Utilization of opioid agonist therapy among incarcerated persons with opioid use disorder in Vancouver, Canada

Abstract

Background: Inability to access opioid agonist therapy (OAT) in correctional settings has previously been reported in Vancouver, Canada, and is associated with harms among people with opioid use disorder (OUD), including overdose death. We investigated the prevalence and correlates of OAT utilization within correctional settings among incarcerated persons with OUD in Vancouver. Methods: Data were derived from three prospective cohorts of people who use drugs in Vancouver between 2005 and 2016. Using multivariable generalized estimating equations, we examined factors associated with OAT utilization among participants with OUD reporting incarceration in the past six months. Results: Among 597 eligible participants, 207 (34.7%) contributed 325 reports of having utilized OAT while incarcerated. Of those, 295 (90.8%) were continuations and 30 (9.2%) were new initiations of OAT while incarcerated. For those currently on OAT (at the time of interview), in multivariable analyses, non-fatal overdose (adjusted odds ratio [AOR]=0.49, 95% confidence interval [CI]: 0.29–0.82) and daily prescription opioid use (AOR=0.42, 95% CI: 0.20–0.85) remained independently and negatively associated with having utilized OAT while incarcerated. For those not currently on OAT, none of the variables considered had significant associations with utilization of OAT while incarcerated. Conclusions: Utilization of OAT in correctional settings was low in our sample. Utilization of OAT was significantly and negatively associated with overdose and ongoing prescription opioid misuse if OAT was continued upon release from correctional settings. Findings underscore the urgent need for improved utilization of OAT in correctional settings, and linkage to community care to prevent harms such as overdose.

Substance Use and Overdose Risk: Documenting the Perspectives of Formerly Incarcerated Persons in the Fraser East Region of BC

“…Further, increased risk of overdose was understood as associated with decreased tolerance as a result of incarceration and was perceived as a signi cant risk following release from prison. Interventions should prioritize harm reduction in the form of OAT during imprisonment to reduce the risk of fatal overdoses due to decreased tolerance 5,7 . Post-incarceration release is a time when relapse can occur and that transition back to community should support connection to harm reduction services and treatment services 12,20 .…”

“…The relationship between recent incarceration and risk of overdose has been well-documented in the literature. Previous research has shown that a large proportion of incarcerated persons around the world, and in Canada speci cally, report a history of substance use 7,8 . In the US, it has been estimated that up to half of incarcerated peoples have a substance use disorder (SUD) 9 .…”

Determination of Common Pharmaceutical Adulterants in Herbal Medicinal Products Used in the Treatment of Opioid Addiction

“…None detected 11.8 to drug overdose, misuse, and side effects, especially among high-risk individuals [6,7]. Based on this view, an increased interest in the administration of herbal remedies is considered an alternative pharmacotherapy modality for opioid addiction.…”

“…These treatments play an effective role in improving opioid abuse/ addiction outcomes [5]. Unfortunately, the utilization of OAT is associated with the high risk of drug overdose, misuse, undesirable side effects, and drug interactions, especially among individuals in correctional settings or the complications of HIV disease [6,7]. Moreover, the effectiveness of OAT is limited by difficulties at all levels of the therapeutic process, such as diagnosis, entry, and persistence of the patients on treatment; it also needs training health care professionals for the treatment and prevention of opioid abstinence syndrome during the therapy [1].…”

Substance use and overdose risk: documenting the perspectives of formerly incarcerated persons in the Fraser East region of BC

“…The relationship between recent incarceration and risk of overdose has been well-documented in the literature. Previous research has shown that a large proportion of incarcerated persons around the world, and in Canada specifically, report a history of substance use [ 3 , 4 ]. In the USA, it has been estimated that up to half of incarcerated peoples have a substance use disorder (SUD) [ 5 ].…”