Substitution Therapy

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Louisa Degenhardt - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of needle syringe programmes and opiate Substitution Therapy in preventing hcv transmission among people who inject drugs
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Lucy Platt, Peter Vickerman, Louisa Degenhardt, Jennifer Reed, Silvia Minozzi, Holly Hagan, Clare E French, Ashly E Jordan, Vivian Hope, Sharon J Hutchinson
    Abstract:

    This is the protocol for a review and there is no abstract. The objectives are as follows: 1.To assess the impact of needle/syringe programmes with and without opiate Substitution Therapy (OST) on the incidence of HCV infection among people who inject drugs (PWID). 2.To assess the effect of OST alone on the incidence of HCV infection among PWID.

  • mortality risk of opioid Substitution Therapy with methadone versus buprenorphine a retrospective cohort study
    The Lancet Psychiatry, 2015
    Co-Authors: Jo Kimber, Sarah Larney, Matthew Hickman, Deborah Randall, Louisa Degenhardt
    Abstract:

    Summary Background Opioid dependence increases risk of premature mortality. Opioid Substitution Therapy with methadone or buprenorphine reduces mortality risk, especially for drug-related overdose. Clinical guidelines recommend methadone as the first line of opioid Substitution Therapy. We aimed to test whether buprenorphine treatment has a lower mortality risk than does methadone treatment by comparing all-cause mortality and drug-related overdose mortality at treatment induction, after in-treatment medication switches, and following treatment cessation. Methods We did a retrospective cohort study of all patients with opioid dependency (n=32 033) in New South Wales, Australia, who started a methadone or buprenorphine treatment episode from Aug 1, 2001, to Dec 31, 2010, including 190 232·6 person-years of follow-up. We compared crude mortality rates (CMRs) for all-cause and drug-related overdose mortality, and mortality rate ratios (MRRs) according to age, sex, period in or out of treatment, medication type, and in-treatment switching. Findings Patients who initiated with buprenorphine had reduced all-cause and drug-related mortality during the first 4 weeks of treatment compared with those who initiated with methadone (adjusted all-cause MRR 2·17, 95% CI 1·29–3·67; adjusted drug-related MRR 4·88, 1·73–13·69). For the remaining time on treatment, drug-related mortality risk did not differ (adjusted MRR 1·18, 95% CI 0·89–1·56), but weak evidence suggested that all-cause mortality was lower for buprenorphine than methadone (1·66, 1·40–1·96). In the 4 weeks after treatment cessation, all-cause mortality did not differ, but drug-related mortality was lower for methadone (adjusted all-cause MRR 1·12, 0·79–1·59; adjusted drug-related MRR 0·50, 0·29–0·86). Patients who switched from buprenorphine to methadone during treatment had lower mortality in the first 4 weeks of methadone treatment than matched controls who received methadone only (CMR difference 7·1 per 1000 person-years, 95% CI 0·1–14·0); no mortality difference was noted for switches from buprenorphine to methadone or for switches to either medication beyond the first 4 weeks of treatment. Interpretation In a setting with high risk of death in the first 4 weeks of opioid Substitution Therapy, buprenorphine seemed to reduce mortality in this period, but little difference between buprenorphine and methadone was noted thereafter or for in-treatment switching of medications. Cross-cohort corroboration of our findings and further assessment of the stepped treatment model is warranted. Funding Australian National Health & Medical Research Council.

  • a comparative study of opioid Substitution Therapy utilisation among opioid dependent men and women
    Drug and Alcohol Review, 2014
    Co-Authors: Natasa Gisev, Jo Kimber, Sarah Larney, Louisa Degenhardt, Amy Gibson, Briony Larance, Lucy Burns
    Abstract:

    Introduction and Aims Few population-based studies have examined differences in opioid Substitution Therapy (OST) treatment utilisation between men and women. Using a population of opioid-dependent people in New South Wales, Australia, first-episode and long-term OST treatment utilisation profiles were compared between men and women, differentiating between treatment initiation in the community and in custody. Design and Methods Retrospective data linkage study using records of new OST entrants (2001–2010) and custody episodes (2000–2012). First OST treatment episode and overall treatment utilisation characteristics were compared between men and women initiating treatment in the community or in custody. Treatment retention was evaluated at 3, 6, 9 and 12 months after first commencing OST and overall, as the median proportion of follow-up time spent in treatment. Results There were 15 600 new OST entrants in the cohort—10 930 were men (70.1%) and 4670 women (29.9%); 12 584 (80.7%) initiated treatment in the community and 3016 (19.3%) in custody. More men initiated OST in custody (24.0% vs. 8.3%, P < 0.001) and only received OST in custody (57.5% vs. 41.8%, P < 0.001). Women were retained longer in their first OST treatment episode at all four time points in both treatment settings and in treatment overall (community: 46.6% vs. 39.1%, P < 0.001; custody: 41.3% vs. 30.8%, P < 0.001). Discussion and Conclusions There are a number of key differences in OST treatment utilisation profiles between men and women. Whereas men commonly initiate and only receive OST in custody, treatment retention is higher among women, independent of the setting treatment is initiated. [Gisev N, Degenhardt L, Larney S, Larance B, Gibson A, Kimber J, Burns L. A comparative study of opioid Substitution Therapy utilisation among opioid-dependent men and women. Drug Alcohol Rev 2014;33:499–505]

  • a latent class analysis of self reported clinical indicators of psychosocial stability and adherence among opioid Substitution Therapy patients do stable patients receive more unsupervised doses
    Drug and Alcohol Dependence, 2014
    Co-Authors: Briony Larance, Natacha Carragher, Richard P Mattick, Nicholas Lintzeris, Robert Ali, Louisa Degenhardt
    Abstract:

    a b s t r a c t Aims: To develop a stability typology among opioid Substitution Therapy patients using a range of adher- ence indicators derived from clinical guidelines, and determine whether stable patients receive more unsupervised doses. Methods: An interviewer-administered cross-sectional survey was used in opioid Substitution Therapy programmes in three Australian jurisdictions, totalling 768 patients in their current treatment episode for ≥4 weeks. A structured questionnaire collated data from patients about their demographics, treatment characteristics, past 6-month drug use and medication adherence, psychosocial stability, comorbidity, child welfare concerns and levels of supervised dosing. Latent class analysis (LCA) was used to derive a stability typology. Linear regression models examined predictors of unsupervised dosing in the past month. Results: LCA identified two classes: (i) a higher-adherence group (67%) who had low-moderate probabil- ities of endorsing the opioid Substitution Therapy stability indicators and (ii) a lower-adherence group (33%) who had moderate-high probabilities of endorsing the stability indicators. There was no associa- tion between adherence profile and the number of unsupervised doses. Significant predictors of receiving larger numbers of unsupervised doses included being older, living in New South Wales or South Australia (vs. Victoria), receiving methadone (vs. mono-buprenorphine), being prescribed in private clinic or gen- eral practice (vs. public clinic), reporting a longer current treatment episode, not receiving a urine drug screen in the past month, being currently employed and not having a prison history. Conclusions: This study suggested that system-level factors and observable indicators of social functioning were more strongly associated with the receipt of less supervised treatment. Future research should examine this issue using prospectively collected data.

