Historique
Article de Périodique
Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study (2014)
Auteur(s) :
S. LARNEY ;
N. GISEV ;
M. FARRELL ;
T. A. DOBBINS ;
L. BURNS ;
A. GIBSON ;
J. KIMBER ;
L. DEGENHARDT
Dans :
BMJ Open (Vol.4, n°4, 2014)
Article en page(s) :
e004666 ; 9 p.
Refs biblio. :
32
Domaine :
Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Thésaurus géographique
AUSTRALIE
Thésaurus mots-clés
ETUDE RETROSPECTIVE
;
TRAITEMENT DE MAINTENANCE
;
PRISON
;
MORTALITE
;
COHORTE
;
SUBSTITUTION
;
CAUSE DE DECES
Résumé :
Objectives: 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.
Design: Retrospective cohort study.
Setting: Adult prisons in New South Wales (NSW), Australia.Participants 16 715 opioid-dependent people who were received to prison between 2000 and 2012.
Interventions: Opioid substitution therapy.
Primary outcome measures: Natural and unnatural (suicide, drug-induced, violent and other injury) deaths in prison.
Result:s 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.
Design: Retrospective cohort study.
Setting: Adult prisons in New South Wales (NSW), Australia.Participants 16 715 opioid-dependent people who were received to prison between 2000 and 2012.
Interventions: Opioid substitution therapy.
Primary outcome measures: Natural and unnatural (suicide, drug-induced, violent and other injury) deaths in prison.
Result:s 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.
Affiliation :
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia