The effect of entry and retention in opioid agonist treatment on contact with the criminal justice system among opioid-dependent people: a retrospective cohort study

Abstract

Summary Background Evidence on the effectiveness of opioid agonist treatment (OAT) in reducing crime is mixed. We aimed to assess the effect of OAT on crime in terms of delaying time to first charge and reducing overall charge rates, as well as the relationship between OAT retention and overall charge rates. Methods We did a retrospective cohort study of opioid-dependent people who entered OAT for the first time between Jan 1, 2004, and Dec 30, 2010, in New South Wales (NSW), Australia. We used three linked NSW and national administrative datasets. Data on OAT were obtained from the Pharmaceutical Drugs of Addiction System, data on charges were obtained from the Reoffending Database, and data on mortality were obtained from the National Death Index. The cohort was followed up until Dec 31, 2011. Time-dependent OAT exposure was modelled using Cox proportional hazards models (time to first charge) and Andersen-Gill intensity models (total charge-days). Retention in OAT was modelled using two features of treatment engagement, number of OAT episodes and proportion of follow-up time in OAT (presented in quartile groupings: lowest, low-mid, low-high, highest) using zero-inflated negative binomial regression (total charges). All models were adjusted for sociodemographic, criminographic, and treatment-related variables. Findings 10 744 new OAT entrants were included in the study. 5751 (53·5%) people were charged with an offence. In adjusted analyses, OAT was associated with an initial benefit in delaying the time to first charge (hazard ratio 0·43, 95% CI 0·33–0·55) and reducing total charge-days (0·39, 95% CI 0·30–0·52); however, these protective effects reduced over time. Total charge rates were higher as the number of OAT episodes increased (incident rate ratio [IRR] 1·13, 95% CI 1·11–1·15), and when relatively lower proportions of time were spent in OAT (IRR among the lowest three quartiles ranged from 1·11 [95% CI 1·02–1·21] to 1·22 [95% CI 1·12–1·33]). Interpretation OAT was associated with a reduction in overall charge rates and was more protective as treatment engagement increased. Maximising treatment retention is crucial to achieving long-term health and social benefits of OAT.

The effect of person, treatment and prescriber characteristics on retention in opioid agonist treatment: a 15‐year retrospective cohort study

“…Used in this context, they are termed opioid agonist treatment (OAT) and have been classified as essential medicines by the World Health Organization [3]. Both have been shown to be effective in reducing illicit opioid use [4] and multiple adverse events among people with opioid dependence [5], including: transmission of HIV and hepatitis C virus [6,7], contact with the criminal justice system [8,9] and mortality [10]. Long‐term use of OAT is recommended [11–13], and retention in OAT is often used as a core outcome in evaluations of treatment effectiveness [14].…”

Individual and structural correlates of willingness for intravenous buprenorphine treatment among people who inject sublingual buprenorphine in France

“…Oral methadone and sublingual buprenorphine are considered gold standards for OAT as both are effective in reducing illicit opioid use and increasing treatment retention [ 1 , 2 ]. Accessibility and retention in OAT treatment have also been associated with reduced morbidity and mortality (in particular regarding overdoses and viral infections) in people who use drugs, as well as improved social outcomes [ 3 – 5 ]. In France, naloxone-free sublingual buprenorphine (i.e., Subutex® and generics) has been widely available in primary care settings since 1996 thanks to its good safety profile [ 6 ].…”

Opioids in COVID-19: Two Sides of a Coin

“…In addition, those individuals might use other substances that are also nervous system depressants such as alcohol and benzodiazepines ( Stowe et al, 2020 ; Thylstrup et al, 2020 ). Another relevant factor affecting this group is the shortage of methadone and buprenorphine, medicines used to treat opioid use disorder, since the delivery of this medication in the pandemic context might be harmed, which might have led to treatment discontinuation and a return to the use of illegal opioids ( Magura and Rosenblum, 2001 ; Elliott et al, 2017 ; Sordo et al, 2017 ; Degenhardt et al, 2019 ; Gisev et al, 2019 ).…”