The impact of opioid substitution therapy on mortality post-release from prison

Response to Bird et al.: The importance of post‐release engagement in treatment in estimating impacts on post‐release deaths

“…Recent work in the United States comparing usual care (in this instance, forced withdrawal from OST) to continued OST demonstrated that entry to community OST within 1 month of prison release was twice as likely among those who remained in OST while in custody [5]. These findings [3,5,7] suggest that examining outcomes of prison OST in isolation from the broader context of treatment as a process that continues prior to, during and after imprisonment is inadequate for understanding treatment effects. We urge researchers in this field to take into account the complementary impacts of OST in prison and post-release.…”

“…We have undertaken this work previously in New South Wales, Australia. In this setting, OST provided in prison reduced deaths in custody [6]; OST in prison immediately prior to release was highly protective against post-release death in the short term, but ongoing OST in the community was needed to maintain this protective effect [3]. Similar findings have been reported in relation to re-incarceration; although OST in prison does not, itself, protect against re-incarceration, remaining in OST when transitioning from custody to the community is associated with a 20% decrease in the risk of re-incarceration [7].…”

“…Bird & Hutchinson were among the first to highlight the risk of post-release mortality and the importance of addressing this particular risk [2]. Opioid substitution therapy (OST) while in custody has been proposed as a means to decrease post-release drug-related deaths, through maintenance of opioid tolerance and reduced likelihood of illicit opioid use [3,4] and improved linkage to treatment after release [5].…”

Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study

“…Receipt of OST in prison also reduces illicit opioid use and injecting drug use,24 27 and is associated with reduced institutional drug charges 28. Opioid-dependent prisoners who receive OST are more likely than their untreated peers to enrol in OST following release,29 and continuation of OST on release is associated with reduced reincarceration30 and reduced postrelease mortality 31…”

Opioid substitution therapy as a strategy to reduce deaths in prison: Retrospective cohort study

“…28 Opioid-dependent prisoners who receive OST are more likely than their untreated peers to enrol in OST following release, 29 and continuation of OST on release is associated with reduced reincarceration 30 and reduced postrelease mortality. 31 Although we have demonstrated a very strong protective effect of OST against death in prison for opioiddependent prisoners, several questions remain to be answered. This study was undertaken in a jurisdiction with relatively high OST coverage.…”