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


METHODS
Retrospective cohort study.


METHODS
Adult prisons in New South Wales (NSW), Australia.


METHODS
16 715 opioid-dependent people who were received to prison between 2000 and 2012.


METHODS
Opioid substitution therapy.


METHODS
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.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Sarah
S
Larney
Natasa
N
Gisev
Michael
M
Farrell
Timothy
T
Dobbins
Lucinda
L
Burns
Amy
A
Gibson
Jo
J
Kimber
Louisa
L
Degenhardt
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D062787:Drug Overdose / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009517:New South Wales; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000401:mortality; D011329:Prisoners / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014754:Violence / Q000517:prevention & control; D014947:Wounds and Injuries / Q000401:mortality / Q000517:prevention & control; D055815:Young Adult; D000092864:Suicide Prevention
EPIDEMIOLOGY; PUBLIC HEALTH