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Paola R, Pavel S, Tatiana D, Hagit BN, Joseph M, Ronny B, Barak S. Impact of opioid maintenance therapy in the community on reincarceration in individuals with opioid use disorder-A linked cohort study. J Subst Use Addict Treat 2024:209393. [PMID: 38754555 DOI: 10.1016/j.josat.2024.209393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Studies have found associations between Opioid Agonist Maintenance Treatment during incarceration and reduced recidivism among recently released formerly incarcerated persons. However, the role of community-based Opioid Agonist Maintenance Treatment in reducing recidivism post-release remains less explored. This study examines whether pre-release arranged, prison-to-rehabilitation Opioid Agonist Maintenance Treatment in the community following release is associated with reduced rates and lengths of re-incarceration among justice-involved individuals with Opioid Use Disorder. METHODS A retrospective matched cohort study was conducted using linked records of 208 individuals with a history of Opioid Use Disorder and treatment during their incarceration. The primary predictor variable was the duration of Opioid Agonist Maintenance Treatment, with re-incarceration rates and lengths of stay after reincarceration being the primary outcomes examined. RESULTS Analysis showed a significant decrease in reincarcerations and or lengths of stay in prison among those who have been reincarcerated and have undergone Opioid Agonist Maintenance Treatment in the community for >24 months. CONCLUSIONS Maintaining Opioid Agonist Maintenance Treatment over 24 months may reduce re-incarcerations and may be significantly associated with a reduction in the length of prison stay for reincarcerated individuals. The effects were consistent across the overall population and the individuals receiving the treatment. Various other unmeasured factors, including judicial discretion, individual motivation, type of offense, and employment status, could influence this association.
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Affiliation(s)
- Rosca Paola
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel; Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Spivak Pavel
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Dudkinski Tatiana
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | | | - Mendlovic Joseph
- Israel Ministry of Health, Jerusalem, Israel; Department of Pediatrics, Shaare Zedek Medical Center, affiliated with Haddasah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Berkovitz Ronny
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
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Marshall AD, Schroeder SE, Lafferty L, Drysdale K, Baldry E, Stoové M, Dietze P, Higgs P, Treloar C. Perceived access to opioid agonist treatment in prison among people with a history of injection drug use: A qualitative study. J Subst Use Addict Treat 2023; 150:209066. [PMID: 37156422 DOI: 10.1016/j.josat.2023.209066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Opioid agonist treatment (OAT) is associated with a reduced likelihood of hepatitis C incidence, nonfatal overdose, and (re)incarceration among people who inject drugs (PWID), yet factors underpinning decisions to access OAT in prison and postrelease are not well understood. The aim of the qualitative study was to explore the perspectives of OAT access while in prison among PWID recently released from prison in Australia. METHODS Eligible participants enrolled in the SuperMix cohort (n = 1303) were invited to take part in a semi-structured interview in Victoria, Australia. Inclusion criteria were informed consent, aged ≥18 years, history of injection drug use, incarcerated for ≥3 months, and released from custody <12 months. The study team analysed data via a candidacy framework to account for macro-structural influences. RESULTS Among 48 participants (33 male; ten Aboriginal), most injected drugs in the prior month (n = 41), with heroin most frequently injected (n = 33) and nearly half (n = 23) were currently on OAT (primarily methadone). Most participants described the navigation and permeability of OAT services in prison as convoluted. If not on OAT pre-entry, prison policies often restricted access, leaving participants to withdraw in cells. In turn, some participants commenced OAT postrelease to ensure OAT continuity of care if reincarcerated. Other participants who experienced delayed access to OAT in prison stated no need to initiate while in prison or postrelease as they were now "clean". Last, implementation of OAT delivery in prison (e.g., lack of confidentiality) frequently led to changes in OAT type to avoid peer violence (pressure to divert OAT). CONCLUSION Findings draw attention to simplistic notions of OAT accessibility in prisons, illuminating how structural determinants influence choice in PWID decision-making. Suboptimal access and acceptability of OAT delivery in prisons will continue to place PWID at risk of harm postrelease (e.g., overdose).
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Sophia E Schroeder
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Mark Stoové
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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Salamanca-Buentello F, Cheng DK, Sabioni P, Majid U, Upshur R, Sud A. Mal/adaptations: A qualitative evidence synthesis of opioid agonist therapy during major disruptions. Int J Drug Policy 2021; 101:103556. [PMID: 34902805 DOI: 10.1016/j.drugpo.2021.103556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Opioid agonist therapy (OAT) has been severely disrupted by the COVID-19 pandemic. The risks of opioid withdrawal, overdose, and diversion have increased, so there is an urgent need to adapt OAT to best support people who use drugs (PWUD). This review examines the views and experiences of PWUD, health care providers, and health system administrators on OAT during major disruptions to medical care to inform appropriate health system responses during the current pandemic and beyond. METHODS We conducted a systematic review and qualitative evidence synthesis. We searched three comprehensive datasets for qualitative and mixed-methods studies that examined OAT in the context of major disruptions such as natural disasters, and analyzed included studies using thematic analysis and the constant comparative method. We used conceptual frameworks of health systems resilience and adaptive systems to interpret our findings. RESULTS We included 10 studies published between 2002 and 2020 that examined OAT in the context of hurricanes, earthquakes, and terrorist attacks. We organized our results into three themes: uncertainty, inconsistency, and vulnerability; regulatory inflexibility; and lack of coordination. The highly regulated but poorly coordinated systems of OAT provision lacked flexibility to adapt to major disruptions, thereby manufacturing vulnerability for both PWUD and health workers. CONCLUSIONS OAT programs must be resilient and adaptable to face major disruptions while maintaining quality care. Our findings provide guidance to develop and implement innovative strategies that increase the adaptive potential of OAT programs while focusing on the needs of PWUD.
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Affiliation(s)
- Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Division of Clinical Public Health, Dalla Lana Faculty of Public Health, 155 College Street, Toronto, Ontario M5G 1L4, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Abhimanyu Sud
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
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Buadze A, Friedl N, Schleifer R, Young S, Schneeberger A, Liebrenz M. Perceptions and Attitudes of Correctional Staff Toward ADHD-A Challenging Disorder in Everyday Prison Life. Front Psychiatry 2020; 11:600005. [PMID: 33633596 PMCID: PMC7901975 DOI: 10.3389/fpsyt.2020.600005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.
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Affiliation(s)
- Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nadine Friedl
- Hospital of Psychiatry Münsingen, Münsingen, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavík, Iceland
| | - Andres Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Psychiatrische Dienste Graubuenden, Chur, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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