The impact of opioid substitution therapy on mortality post‐release from prison: retrospective data linkage study

Degenhardt, Louisa; Larney, Sarah; Kimber, Jo; Gisev, Natasa; Farrell, Michael; Dobbins, Timothy; Weatherburn, Don; Gibson, Amy; Mattick, Richard P.; Butler, Tony; Burns, Lucy

doi:10.1111/add.12536

Cited by 182 publications

(184 citation statements)

References 38 publications

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“…11,45 Maintenance programs decrease mortality by approximately 50% among persons with opioid-use disorders, decrease acquisition of HIV infection and hepatitis, decrease crime and illicit-substance use, improve social functioning, and increase the rate of retention in rehabilitation programs. 15,50,54,55 Buprenorphine Maintenance…”

Section: Methadone Maintenance Approachesmentioning

confidence: 99%

Treatment of Opioid-Use Disorders

Benumof

2016

N Engl J Med

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Section: Methadone Maintenance Approachesmentioning

confidence: 99%

Treatment of Opioid-Use Disorders

Benumof

2016

N Engl J Med

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“…Being enrolled in OMT is clearly protective against mortality [58] ; however, it has to be considered that patients frequently cycle in and out of treatment, with treatment dropout being a time of particularly high overdose risk [3] . The excess overdose mortality risk may be related to relapse to illicit (poly-)drug use.…”

Section: Future Challenges To Address In Treatment Approaches Across mentioning

confidence: 99%

“…In addition, patients who drop out of treatment may be those with the largest psychiatric burden at high risk for suicide by intentional overdose [59,60] . Thus, scaling-up harm reduction measures [30,58] and ensuring a high OMT coverage in the community as well as in prison [61] , while also supporting patients in their recovery oriented goals [62] , are vital to improve outcomes.…”

Section: Future Challenges To Address In Treatment Approaches Across mentioning

confidence: 99%

Opioid Maintenance Treatment - A Call for a Joint European Quality Care Approach

Brandt¹,

Unger²,

Moser

et al. 2015

Eur Addict Res

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Aims: The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. Methods: Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). Results: The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). Conclusion: Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.

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“…The paper by Degenhardt et al [4] is therefore a welcome addition to the literature and represents a valuable contribution to informing evidence-based harm reduction responses in the criminal justice sector. The study makes the most of large, population-level data sets from one Australian jurisdiction, combined through data linkage, to examine the relationships between OST utilization, incarceration and mortality.…”

mentioning

confidence: 98%

Commentary on Degenhardt et al. (2014): Access to opioid substitution therapy in prison is not enough—the crucial role of post‐release retention in preventing drug‐related harms

Stoové

Kinner

2014

Addiction

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Commentary on Degenhardt et al. (2014): Access to opioid substitution therapy in prison is not enough-the crucial role of post-release retention in preventing drug-related harmsPrison opioid substitution therapy (OST) programmes have expanded considerably over the past decade in line with compelling evidence of the effectiveness of community-based OST programmes in reducing the health and social harms associated with injecting drug use [1]. Prison OST programmes have demonstrated utility in reducing heroin use, injecting and syringesharing in prison and increasing post-release treatment entry and retention [2]. But despite release from prison being identified as a particularly vulnerable period for drug-related mortality [3], there remains limited evidence of the impact of OST on post-release mortality [2].The paper by Degenhardt et al. [4] is therefore a welcome addition to the literature and represents a valuable contribution to informing evidence-based harm reduction responses in the criminal justice sector. The study makes the most of large, population-level data sets from one Australian jurisdiction, combined through data linkage, to examine the relationships between OST utilization, incarceration and mortality. Although these data are not without limitations, especially those related to unobserved confounding factors, the considerable population coverage and extensive retrospective time-period support the authors' contention that their findings represent 'unequivocal evidence' that providing prisoners with OST and, crucially, retaining them in OST as they transition into the community, will save lives.The impact of programme retention in reducing mortality is the most compelling finding reported by Degenhardt et al. Beyond simply making OST available, their findings highlight the importance of effective systems to retain people in OST as they transition from prison to the community and beyond. The more than eightfold reduced risk of drug-related mortality associated with OST retention in the immediate post-release period underscores the crucial role transitional OST programmes play in reducing drug-related harms. In this regard, it is encouraging that in more than 80% of incarceration episodes where OST was accessed, OST was also provided upon release. However, the high mortality risk in the initial post-release period also recommends other responses. Provision of naloxone with appropriate training [5], including through prison release programmes [6], is critical to reducing drug-related mortality in recently released prisoners [7]. Degenhardt et al. provide potentially useful data to inform the targeting of naloxone provision to those most at risk, including those who may face barriers to accessing and being retained on OST.While Degenhardt et al. replicate the immediate spike in post-release drug-related deaths demonstrated by others [3], it is important to note that most drug-related deaths in their cohort occurred after this 'high-risk period'. A focus on OST retention in the acute postrelease period ...

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The impact of opioid substitution therapy on mortality post‐release from prison: retrospective data linkage study

Abstract: In New South Wales, Australia, opioid substitution therapy in prison and post-release appears to reduce mortality risk in the immediate post-release period.

Cited by 182 publications

References 38 publications

Treatment of Opioid-Use Disorders

Treatment of Opioid-Use Disorders

Opioid Maintenance Treatment - A Call for a Joint European Quality Care Approach

Commentary on Degenhardt et al. (2014): Access to opioid substitution therapy in prison is not enough—the crucial role of post‐release retention in preventing drug‐related harms

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