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

Sarah Larney, Natasa Gisev, Michael Farrell, Timothy Dobbins, Lucinda Burns, Amy Gibson, Jo Kimber, Louisa Degenhardt

    Research output: Contribution to journalArticlepeer-review

    70 Citations (Scopus)

    Abstract

    Objectives: To describe deaths in prison among opioid-dependent people, and examine associations between receipt of opioid substitution therapy (OST) and risk of death in prison. Design: Retrospective cohort study. Setting: Adult prisons in New South Wales (NSW), Australia. Participants: 16 715 opioid-dependent people who were received to prison between 2000 and 2012. Interventions: Opioid substitution therapy. Primary outcome measures: Natural and unnatural (suicide, drug-induced, violent and other injury) deaths in prison. Results: Cohort members were in prison for 30 998 person-years (PY), during which time there were 51 deaths. The all-cause crude mortality rate (CMR) in prison was 1.6/1000 PY (95% CI 1.2 to 2.2/1000 PY), and the unnatural death CMR was 1.1/1000 PY (95% CI 0.8 to 1.6/1000 PY). Compared to time out of OST, the hazard of all-cause death was 74% lower while in OST (adjusted HR (AHR): 0.26; 95% CI 0.13 to 0.50), and the hazard of unnatural death was 87% lower while in OST (AHR: 0.13; 95% CI 0.05 to 0.35). The all-cause and unnatural death CMRs during the first 4 weeks of incarceration were 6.6/1000 PY (95% CI 3.8 to 10.6/1000 PY) and 5.5/1000 PY (95% CI 2.9 to 9.4/1000 PY), respectively. Compared to periods not in OST, the hazard of all-cause death during the first 4 weeks of incarceration was 94% lower while in OST (AHR: 0.06; 95% CI 0.01 to 0.48), and the hazard of unnatural death was 93% lower while in OST (AHR: 0.07; 95% CI 0.01 to 0.53). Conclusions: Mortality of opioid-dependent prisoners was significantly lower while in receipt of OST.
    Original languageEnglish
    Article numbere004666
    Number of pages9
    JournalBMJ Open
    Volume4
    Issue number4
    DOIs
    Publication statusPublished - 2014

    Open Access - Access Right Statement

    © The Authors. BMJ Open. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

    Fingerprint

    Dive into the research topics of 'Opioid substitution therapy as a strategy to reduce deaths in prison : retrospective cohort study'. Together they form a unique fingerprint.

    Cite this