  • the impact of opioid Substitution Therapy on mortality post release from prison retrospective data linkage study
    Addiction, 2014
    Co-Authors: Louisa Degenhardt, Jo Kimber, Sarah Larney, Natasa Gisev, Michael Farrell, Timothy Dobbins, Don Weatherburn, Amy Gibson
    Abstract:

    Aims Release from prison is a high-risk period for mortality. We examined the impact of opioid Substitution Therapy (OST), for opioid dependence during and after incarceration, upon mortality post-release. Design A cohort was formed of all opioid-dependent people who entered OST between 1985 and 2010 and who, following first OST entry, were released from prison at least once between 2000 and 2012. We linked data on OST history, court and prison records and deaths. Setting New South Wales (NSW), Australia. Participants A total of 16 453 people released from prison 60 161 times. Measurements Crude mortality rates (CMRs) were calculated according to OST retention; multivariable Cox regressions for post-release periods were undertaken to examine the association between OST exposure (a time-dependent variable) and mortality post-release, for which covariates were updated per-release. Findings There were 100 978 person-years (PY) post-release; 1050 deaths occurred. Most received OST while incar- cerated (76.5%); individuals were receiving OST in 51% of releases. Lowest post-release mortality was among those continuously retained in OST post-release CMR 4 weeks post-release = 6.4 per 1000 PY; 95% confidence interval (CI) = 5.2, 7.8, highest among those with no OST (CMR = 36.7 per 1000 PY; 95% CI = 28.8, 45.9). Multi-factorial models showed OST exposure in the 4 weeks post-release reduced hazard of death by 75% (adjusted hazard ratio 0.25; 95% CI = 0.12, 0.53); OST receipt in prison had a short-term protective effect that decayed quickly across time. Conclusion In New South Wales, Australia, opioid Substitution Therapy in prison and post-release appears to reduce mortality risk in the immediate post-release period.

Graham R. Foster - One of the best experts on this subject based on the ideXlab platform.

Jason Grebely - One of the best experts on this subject based on the ideXlab platform.

Sarah Larney - One of the best experts on this subject based on the ideXlab platform.

  • mortality risk of opioid Substitution Therapy with methadone versus buprenorphine a retrospective cohort study
    The Lancet Psychiatry, 2015
    Co-Authors: Jo Kimber, Sarah Larney, Matthew Hickman, Deborah Randall, Louisa Degenhardt
    Abstract:

    Summary Background Opioid dependence increases risk of premature mortality. Opioid Substitution Therapy with methadone or buprenorphine reduces mortality risk, especially for drug-related overdose. Clinical guidelines recommend methadone as the first line of opioid Substitution Therapy. We aimed to test whether buprenorphine treatment has a lower mortality risk than does methadone treatment by comparing all-cause mortality and drug-related overdose mortality at treatment induction, after in-treatment medication switches, and following treatment cessation. Methods We did a retrospective cohort study of all patients with opioid dependency (n=32 033) in New South Wales, Australia, who started a methadone or buprenorphine treatment episode from Aug 1, 2001, to Dec 31, 2010, including 190 232·6 person-years of follow-up. We compared crude mortality rates (CMRs) for all-cause and drug-related overdose mortality, and mortality rate ratios (MRRs) according to age, sex, period in or out of treatment, medication type, and in-treatment switching. Findings Patients who initiated with buprenorphine had reduced all-cause and drug-related mortality during the first 4 weeks of treatment compared with those who initiated with methadone (adjusted all-cause MRR 2·17, 95% CI 1·29–3·67; adjusted drug-related MRR 4·88, 1·73–13·69). For the remaining time on treatment, drug-related mortality risk did not differ (adjusted MRR 1·18, 95% CI 0·89–1·56), but weak evidence suggested that all-cause mortality was lower for buprenorphine than methadone (1·66, 1·40–1·96). In the 4 weeks after treatment cessation, all-cause mortality did not differ, but drug-related mortality was lower for methadone (adjusted all-cause MRR 1·12, 0·79–1·59; adjusted drug-related MRR 0·50, 0·29–0·86). Patients who switched from buprenorphine to methadone during treatment had lower mortality in the first 4 weeks of methadone treatment than matched controls who received methadone only (CMR difference 7·1 per 1000 person-years, 95% CI 0·1–14·0); no mortality difference was noted for switches from buprenorphine to methadone or for switches to either medication beyond the first 4 weeks of treatment. Interpretation In a setting with high risk of death in the first 4 weeks of opioid Substitution Therapy, buprenorphine seemed to reduce mortality in this period, but little difference between buprenorphine and methadone was noted thereafter or for in-treatment switching of medications. Cross-cohort corroboration of our findings and further assessment of the stepped treatment model is warranted. Funding Australian National Health & Medical Research Council.

  • a comparative study of opioid Substitution Therapy utilisation among opioid dependent men and women
    Drug and Alcohol Review, 2014
    Co-Authors: Natasa Gisev, Jo Kimber, Sarah Larney, Louisa Degenhardt, Amy Gibson, Briony Larance, Lucy Burns
    Abstract:

    Introduction and Aims Few population-based studies have examined differences in opioid Substitution Therapy (OST) treatment utilisation between men and women. Using a population of opioid-dependent people in New South Wales, Australia, first-episode and long-term OST treatment utilisation profiles were compared between men and women, differentiating between treatment initiation in the community and in custody. Design and Methods Retrospective data linkage study using records of new OST entrants (2001–2010) and custody episodes (2000–2012). First OST treatment episode and overall treatment utilisation characteristics were compared between men and women initiating treatment in the community or in custody. Treatment retention was evaluated at 3, 6, 9 and 12 months after first commencing OST and overall, as the median proportion of follow-up time spent in treatment. Results There were 15 600 new OST entrants in the cohort—10 930 were men (70.1%) and 4670 women (29.9%); 12 584 (80.7%) initiated treatment in the community and 3016 (19.3%) in custody. More men initiated OST in custody (24.0% vs. 8.3%, P < 0.001) and only received OST in custody (57.5% vs. 41.8%, P < 0.001). Women were retained longer in their first OST treatment episode at all four time points in both treatment settings and in treatment overall (community: 46.6% vs. 39.1%, P < 0.001; custody: 41.3% vs. 30.8%, P < 0.001). Discussion and Conclusions There are a number of key differences in OST treatment utilisation profiles between men and women. Whereas men commonly initiate and only receive OST in custody, treatment retention is higher among women, independent of the setting treatment is initiated. [Gisev N, Degenhardt L, Larney S, Larance B, Gibson A, Kimber J, Burns L. A comparative study of opioid Substitution Therapy utilisation among opioid-dependent men and women. Drug Alcohol Rev 2014;33:499–505]

  • the impact of opioid Substitution Therapy on mortality post release from prison retrospective data linkage study
    Addiction, 2014
    Co-Authors: Louisa Degenhardt, Jo Kimber, Sarah Larney, Natasa Gisev, Michael Farrell, Timothy Dobbins, Don Weatherburn, Amy Gibson
    Abstract:

    Aims Release from prison is a high-risk period for mortality. We examined the impact of opioid Substitution Therapy (OST), for opioid dependence during and after incarceration, upon mortality post-release. Design A cohort was formed of all opioid-dependent people who entered OST between 1985 and 2010 and who, following first OST entry, were released from prison at least once between 2000 and 2012. We linked data on OST history, court and prison records and deaths. Setting New South Wales (NSW), Australia. Participants A total of 16 453 people released from prison 60 161 times. Measurements Crude mortality rates (CMRs) were calculated according to OST retention; multivariable Cox regressions for post-release periods were undertaken to examine the association between OST exposure (a time-dependent variable) and mortality post-release, for which covariates were updated per-release. Findings There were 100 978 person-years (PY) post-release; 1050 deaths occurred. Most received OST while incar- cerated (76.5%); individuals were receiving OST in 51% of releases. Lowest post-release mortality was among those continuously retained in OST post-release CMR 4 weeks post-release = 6.4 per 1000 PY; 95% confidence interval (CI) = 5.2, 7.8, highest among those with no OST (CMR = 36.7 per 1000 PY; 95% CI = 28.8, 45.9). Multi-factorial models showed OST exposure in the 4 weeks post-release reduced hazard of death by 75% (adjusted hazard ratio 0.25; 95% CI = 0.12, 0.53); OST receipt in prison had a short-term protective effect that decayed quickly across time. Conclusion In New South Wales, Australia, opioid Substitution Therapy in prison and post-release appears to reduce mortality risk in the immediate post-release period.

