title: Incarceration and drug use patterns among a cohort of injection drug users.
abstract: OBJECTIVE
  Drug law enforcement remains the dominant response to drug-related harm. However, the impact of incarceration on deterring drug use remains under-evaluated. We sought to explore the relationship between incarceration and patterns of drug use among people who inject drugs (IDU).
  
  
  METHODS
  Using generalized estimating equations (GEE), we examined the prevalence and correlates of injection cessation among participants in the Vancouver Injection Drug User Study followed over 9 years. In subanalyses, we used McNemar's tests and linear growth curve analyses to assess changes in drug use patterns before and after a period of incarceration among participants reporting incarceration and those not incarcerated.
  
  
  RESULTS
  Among 1603 IDU, 842 (53%) reported injection cessation for at least 6 months at some point during follow-up. In multivariate GEE analyses, recent incarceration was associated negatively with injection cessation [adjusted odds ratio (AOR) = 0.43, 95% confidence interval (CI) 0.37-0.50], whereas the use of methadone was associated positively with cessation (AOR = 1.38, 95% CI 1.22-1.56). In subanalyses assessing longitudinal patterns of drug use among incarcerated individuals and those not incarcerated over the study period, linear growth curve analyses indicated that there were no statistically significant differences in patterns of drug use between the two groups (all P > 0.05).
  
  
  CONCLUSIONS
  These observational data suggest that incarceration does not reduce drug use among IDU. Incarceration may inhibit access to mechanisms that promote injection cessation among IDU. In contrast, results indicate that methadone use is associated positively with injection cessation, independent of previous frequency of drug use.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Kathy
authors.initials: K
authors.lastname: Li
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D035846:Law Enforcement / Q000379:methods; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D011050:Policy Making; D015995:Prevalence; D011330:Prisons / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000534:rehabilitation; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone