Stimulant use disorder diagnosis and opioid agonist treatment dispensation following release from prison: a cohort study

Abstract

Background Concurrent opioid and stimulant use is on the rise in North America. This increasing trend of use has been observed in the general population, and among people released from prison in British Columbia (BC), who face an elevated risk of overdose post-release. Opioid agonist treatment is an effective treatment for opioid use disorder and reduces risk of overdose mortality. In the context of rising concurrent stimulant use among people with opioid use disorder, this study aims to investigate the impact of stimulant use disorder on opioid agonist treatment dispensation following release from prison in BC. Methods Linked health and corrections records were retrieved for releases between January 1st 2015 and December 29th 2018 (N = 13,380). Hospital and primary-care administrative health records were used to identify opioid and stimulant use disorder and mental illness. Age, sex, and health region were derived from BC’s Client Roster. Incarceration data were retrieved from provincial prison records. Opioid agonist treatment data was retrieved from BC’s provincial drug dispensation database. A generalized estimating equation produced estimates for the relationship of stimulant use disorder and opioid agonist treatment dispensation within two days post-release. Results Cases of release among people with an opioid use disorder were identified (N = 13,380). Approximately 25% (N = 3,328) of releases ended in opioid agonist treatment dispensation within two days post-release. A statistically significant interaction of stimulant use disorder and mental illness was identified. Stratified odds ratios (ORs) found that in the presence of mental illness, stimulant use disorder was associated with lower odds of obtaining OAT [(OR) = 0.73, 95% confidence interval (CI) = 0.64–0.84)] while in the absence of mental illness, this relationship did not hold [OR = 0.89, 95% CI = 0.70–1.13]. Conclusions People with mental illness and stimulant use disorder diagnoses have a lower odds of being dispensed agonist treatment post-release compared to people with mental illness alone. There is a critical need to scale up and adapt opioid agonist treatment and ancillary harm reduction, and treatment services to reach people released from prison who have concurrent stimulant use disorder and mental illness diagnoses.

Creating an 11-year longitudinal substance use harm cohort from linked health and census data to analyze social drivers of health

“…This makes the cohort population younger and healthier than the Canadian population. Substance use harm events occurring in correctional settings and following release are well documented and particularly prevalent immediately following release, [36][37][38][39][40][41][42][43][44][45] when many individuals are without an address or are residing in a group home so are not likely to be included with CanCHEC data. A recent scoping review also suggests that prescription misuse is a growing concern among older adults in Canada, 46 suggesting that harm events in nursing homes may also be missed in the CanCHEC data.…”

Factors associated with obtaining prescribed safer supply among people accessing harm reduction services: findings from a cross-sectional survey

“…Furthermore, data on history of incarceration and recent contact with the criminal legal system were not collected in this study and could be prioritized in future studies, given the known associations between incarceration and elevated overdose risk in BC (48, 49) and barriers to community health, harm reduction, and treatment services facing this population (50)(51)(52). Number of participants receiving one or more Prescribed Safer Supply medication, by medication type Footnote: The N=81 PSS recipients include: Opioids (N=55); Stimulants (N=27); Benzo (N=8).…”

“Shared experience makes this all possible”: documenting the guiding principles of peer-led services for people released from prison

“…Upon return to community, the most immediate needs facing this population are income and social support to obtain basic needs, including access to food, clothing, and safe and stable housing [ 5 , 6 ]. Alongside these immediate basic needs, are significant service needs to address the disproportionately high rates of chronic physical health problems faced by people who have been incarcerated, often coupled with the need for health system support to address mental health and or substance use needs [ 7 , 8 ].…”