  • Opioid Substitution Therapy as a strategy to reduce deaths in prison: retrospective cohort study
    BMJ Open, 2014
    Co-Authors: Sarah Larney, Jo Kimber, Natasa Gisev, Michael Farrell, Timothy Dobbins, Lucy Burns, Amy Gibson, Louisa Degenhardt
    Abstract:

    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. Results 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.

Jo Kimber - One of the best experts on this subject based on the ideXlab platform.

  • mortality risk of opioid Substitution Therapy with methadone versus buprenorphine a retrospective cohort study
    The Lancet Psychiatry, 2015
    Co-Authors: Jo Kimber, Sarah Larney, Matthew Hickman, Deborah Randall, Louisa Degenhardt
    Abstract:

    Summary Background Opioid dependence increases risk of premature mortality. Opioid Substitution Therapy with methadone or buprenorphine reduces mortality risk, especially for drug-related overdose. Clinical guidelines recommend methadone as the first line of opioid Substitution Therapy. We aimed to test whether buprenorphine treatment has a lower mortality risk than does methadone treatment by comparing all-cause mortality and drug-related overdose mortality at treatment induction, after in-treatment medication switches, and following treatment cessation. Methods We did a retrospective cohort study of all patients with opioid dependency (n=32 033) in New South Wales, Australia, who started a methadone or buprenorphine treatment episode from Aug 1, 2001, to Dec 31, 2010, including 190 232·6 person-years of follow-up. We compared crude mortality rates (CMRs) for all-cause and drug-related overdose mortality, and mortality rate ratios (MRRs) according to age, sex, period in or out of treatment, medication type, and in-treatment switching. Findings Patients who initiated with buprenorphine had reduced all-cause and drug-related mortality during the first 4 weeks of treatment compared with those who initiated with methadone (adjusted all-cause MRR 2·17, 95% CI 1·29–3·67; adjusted drug-related MRR 4·88, 1·73–13·69). For the remaining time on treatment, drug-related mortality risk did not differ (adjusted MRR 1·18, 95% CI 0·89–1·56), but weak evidence suggested that all-cause mortality was lower for buprenorphine than methadone (1·66, 1·40–1·96). In the 4 weeks after treatment cessation, all-cause mortality did not differ, but drug-related mortality was lower for methadone (adjusted all-cause MRR 1·12, 0·79–1·59; adjusted drug-related MRR 0·50, 0·29–0·86). Patients who switched from buprenorphine to methadone during treatment had lower mortality in the first 4 weeks of methadone treatment than matched controls who received methadone only (CMR difference 7·1 per 1000 person-years, 95% CI 0·1–14·0); no mortality difference was noted for switches from buprenorphine to methadone or for switches to either medication beyond the first 4 weeks of treatment. Interpretation In a setting with high risk of death in the first 4 weeks of opioid Substitution Therapy, buprenorphine seemed to reduce mortality in this period, but little difference between buprenorphine and methadone was noted thereafter or for in-treatment switching of medications. Cross-cohort corroboration of our findings and further assessment of the stepped treatment model is warranted. Funding Australian National Health & Medical Research Council.

  • a comparative study of opioid Substitution Therapy utilisation among opioid dependent men and women
    Drug and Alcohol Review, 2014
    Co-Authors: Natasa Gisev, Jo Kimber, Sarah Larney, Louisa Degenhardt, Amy Gibson, Briony Larance, Lucy Burns
    Abstract:

    Introduction and Aims Few population-based studies have examined differences in opioid Substitution Therapy (OST) treatment utilisation between men and women. Using a population of opioid-dependent people in New South Wales, Australia, first-episode and long-term OST treatment utilisation profiles were compared between men and women, differentiating between treatment initiation in the community and in custody. Design and Methods Retrospective data linkage study using records of new OST entrants (2001–2010) and custody episodes (2000–2012). First OST treatment episode and overall treatment utilisation characteristics were compared between men and women initiating treatment in the community or in custody. Treatment retention was evaluated at 3, 6, 9 and 12 months after first commencing OST and overall, as the median proportion of follow-up time spent in treatment. Results There were 15 600 new OST entrants in the cohort—10 930 were men (70.1%) and 4670 women (29.9%); 12 584 (80.7%) initiated treatment in the community and 3016 (19.3%) in custody. More men initiated OST in custody (24.0% vs. 8.3%, P < 0.001) and only received OST in custody (57.5% vs. 41.8%, P < 0.001). Women were retained longer in their first OST treatment episode at all four time points in both treatment settings and in treatment overall (community: 46.6% vs. 39.1%, P < 0.001; custody: 41.3% vs. 30.8%, P < 0.001). Discussion and Conclusions There are a number of key differences in OST treatment utilisation profiles between men and women. Whereas men commonly initiate and only receive OST in custody, treatment retention is higher among women, independent of the setting treatment is initiated. [Gisev N, Degenhardt L, Larney S, Larance B, Gibson A, Kimber J, Burns L. A comparative study of opioid Substitution Therapy utilisation among opioid-dependent men and women. Drug Alcohol Rev 2014;33:499–505]

  • the impact of opioid Substitution Therapy on mortality post release from prison retrospective data linkage study
    Addiction, 2014
    Co-Authors: Louisa Degenhardt, Jo Kimber, Sarah Larney, Natasa Gisev, Michael Farrell, Timothy Dobbins, Don Weatherburn, Amy Gibson
    Abstract:

    Aims Release from prison is a high-risk period for mortality. We examined the impact of opioid Substitution Therapy (OST), for opioid dependence during and after incarceration, upon mortality post-release. Design A cohort was formed of all opioid-dependent people who entered OST between 1985 and 2010 and who, following first OST entry, were released from prison at least once between 2000 and 2012. We linked data on OST history, court and prison records and deaths. Setting New South Wales (NSW), Australia. Participants A total of 16 453 people released from prison 60 161 times. Measurements Crude mortality rates (CMRs) were calculated according to OST retention; multivariable Cox regressions for post-release periods were undertaken to examine the association between OST exposure (a time-dependent variable) and mortality post-release, for which covariates were updated per-release. Findings There were 100 978 person-years (PY) post-release; 1050 deaths occurred. Most received OST while incar- cerated (76.5%); individuals were receiving OST in 51% of releases. Lowest post-release mortality was among those continuously retained in OST post-release CMR 4 weeks post-release = 6.4 per 1000 PY; 95% confidence interval (CI) = 5.2, 7.8, highest among those with no OST (CMR = 36.7 per 1000 PY; 95% CI = 28.8, 45.9). Multi-factorial models showed OST exposure in the 4 weeks post-release reduced hazard of death by 75% (adjusted hazard ratio 0.25; 95% CI = 0.12, 0.53); OST receipt in prison had a short-term protective effect that decayed quickly across time. Conclusion In New South Wales, Australia, opioid Substitution Therapy in prison and post-release appears to reduce mortality risk in the immediate post-release period.

  • Opioid Substitution Therapy as a strategy to reduce deaths in prison: retrospective cohort study
    BMJ Open, 2014
    Co-Authors: Sarah Larney, Jo Kimber, Natasa Gisev, Michael Farrell, Timothy Dobbins, Lucy Burns, Amy Gibson, Louisa Degenhardt
    Abstract:

    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. Results 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.

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