Does Opioid Agonist Therapy for Prisoners Reduce Drug-Related Deaths After Prison Release?

Incarcerated people with opioid use are at high risk of drug-related death after release from prison, partly because they can lose opioid tolerance during imprisonment. Opioid agonist therapy during imprisonment may mitigate this risk. To assess the effect of a national prison-based opioid agonist program on mortality, researchers linked the records of all Scottish prisons to a national death index and then compared drug-related death rates before (1996–2002) and after (2003–2007) the opioid agonist program implementation. Eligible prisoners were those released after a minimum 14-day imprisonment.

• 150,157 prisoners were released between January 1996 and December 2007.
• Drug-related death rates at 12 weeks post-release were 3.8 per 1000 releases pre-implementation of the opioid agonist program, versus 2.2 per 1000 releases post-implementation.
• 57% of pre-implementation and 56% of post-implementation drug-related deaths were within 14 days of release.
• Overall, 61% of opioid-related deaths occurred within 14 days of release; this did not differ pre- and post-implementation.

Comments:

Overall drug-related death rates decreased among former prisoners after implementation of an in-prison opioid agonist program. However, the proportion of deaths within 14 days of prison release remained the same; this was the outcome thought to be most sensitive to the in-prison program. The researchers attributed the decrease to the improved quality of community methadone programs and access to drug treatment. Additional post-release programs—such as early engagement in community opioid agonist programs or ready access to naloxone—may be necessary to further decrease the rate of drug-related deaths occurring soon after release.

Kevin L. Kraemer, MD, MSc

Reference:

Bird SM, Fischbacher C, Graham L, Fraser A. Impact of opioid substitution therapy for Scotland’s prisoners on drug-related deaths soon after prisoner release. Addiction. 2015;110:1617–1624.