|Titre :||Does exposure to opioid substitution treatment in prison reduce the risk of death after release? A national prospective observational study in England (2017)|
|Auteurs :||J. MARSDEN ; G. STILLWELL ; H. JONES ; A. COOPER ; B. EASTWOOD ; M. FARRELL ; T. LOWDEN ; N. MADDALENA ; C. METCALFE ; J. SHAW ; M. HICKMAN|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.112, n°8, August 2017)|
|Article en page(s) :||1408-1418|
|Note générale :||Commentary: While epidemiological studies can help to identify areas of overdose risk, we need more focused hypothesis-driven trials to inform clinical intervention strategies. Kidd B., Matthews C., p. 1419-1420.|
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus GéographiqueANGLETERRE ; ROYAUME-UNI
Thésaurus TOXIBASETRAITEMENT DE MAINTENANCE ; PRISON ; MORTALITE ; HEROINE ; ENQUETE ; SURDOSE
Background and Aims: People with opioid use disorder (OUD) in prison face an acute risk of death after release. We estimated whether prison-based opioid substitution treatment (OST) reduces this risk. Design Prospective observational cohort study using prison health care, national community drug misuse treatment and deaths registers.
Setting: Recruitment at 39 adult prisons in England (32 male; seven female) accounting for 95% of OST treatment in England during study planning.
Participants: Adult prisoners diagnosed with OUD (recruited: September 2010-August 2013; first release: September 2010; last release: October 2014; follow-up to February 2016; n = 15?141 in the risk set).
Intervention and Comparator: At release, participants were classified as OST exposed (n = 8645) or OST unexposed (n = 6496). The OST unexposed group did not receive OST, or had been withdrawn, or had a low dose.
Measurements: Primary outcome: all-cause mortality (ACM) in the first 4 weeks. Secondary outcomes: drug-related poisoning (DRP) deaths in the first 4 weeks; ACM and DRP mortality after 4 weeks to 1 year; admission to community drug misuse treatment in the first 4 weeks. Unadjusted and adjusted Cox regression models (covariates: sex, age, drug injecting, problem alcohol use, use of benzodiazepines, cocaine, prison transfer and admission to community treatment), tested difference in mortality rates and community treatment uptake.
Findings: During the first 4 weeks after prison release there were 24 ACM deaths: six in the OST exposed group and 18 in the OST unexposed group [mortality rate 0.93 per 100 person-years (py) versus 3.67 per 100 py; hazard ratio (HR) = 0.25; 95% confidence interval (CI) = 0.10-0.64]. There were 18 DRP deaths: OST exposed group mortality rate 0.47 per 100 py versus 3.06 per 100 py in the OST unexposed group (HR = 0.15; 95% CI = 0.04-0.53). There was no group difference in mortality risk after the first month. The OST exposed group was more likely to enter drug misuse treatment in the first month post-release (odds ratio 2.47, 95% CI = 2.31-2.65). The OST mortality protective effect on ACM and DRP mortality risk was not attenuated by demographic, overdose risk factors, prison transfer or community treatment (fully adjusted HR = 0.25; 95% CI = 0.09-0.64 and HR = 0.15; 95% CI = 0.04-0.52, respectively).
Conclusions: In an English national study, prison-based opioid substitution therapy was associated with a 75% reduction in all-cause mortality and an 85% reduction in fatal drug-related poisoning in the first month after release.
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||39|
|Affiliation :||Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK|