to alleviate boredom or cope with stress) and interventions should prioritise increasing the time individuals spend out of cells and in meaningful activity.

Leaving Their Drugs at the Gate? Exploring Changes in Drug Use From Before to During Incarceration in Norway

As the number of incarcerated persons who use drugs increases in many countries, it is important to understand the nature of drug use in prison by exploring how substance use patterns change from before to during incarceration. In this study, we rely on cross-sectional, self-report data from The Norwegian Offender Mental Health and Addiction (NorMA) study to identify the nature of changes in drug use among incarcerated respondents who reported having used either narcotics, non-prescribed medications, or both, during the 6 months before their incarceration (n = 824). Results show that about 60% (n = 490) stop using drugs. Of the remaining 40% (n = 324), about 86% changed their use patterns. Most commonly, incarcerated people stopped using stimulants and started using opioids; switching from cannabis to stimulants was the least common change. Overall, the study illustrates that the prison context leads most individuals to change their use patterns, some in unanticipated ways.

Prevalence of drug use before and during imprisonment in seven European countries (2014-2018)

Substance use is a global phenomenon that is particularly affecting the prison population. This study aimed to describe the prevalence of drug use among people in prison before and during incarceration in seven European countries and to compare it with the prevalence in the general population. Individual data collection was carried out between 2014 and 2018 with a model European Questionnaire on Drug Use among people in prison. A total of 12,918 people living in prison filled in the survey. People in prison report higher level of drug use when compared with the general population and the use of drug inside prison exist, although at lower levels when compared with predetention. Prisons can represent a point of access to engage individuals who use drugs in interventions that address drug use and risk factors related to both drug use and imprisonment.

The health needs of people leaving prison with a history of methamphetamine and/or opioid use

INTRODUCTION

Methamphetamine use is more common than opioid use among prison entrants in some countries, including Australia, yet most research and policy focuses on opioid use. This suggests that traditional opioid-focused interventions are no longer appropriate for the majority of this group in countries such as Australia. To inform policy and practice, we compared socio-demographic characteristics and health needs of people leaving prison with a history of methamphetamine use and/or opioid use.

METHODS

A cross-sectional survey of incarcerated adults administered the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test was used to identify moderate-/high-risk methamphetamine use (n = 909), opioid use (n = 115) or combined methamphetamine/opioid use (n = 356) before incarceration. We compared groups using modified log-linked Poisson regression with robust error variance.

RESULTS

Compared to the opioid-only group, the methamphetamine-only group were: significantly more often aged <25 years; significantly more likely to identify as Indigenous; significantly less likely to have a history of prior incarceration, drug injection or overdose. A significantly lower proportion of methamphetamine-only and methamphetamine-and-opioid participants self-reported current hepatitis C infection compared to opioid-only participants. A majority of participants in all groups screened positive for current psychological distress according to the K10.

DISCUSSION AND CONCLUSIONS

People leaving prison with a history of methamphetamine use differ from opioid users with respect to demographics, patterns of substance use and related health concerns. Treatment and harm reduction efforts for people who experience incarceration must respond to patterns of drug use in this population, and invest at scale in coordinated, continuous services for co-occurring substance use and mental health problems.

The association between drug use and mortality in a norwegian prison cohort: a prospective cohort study

BACKGROUND

Elevated mortality rates are found among people who have experienced incarceration, even long after release from prison. The mechanisms related to this excess mortality are complex products of both individual and situational factors. The aim of this study was to describe all-cause and cause-specific mortality among people with a history of imprisonment, and to examine both individual and situational factors associated with mortality.

METHODS

In this prospective cohort study we used baseline survey data from the Norwegian Offender Mental Health and Addiction (NorMA) study (N = 733) linked with data from the Norwegian Cause of Death Registry during eight years of follow-up (2013-2021).

RESULTS

At end of follow-up, 56 persons (8%) of the cohort were deceased; 55% (n = 31) due to external causes such as overdoses or suicides, and 29% (n = 16) to internal causes such as cancer or lung disease. Having a score > 24 on the Drug Use Disorders Identification Test (DUDIT), indicating likely drug dependence was highly associated with external causes of death (OR 3.31, 95% CI 1.34-8.16), while having a job before baseline imprisonment had a protective effect on all-cause mortality (OR 0.51, ,95% CI 0.28-0.95).

CONCLUSIONS

High DUDIT score at baseline were highly associated with external causes of death, even years after the DUDIT screening was done. Screening incarcerated people using validated clinical tools, such as the DUDIT, together with initiation of appropriate treatment, may contribute to reduced mortality in this marginalized population.

Drug use before and during imprisonment: Drivers of continuation

BACKGROUND

Many people who enter prison have recently used drugs in the community, a substantial portion of whom will continue to do so while incarcerated. To date, little is known about what factors may contribute to the continuation of drug use during imprisonment.

METHODS

Self-reported data were collected from a random sample of 1326 adults (123 women) incarcerated across 15 prisons in Belgium. Multivariate regression was used to investigate associations between in-prison drug use and sociodemographic background, criminological profile, drug-related history, and mental health among participants who reported pre-prison drug use.

RESULTS

Of all 1326 participants, 719 (54%) used drugs in the 12 months prior to their incarceration and 462 (35%) did so while in prison. There was a strong association between drug use before and during imprisonment (OR = 6.77, 95% CI 5.16-8.89). Of those who recently used drugs in the community, half (52%) continued to do so while incarcerated. Factors independently associated with continuation (versus cessation) were young age, treatment history, polydrug use, and poor mental health. In a secondary analysis, initiation of drug use while in prison was further related to incarceration history and low education.

CONCLUSION

Persistence of drug use following prison entry is common. People who continue to use drugs inside prison can be differentiated from those who discontinue in terms of drug-related history and mental health. Routine screening for drug use and psychiatric morbidity on admission to prison would allow for identifying unmet needs and initiating appropriate treatment.

Exploring the Intersection of Drug Addiction and Mental Ill-Health in Scottish Prisons: A Qualitative Study of Incarcerated Men

This article presents insights from small-scale qualitative research exploring the intertwining nature of drug addiction and mental ill-health among men in Scottish prisons. Semi-structured interviews were conducted with 24 men in two Scottish prisons. The men’s narratives suggested that increased tension in prison halls had stimulated a huge surge in the use of New Psychoactive Substances (NPS), in turn increasing and deepening existing mental ill-health and violence. They believed health care in the prisons to be of low quality, and that methadone was prescribed as a mechanism for social control. Implications for future policy, practice and research are outlined.

Psychiatric disorders and comorbidity in a Spanish sample of prisoners at the end of their sentence: Prevalence rates and associations with criminal history

Introduction

This study examined, for the first time, the prevalence of mental disorders and comorbidities among inmates who were about to be released, and their association with criminal history.

Methods

A Spanish sample of 140 prisoners at the end of their sentence was recruited from an occupational program. Psychiatric disorders were determined according to the Diagnostic and Statistical Manual of Mental Disorders criteria. Bivariate analyses followed by multivariate regression models were conducted to identify significant variables for repeat incarceration and violent offending.

Results

The lifetime prevalence of Axis I disorders was 81.4%, with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) being the most common diagnoses (51.4 and 31.4%, respectively). The current prevalence of Axis I disorders was 59.0%, including learning disorders (38.6%), ADHD (16.4%), and SUD (5.71%) among the most frequent syndromes. Thirty-six (26.5%) participants met criteria for a current Axis II disorder, which commonly was an antisocial personality disorder (12.5%). The majority of the sample (60.8%) suffered from two or more comorbid disorders during their lifetime, although the current prevalence fell to 23.3%. Childhood ADHD increased the number of imprisonments, while inmates convicted of a violent crime were more likely to present a learning disorder. Having a lifetime diagnosis of SUD or multiple psychiatric disorders appeared to be associated with both repeat incarceration and violent offending.

Conclusion

Given the high rate of mental disorders still present among subjects completing prison sentences and the challenges they may encounter to benefit from vocational programs, our results suggest that appropriate psychiatric care should be provided during imprisonment and after release to facilitate their community reintegration.

Factors associated with risk related to the use of psychoactive substances by men deprived of their liberty

Objective:

to evaluate the factors associated with risk related to the use of psychoactive substances in male inmates of a prison in a city in the South of Brazil.

Method:

a cross-sectional data from 220 men deprived of liberty, inmates of a provisional custody institution in the State of Paraná, collected with a screening instrument and questionnaire. Binary logistic regression and odds ratio analysis were used to verify associations between risk related to substance use and socio-demographic characteristics of living conditions before incarceration and current incarceration.

Results:

the adjusted model revealed association of consumption with skin color brown/black and yellow, those who had only one parent responsible until age 15, age at first arrest 18 or older, professing religion, working before arrest, owning their own house, living alone, receiving visitors in prison.

Conclusion:

the identified factors are useful to insert effective treatment proposals and reduce the gaps and social vulnerability existing in prison.

Factores asociados al riesgo relacionado con el uso de sustancias psicoactivas por hombres privados de libertad

Resumen Objetivo: evaluar los factores asociados al riesgo relacionado con el uso de sustancias psicoactivas en hombres internados en una prisión, en un municipio en el Sur de Brasil. Método: datos transversales de 220 hombres privados de libertad, internados en una institución de custodia provisional, en el estado de Paraná, recolectados con instrumento de rastreo y cuestionario. Se utilizó el análisis de regresión logística binaria y la razón de chances para verificar asociaciones entre el riesgo relacionado con el uso de sustancias psicoactivas y las características sociodemográficas, de las condiciones de vida antes del encarcelamiento y del encarcelamiento actual. Resultados: el modelo ajustado reveló asociación del consumo con: el color de la piel marrón/negra y amarilla; aquellos que tuvieron apenas uno de los padres responsables hasta los 15 años de edad; edad de la primera prisión con 18 años o más; profesar religión; trabajar antes de la prisión; residencia propia; vivir solo; y, recibir visitas en la prisión. Conclusión: los factores identificados son útiles para introducir propuestas de tratamientos eficaces y reducir los vacíos y la vulnerabilidad social existentes en la prisión.

Latent class analysis of self-reported substance use during incarceration: Gender differences and associations with emotional distress and aggressiveness

INTRODUCTION

We know little about the prevalence and patterns of substance use during incarceration, and we know even less about comparative substance use patterns by gender. To address these gaps in the literature, this study used latent class analysis (LCA) to identify substance use subgroups of incarcerated men (n = 1118) and women (n = 207).

METHODS

The study drew data from six prisons in Spain. Participants completed a self-administered questionnaire with items probing for types of drugs used in the past three months, depression, anxiety, stress symptoms, aggressiveness, and perceived social support.

RESULTS

Substance use was common among incarcerated men and women, with tobacco, cannabis, and sedatives being most prevalent. LCA revealed different patterns of substance use by gender. Four- and two-class solutions best fitted the data for men and women, respectively. Aggressiveness and depression were associated with high depressant use membership for men. Among women, aggressiveness and anxiety symptoms were positively associated with high polydrug use membership.

CONCLUSIONS

The prevalent and patterned use of substances inside Spanish prisons and their association with aggressiveness and depression elevates the risk of harm during incarceration. In the interest of safety and wellness, correctional behavioral health services should include and expand the availability of gender-specific integrated mental health and substance use interventions that address maladaptive behaviors such as aggression.

Scopolamine fatal outcome in an inmate after buscopan® smoking

Scopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic receptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died in the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults had been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic autopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema and lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in peripheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide at 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate were also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to use any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption of prescribed drugs could avoid fatal acute intoxication.

Use of anabolic-androgenic steroids and other substances prior to and during imprisonment - Results from the Norwegian Offender Mental Health and Addiction (NorMA) study

BACKGROUND

Anabolic-androgenic steroid (AAS) use is associated with health problems and substance use. Substance use is common among inmates. This study aims to estimate lifetime and prison use of AAS and other substances, compare characteristics of groups of inmates, and describe factors associated with AAS use in a national prison population.

METHODS

Data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of people in prisons, included sociodemographic variables and lifetime and prison use of AAS and other substances. Altogether 1,499 inmates, including 96 (6.4%) women, were divided into three mutually exclusive groups according to lifetime AAS use, non-AAS substance use and no substance use.

RESULTS

Lifetime AAS use was reported by 427 (28.5%) inmates; 6 women and 421 men. Non-AAS substance use was reported by 593 (39.6%) and 479 (31.9%) had never used AAS or non-AAS substances. Compared to the non-AAS substance group, the AAS group reported younger debut ages for nearly all non-AAS substances, higher mean number of non-AAS substances used in their lifetime (8.9, 6.6, p < 0.001), during the six months prior to incarceration (5.2, 3.1, p < 0.001), and during (2.3, 1.3, p < 0.001) imprisonment. Although 120 (8.0%) inmates used AAS during the six months prior to incarceration, only ten continued during imprisonment.

CONCLUSIONS

Lifetime AAS use is common among inmates and may be an indicator of more severe substance use problems. Screening for previous and present AAS use at incarceration and increased staff awareness are needed to tailor treatment approaches appropriately.