Determining the Impact of Opioid Substitution Therapy upon Mortality and Recidivism among Prisoners: A 22 Year Data Linkage Study

By Gisev, Natasa; Larney, Sarah et al. | Trends & Issues in Crime and Criminal Justice, June 2015 | Go to article overview

Determining the Impact of Opioid Substitution Therapy upon Mortality and Recidivism among Prisoners: A 22 Year Data Linkage Study


Gisev, Natasa, Larney, Sarah, Kimber, Jo, Burns, Lucy, Weatherburn, Don, Gibson, Amy, Dobbins, Tim, Mattick, Richard, Butler, Tony, Degenhardt, Louisa, Trends & Issues in Crime and Criminal Justice


Prisoners are one of the most vulnerable groups in the community, experiencing high rates of mental illness, drug and alcohol dependence, chronic health conditions, exposure to violence, stigmatisation, social isolation and mortality (Kariminia et al. 2007). The World Health Organization (WHO 2010: np) states that

[prisoners are members of the general population: they come from and usually return to the community. The relation between the health of prisoners, their families and the wider community is thus an acute concern.

Crime also carries costs to the wider community-impacts upon public amenity, financial loss, personal/property damage and the public health burden associated with premature morbidity and mortality of prisoners.

Prisoners have elevated rates of heroin dependence relative to the general population (Butler et al. 2004). Heroin dependence significantly impacts public health and public order, and has the greatest Impact of all illicit drugs in Australia and globally (Begg et al. 2007; Degenhardt et al. 2013b).

Opioid dependence is commonly managed through the use of opioid substitution therapy (OST-methadone or buprénorphine maintenance), which is effective in achieving a number of positive treatment outcomes (Mattick et al. 2014)

Using a population of opioid-dependent people in New South Wales, Australia, the aims of the current study were to examine the:

* natural history of criminal justice system involvement among opioid dependent people, 1993-2011;

* extent of imprisonment of opioid dependent people, 2000-12;

* potential differences in the impacts of buprénorphine and methadone on treatment retention and mortality;

* differences in OST engagement and crime among Aboriginal and Torres Strait Islanders;

* gender differences In OST engagement;

* association between retention in OST and crime among opioid-dependent people;

* impact of OST provision in prison on inprison mortality;

* impact of OST on mortality following release from prison; and

* cost effectiveness of OST in reducing mortality post-release among this group.

Many of these results have already been published, or are currently in the process of being peer-reviewed for publication. For that reason, the key findings from each piece of work are summarised here and interested readers are directed to full details in the published works.

Methods

Datasets

This study involved the linkage of four datasets:

* Pharmaceutical Drugs of Addiction System (PHDAS) at the NSW Department of Health.

* National Death Index (NDI) at the Australian Institute of Health and Welfare.

* Offender Integrated Management System at the NSW Department of Corrective Services.

* Reoffending Database (ROD) at the Bureau of Crime Statistics and Research (BOCSAR).

The Pharmaceutical Drugs of Addiction System

PHDAS is a database of all methadone and buprénorphine recipients in New South Wales, as notified to the NSW Pharmaceutical Services Branch since 1985. Clients in the PHDAS are fully identified and the database records each client's full name, date of birth, sex, treatment entry and exit dates, the type of OST medicine received, the approved prescriber, the treatment setting (community or prison) and the reason for exiting treatment.

National Death Index

The NDI is a database held by the Australian Institute of Health and Welfare and contains fully identified mortality data collected from each of the state and territory Births, Deaths and Marriage Registers. It collects information including date, state and causes of death (primary causes for all records, secondary causes for deaths occurring 1997 and later).

Offender Integrated Management System

The Offender Integrated Management System is an administrative database of the NSW Department of Corrective Services. An extract from this system's fully identified 'Prisoner database' was used to obtain demographic and criminographic information about all adults in full-time custody in New South Wales. …

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