%0 Journal Article
%T Does exposure to opioid substitution treatment in prison reduce the risk of death after release? A national prospective observational study in England
%J Addiction
%D 2017
%A Marsden, John
%A Stillwell, Garry
%A Jones, Hayley
%A Cooper, Alisha
%A Eastwood, Brian
%A Farrell, Michael
%A Lowden, Tim
%A Maddalena, Nino
%A Metcalfe, Chris
%A Shaw, Jenny
%A Hickman, Matthew
%V 112
%N 8
%P 1408-1418
%X BACKGROUND AND AIMS: People with opioid use disorder (OUD) in prison face an acute risk of death after release. We estimated whether prison-based opioid substitution treatment (OST) reduces this risk. <br><br>DESIGN: Prospective observational cohort study using prison healthcare, national community drug misuse treatment and deaths registers. SETTING: Recruitment at 39 adult prisons in England (32 male; 7 female) accounting for 95% of OST treatment in England during study planning. PARTICIPANTS: Adult prisoners diagnosed with OUD (recruited: September 2010 to August 2013; first release: September 2010; last release: October 2014; follow-up to February 2016; n = 15,141 in the risk set). INTERVENTION AND COMPARATOR At release, participants were classified as OST exposed (n = 8,645) or OST unexposed (n = 6,496). The OST unexposed group did not receive OST, or had been withdrawn, or had a low dose. MEASUREMENTS: Primary outcome: all-cause mortality (ACM) in the first 4 weeks. SECONDARY OUTCOMES: drug-related poisoning (DRP) deaths in the first 4 weeks; ACM and DRP mortality after 4 weeks to 1 year; admission to community drug misuse treatment in the first 4 weeks. Unadjusted and adjusted cox regression models (covariates: sex, age, drug injecting, problem alcohol use, use of benzodiazepines, cocaine, prison transfer and admission to community treatment), tested difference in mortality rates and community treatment uptake. <br><br>FINDINGS: In the first 4 weeks after prison release, there were 24 ACM deaths: 6 in the OST exposed group and 18 in the OST unexposed group (mortality rate 0.93 per 100 person years [PY] versus 3.67 per 100 PY; Hazard Ratio [HR] 0.25; 95% Confidence interval [CI] 0.10 to 0.64). There were 18 DRP deaths: OST exposed group mortality rate 0.47 per 100 PY versus 3.06 per 100 PY in the OST unexposed group (HR 0.15; 95% CI 0.04 to 0.53). There was no group difference in mortality risk after the first month. The OST exposed group was more likely to enter drug misuse treatment in the first month post-release (odds ratio 2.47, 95% CI 2.31 to 2.65). The OST mortality protective effect on ACM and DRP mortality risk was not attenuated by demographic, overdose risk factors, prison transfer or community treatment (fully adjusted HR 0.25; 95% CI 0.09 to 0.64 and HR 0.15; 95% CI 0.04 to 0.52, respectively). <br><br>CONCLUSIONS: In an English national study, prison-based opioid substitution therapy was associated with a 75% reduction in all-cause mortality and an 85% reduction in fatal drug-related poisoning in the first month after release.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>
%G en
%I John Wiley and Sons
%@ 0965-2140
%U http://dx.doi.org/10.1111/add.13779