TY - JOUR
T1 - Prospective study of retention in opioid agonist treatment and contact with emergency healthcare following release from prisons in Victoria, Australia
AU - Curtis, Michael
AU - Wilkinson, Anna L.
AU - Dietze, Paul
AU - Stewart, Ashleigh Cara
AU - Kinner, Stuart A.
AU - Cossar, Reece David
AU - Nehme, Emily
AU - Aitken, Campbell
AU - Walker, Shelley
AU - Butler, Tony
AU - Winter, Rebecca J.
AU - Smith, Karen
AU - Stoove, Mark
N1 - Funding Information:
We would like to acknowledge the participants involved in the Prison and Transition Health study for the time and knowledge they contributed to this study. We gratefully acknowledge the support provided to the Burnet Institute by the Victorian Government Operational Infrastructure Support Programme. We would also like to acknowledge the Victorian Department of Justice and Community Safety, Australian Department of Health, Ambulance Victoria, the Australian Institute of Health and Welfare and the Centre for Victorian Data Linkage for their support.
Funding Information:
The Prison and Transition Health Cohort Study was funded by an NHMRC Project Grant (APP1029915). MC (APP1168954) and EN (APP2003449) are recipients of NHMRC postgraduate awards. MC is also the recipient of a Monash Addiction Research Centre PhD top-up scholarship. PD (APP1136908) and MS (APP1136970) are recipients of NHMRC Senior Research Fellowships.
Publisher Copyright:
© 2023 Author(s). Published by BMJ.
PY - 2023/5
Y1 - 2023/5
N2 - Background: People recently released from prison engage with emergency healthcare at greater rates than the general population. While retention in opioid agonist treatment (OAT) is associated with substantial reductions in the risk of opioid-related mortality postrelease, it is unknown how OAT affects contact with emergency healthcare. In a cohort of men who injected drugs regularly prior to imprisonment, we described rates of contact with ambulance services and EDs, and their associations with use of OAT, in the 3 months after release from prison. Methods: Self-report data from a prospective observational cohort of men who regularly injected drugs before a period of sentenced imprisonment, recruited between September 2014 and May 2016, were linked to state-wide ambulance and ED records over a 3-month postrelease period in Victoria, Australia. We used generalised linear models to estimate associations between OAT use (none/interrupted/retained) and contact with ambulance and EDs postrelease, adjusted for other covariates. Results: Among 265 participants, we observed 77 ambulance contacts and 123 ED contacts over a median of 98 days of observation (IQR 87-125 days). Participants who were retained in OAT between prison release and scheduled 3-month postrelease follow-up interviews had lower rates of contact with ambulance (adjusted incidence rate ratio (AIRR) 0.33, 95% CI 0.14 to 0.76) and ED (AIRR 0.43, 95% CI 0.22 to 0.83), compared with participants with no OAT use postrelease. Participants with interrupted OAT use did not differ from those with no OAT use in rates of contact with ambulance or ED. Conclusion: We found lower rates of contact with emergency healthcare after release among people retained in OAT, but not among people reporting interrupted OAT use, underscoring the benefits of postrelease OAT retention. Strategies to improve accessibility and support OAT retention after leaving prison are important for men who inject drugs.
AB - Background: People recently released from prison engage with emergency healthcare at greater rates than the general population. While retention in opioid agonist treatment (OAT) is associated with substantial reductions in the risk of opioid-related mortality postrelease, it is unknown how OAT affects contact with emergency healthcare. In a cohort of men who injected drugs regularly prior to imprisonment, we described rates of contact with ambulance services and EDs, and their associations with use of OAT, in the 3 months after release from prison. Methods: Self-report data from a prospective observational cohort of men who regularly injected drugs before a period of sentenced imprisonment, recruited between September 2014 and May 2016, were linked to state-wide ambulance and ED records over a 3-month postrelease period in Victoria, Australia. We used generalised linear models to estimate associations between OAT use (none/interrupted/retained) and contact with ambulance and EDs postrelease, adjusted for other covariates. Results: Among 265 participants, we observed 77 ambulance contacts and 123 ED contacts over a median of 98 days of observation (IQR 87-125 days). Participants who were retained in OAT between prison release and scheduled 3-month postrelease follow-up interviews had lower rates of contact with ambulance (adjusted incidence rate ratio (AIRR) 0.33, 95% CI 0.14 to 0.76) and ED (AIRR 0.43, 95% CI 0.22 to 0.83), compared with participants with no OAT use postrelease. Participants with interrupted OAT use did not differ from those with no OAT use in rates of contact with ambulance or ED. Conclusion: We found lower rates of contact with emergency healthcare after release among people retained in OAT, but not among people reporting interrupted OAT use, underscoring the benefits of postrelease OAT retention. Strategies to improve accessibility and support OAT retention after leaving prison are important for men who inject drugs.
KW - drug abuse
KW - drug overdoses
KW - epidemiology
KW - substance-related disorders
UR - http://www.scopus.com/inward/record.url?scp=85148668380&partnerID=8YFLogxK
U2 - 10.1136/emermed-2022-212755
DO - 10.1136/emermed-2022-212755
M3 - Article
C2 - 36759173
AN - SCOPUS:85148668380
SN - 1472-0205
VL - 40
SP - 347
EP - 354
JO - Emergency Medicine Journal
JF - Emergency Medicine Journal
IS - 5
ER -
