Impact of incarceration on rates of methadone use in a community recruited cohort of injection drug users.
BACKGROUND
Despite barriers to its use in many settings, opioid agonist therapy with methadone has become the standard of care for treating opioid (e.g. heroin) use disorder. Since people with opioid use disorders have an increased incidence of incarceration, we undertook the present study to evaluate the association between incarceration and methadone maintenance therapy among a cohort of injection drug users in a Canadian setting.


METHODS
A cohort of people who inject drugs was prospectively followed between May 1996 and May 2013 in Vancouver, Canada. We investigated the relationship between recent incarceration and methadone use using multivariate generalized estimating equation (GEE) logistic regression analysis.


RESULTS
Overall, 2758 individuals were recruited during the study period and followed for a median of 64 (interquartile range: 23-106) months. After adjusting for various potential confounders in the multivariate GEE model, being incarcerated remained independently associated with a lower likelihood of having received methadone treatment (Adjusted Odds Ratio: 0.87, 95% confidence interval: 0.81-0.93).


CONCLUSIONS
Our study demonstrates that incarceration was independently associated with a significantly lower likelihood of being on methadone. Given the role of methadone in reducing the harms of heroin use, including drug acquisitive crime and recidivism, these data suggest a need to scale-up methadone provision for incarcerated injection drug users.
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
John D
JD
Koehn
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 10203-2775 Laurel Street, Vancouver, BC V5Z 1M3, Canada.
Paxton
P
Bach
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 10203-2775 Laurel Street, Vancouver, BC V5Z 1M3, Canada.
Kanna
K
Hayashi
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
Paul
P
Nguyen
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 10203-2775 Laurel Street, Vancouver, BC V5Z 1M3, Canada.
Thomas
T
Kerr
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 10203-2775 Laurel Street, Vancouver, BC V5Z 1M3, Canada.
M-J
MJ
Milloy
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Family Practice, University of British Columbia, 3rd Floor, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada.
Launette
L
Rieb
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 10203-2775 Laurel Street, Vancouver, BC V5Z 1M3, Canada. Electronic address: uhri-ew@cfenet.ubc.ca.
Evan
E
Wood
D000328:Adult; D019970:Cocaine-Related Disorders / Q000534:rehabilitation*; D005260:Female; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011329:Prisoners / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011477:Sex Work / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D055815:Young Adult
D009294:Narcotics; D008691:Methadone
Incarceration; Injection drug use; Methadone maintenance therapy