Determining the impact of opioid substitution therapy upon mortality and recidivism among prisoners: A 22-year data linkage study.

image - Chain Link Square 0
Date Commenced:
01/2011
Expected Date of Completion:
12/2016
Project Supporters:

Australian Institute of Criminology through the Criminology Research Grants Program;
National Health and Medical Research Council

Drug Type:
Project Members: 
image - Michael Farrell  Square
Director
Ph EA Jemma Sale: 02 9385 0292 / j.sale@unsw.edu.au
image - Timothy Dobbins Square
Associate Professor
Ph +61 (2) 9385 0333
image - 1357519930 Natasa Gisev 280
Lecturer
Ph 02 9385 0333
image - 1338781867 Jo Kimber
Dr Jo Kimber
Visiting Senior Lecturer
image - Sarah Larney
Senior Lecturer
Ph +61 (2) 9385 0333
image - Marian Shanahan
Senior Research Fellow
Ph 02 9385 0333
Project Main Description: 

Prisoners are a marginalised group placing considerable costs on society. They experience very high rates of drug dependence, health problems and premature mortality. Without intervention they are highly likely to come into further health risk. This study will quantify the impact of opioid substitution therapy (OST; methadone or buprenorphine) on two important outcomes for opioid dependent prisoners: mortality, particularly in the post-release period; and subsequent criminal activity. Using linked data, the study will have almost 600,000 person-years of follow-up over 22 years.Study results will have clear implications for the health and welfare of this population, and will provide evidence of potential health and crime reduction gains, and the cost savings that might result.

Project Collaborators: External: 

Dr Don Weatherburn
NSW Bureau of Crime Statistics and Research

Professor Tony Butler
The Kirby Institute, UNSW

Dr Amy Gibson
Centre for Big Data Research in Health, UNSW

Rationale: 

Prisoners experience very high rates of drug dependence, health problems and premature mortality. Without intervention they are highly likely to come into further contact with the criminal justice system, creating further health risk. Opioid dependence is a common problem among prisoners, and opioid substitution therapy (with methadone and buprenorphine) for opioid dependence may be an effective intervention in preventing this morbidity/mortality and re-offending.

This research will quantify, for the first time, the population-level impact of opioid substitution therapy (OST; methadone or buprenorphine) on two important outcomes for opioid dependent prisoners: (a) mortality, particularly in the post-release period; and (b) subsequent criminal activity. This work builds on our successful previous research project (NHMRC 455451) examining overall mortality among OST recipients. Although successfully determining the association between mortality and OST overall, we were unable to examine (a) and (b) among prisoners in our previous work because admission, retention and discharge from prison could not be ascertained from the databases examined.

Aims: 

To examine:

  1. The impact of OST provision in prison, and following release, upon prisoner mortality;
  2. The extent to which OST reduces incidence and time to re-offence among opioid dependent persons, stratified by crime type;
  3. Potential differences in the impacts of buprenorphine and methadone upon the extent and timing of re-incarceration;
  4. Differences in duration of OST, and its impact on crime and mortality, among vulnerable subgroups including Aboriginal and Torres Strait Islanders and women;
  5. Estimated years of life lost (YLL) to prison in the cohort, and potential impact of OST in reducing YLL;
  6. Cost savings of OST provision in reducing crime and imprisonment among this group.
  7. Circumstances of deaths occurring in prison or immediately post-release
Design and Method: 

This study is using a retrospective cohort design with data linkage.

The base cohort comprised all NSW OST registrants between 1985 and 2010, approximately 48,000 people and 580,000 person-years of follow-up.  Information on treatment, prison and crime histories, and deaths in the cohort during this period were ascertained via linkage of the following databases:

  • Pharmaceutical Drugs of Addiction System (PHDAS) -Pharmaceutical Services, NSW Health
  • Offender Integrated Management System (OIMS) - NSW Department of Corrective Services;
  • Reoffending Database (ROD) - NSW Bureau of Crime Statistics and Research (BOCSAR)
  • National Death Index (NDI) - Australian Institute of Health and Welfare (AIHW)

The linkage was undertaken by two third-party agencies: AIHW (linking PHDAS and NDI) and the Bureau of Crime Statistics and Research (linking PHDAS, OIMS and ROD). NDARC received only de-identified datasets for analysis. 

Progress/Update: 

All data for this project has been linked and we are currently in the process of undertaking the various analyses outlined in the objectives. The results from the project so far are summarised below.

Findings: 

The first of our analyses described the rates of the offending and estimated the costs of court appearances using a cohort of 48,069 opioid-dependent people in contact with the criminal justice system in New South Wales between 1993 and 2011. A total of 638,545 charges were laid against cohort members between 1993-2011. Eight in ten males (79.7%) and 67.9 percent of females had at least one charge; rates were 94.15 per 100 PY (95% CI 93.89-94.41) among males, and 53.19 per 100 PY (95% CI 52.91-53.46) among females, and highest at 15-19 years (175.74 per 100 PY males (95% CI 174.45-177.03), 75.60 per 100 PY females (95% CI 74.46-76.76)) and 20-24 years (144.61 per 100 PY males (95% CI 143.70-145.53), 84.50 per 100 PY females (95% CI 83.53-85.48)). The most frequent charges were theft (24.5% of all charges), traffic/vehicle offences (16.3%), offences against justice procedures (10.5%), illicit drug offences (10.0%), intentional injury offences (9.9%) and public order offences (8.9%).

Following on from this, we also examined episodes of incarceration and time spent in custody among opioid-dependent people between 2000 and 2012 (n=47,196). Almost four in ten of the cohort (37%; 43% of men and 24% of women) had at least one episode of incarceration between 2000-2012. Men had a median of 3 (ranging between 1-47) incarcerations, and women, 2 (ranging between 1-35). Costs of incarceration of this cohort between 2000 and 2012 totalled nearly AUD$3 billion. Our findings suggest that a substantial minority of opioid dependent people experience incarceration, usually on multiple occasions and at significant cost.

Of the 34,962 people in the cohort with valid information regarding their Indigenous identity, 6,830 were Indigenous and 28,132 were non-Indigenous. Among the 6,830 Indigenous people, 4,615 (67.6%) were male and 2,215 (32.4%) female. The median number of charges against Indigenous people (25, IQR 31) was significantly greater than non-Indigenous people (9, IQR 16) (p<0.001). The median proportion of follow-up time that Indigenous males and females spent in custody was twice that of non-Indigenous males (21.6% vs. 10.1%, p<0.001) and females (6.1% vs. 2.9%, p<0.001). The proportion of Indigenous people who first commenced OST in prison (30.2%) was three times that of non-Indigenous people (11.2%) (p<0.001).

Among a cohort of 15,600 new treatment entrants between 1 August 2001 and 31 December 2010, we examined characteristics of first-time methadone and buprenorphine clients and factors associated with risk of leaving first treatment. In total, 7,183 (46%) commenced buprenorphine and 8,417 (54%) methadone; with the proportion entering buprenorphine increasing over time. Those starting buprenorphine switched medications more frequently and had more subsequent treatment episodes. Buprenorphine retention was also poorer: 44% spent 3+ months in treatment, compared to 70% of those commencing methadone; however, buprenorphine retention for first-time entrants improved over time, whereas methadone retention did not. Multivariable Cox models indicated that in addition to sex, age, treatment setting and criminographic variables, risk of leaving a first treatment episode was greater on any given day for those receiving buprenorphine, and was dependent on the year treatment was initiated There was no interaction between any demographic variables and medication received, suggesting no clear evidence of any particular groups for whom each medication might be better suited in terms of improving retention.

Following on from our study of patterns of offending among opioid-dependent people, we also examined the effect of OST treatment and retention on crime rates among 10,744 opioid-dependent people who first entered OST on or after 1 January 2004. This allowed a comparison of crime rates in the four years immediately prior to treatment entry (the average time before an individual enters treatment after becoming opioid dependent), as well as periods in and out of OST after initiating treatment. We adjusted for time spent in custody over this period.

The crude crime rate (CCR) per 100 person-years for all offences that individuals were charged with prior to treatment entry was 130.78 (95% CI 129.65-131.91). A 32% reduction was observed while individuals were in OST [CCR per 100PY 88.29, 95% CI 86.96-89.63] and a 20 percent reduction was observed while individuals were out of OST [CCR per 100PY 101.67, 95% CI 100.35-102.99]. When comparing the crime rates after treatment entry only, being out of treatment was associated with a 15% increase, compared to the rate during time spent in treatment.

Comparing all-cause and drug-related overdose mortality rates for methadone and buprenorphine, individuals who initiated OST 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.

We found that 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 per 1,000 PY (95% CI: 1.2, 2.2 per 1,000 PY), and the unnatural death CMR was 1.1 per 1,000 PY (95% CI: 0.8, 1.6 per 1,000 PY). Compared to prison time spent out of OST, the hazard of all-cause death was 74 percent lower while in OST in prison (adjusted hazard ratio (AHR): 0.26; 95% CI: 0.13 to 0.50), and the hazard of unnatural death was 87 percent lower while in OST (AHR: 0.13; 95% CI: 0.05 to 0.35). Compared to periods not in OST, the hazard of all-cause death during the first four weeks of incarceration was 94% lower while in OST (AHR: 0.06; 95% CI: 0.01 to 0.48).

There were 100,978 person-years of follow-up post-release, during which time 1,050 deaths occurred, for a CMR of 10.4 per 1000 person-years (95% CI: 9.8-11.0). Accidental drug-induced deaths were the most common cause of death. OST exposure in the four weeks post-release reduced the hazard of death by 75% (adjusted hazard ratio 0.25; 95%CI: 0.15, 0.52); OST receipt in prison had a short-term protective effect that decayed quickly across time.

Finally, the results of the cost-effectiveness analysis examining the effect of OST in reducing deaths after prison demonstrated that treatment immediately after prison release was deemed to be cost-effective. Accounting for all treatment and criminal justice system costs in the 6-months after prison release, the group that received OST post-release incurred $7,150 fewer costs and there were 26 fewer deaths. Overall, the incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.

Output: 
Publications:
 
Degenhardt, L., Gisev, N., Trevena, J., Larney, S., Kimber, J., Burns, L., Shanahan, M., Weatherburn, D. (2013). Engagement with the criminal justice system among opioid-dependent people: Retrospective cohort study. Addiction. 108: 2152-2165.

Degenhardt, L., Larney, S., Gisev, N., Trevena, J., Burns,L., Kimber, J., Shanahan, M., Butler, T., Mattick, R.P., Weatherburn, D. (2014). Imprisonment of opioid-dependent people in New South Wales, Australia, 2000-2012: Retrospective linkage study. Australian and New Zealand Journal of Public Health. 38: 165-170.

Larney, S., Gisev, N., Farrell, M., Dobbins, T., Burns, L., Gibson, A., Kimber, J., Degenhardt, L. (2014). Opioid substitution therapy as a strategy to reduce deaths in prison: Retrospective cohort study. BMJ Open. 4:e004666. DOI: 10.1136/bmjopen-2013-004666.

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D., Gibson, A., Mattick, R.P., Butler, T., Burns, L. (2014). The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction. 109: 1306-1317.

Gisev, N., Degenhardt, L., Larney, S., Larance, B., Gibson, A., Kimber, J., Burns, L. (2014). A comparative study of opioid substitution therapy utilization among opioid-dependent men and women. Drug and Alcohol Review.33: 499-505.

Gisev, N., Gibson, A., Larney, S., Kimber, J., Williams, M., Clifford, A., Doyle, M., Burns, L., Butler, T., Weatherburn, D.J., Degenhardt, L. (2014). Offending, custody and opioid substitution therapy treatment utilisation among opioid-dependent people in contact with the criminal justice system: Comparison of Indigenous and non-Indigenous Australians. BMC Public Health. 14: 920. DOI: 10.1186/1471-2458-14-920.

Burns, L., Gisev, N., Larney, S., Dobbins, T., Gibson, A., Kimber, J., Larance, B., Mattick, R.P., Butler T., Degenhardt, L. (2015). A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, Australia. Addiction. 110: 646-655.

Kimber, J., Larney, S., Hickman, M., Randall, D., Degenhardt, L.(2015). Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study. Lancet Psychiatry. 2:901-918.

Gisev, N., Shanahan, M., Weatherburn, D.J., Mattick, R.P., Larney, S., Burns, L., Degenhardt, L. (2015). A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history. Addiction 110: 1975-1984.  Reports:

Gisev, N., Larney, S., Kimber, J., Burns, L., Weatherburn, D., Gibson, A., Dobbins, T., Mattick, R., Butler, T., Degenhardt, L. (2014). Determining the impact of opioid substitution therapy upon mortality and recidivism among prisoners: A 22 year data linkage study. NDARC Technical Report No. 330. Sydney, Australia: National Drug and Alcohol Research Centre. ISBN 978-0-7334-3486-0. 

Reports:

Gisev, N., Larney, S., Kimber, J., Burns, L., Weatherburn, D., Gibson, A., Dobbins, T., Mattick, R., Butler, T., Degenhardt, L. (2014). Determining the impact of opioid substitution therapy upon mortality and recidivism among prisoners: A 22 year data linkage study. NDARC Technical Report No. 330. Sydney, Australia: National Drug and Alcohol Research Centre. ISBN 978-0-7334-3486-0.

Gisev, N., Larney, S., Kimber, J., Burns, L., Weatherburn, D., Gibson, A., Dobbins, T., Mattick, R., Butler, T., Degenhardt, L. (2015). Determining the impact of opioid substitution therapy upon mortality and recidivism among prisoners: A 22 year data linkage study. Trends and Issues in Crime and Criminal Justice. Canberra, Australia: Australian Institute of Criminology.

Workshops:

Gisev, N., Degenhardt, L., Shanahan, M. The cost effectiveness of opioid substitution therapy and impact on criminal offending and mortality. Presented at the National Drug and Alcohol Research Centre 2014 Annual Symposium. 8 September 2014. Sydney, Australia.

Presentations:

Degenhardt, L. (2013) The epidemiology of engagement with the criminal justice system among opioid dependent people: Retrospective cohort study. The NSW Bureau of Crime Statistics and Research Applied Research in Crime and Justice Conference 2013, Sydney, 27-28 February 2013.

Burns, L. (2013) Engagement with the criminal justice system and imprisonment among opioid dependent people. NDARC Annual Symposium, Sydney, 4 September.

Gisev, N. (2013) Determining the impact of opioid substitution therapy on crime and mortality among prisoners using data linkage. NDARC Seminar Series, Sydney, 19 September.

Farrell, M. (2013) Moderating risks for drug users in prison. International College of Neuropsychopharmacology Special Congress on Addiction and Mental health. 1-3 October 2013. Kuala Lumpur, Malaysia.

Degenhardt, L.(2013) Morbidity and mortality among people using opioid medications. Invited symposium presentation at the International Society for Addiction Medicine (ISAM) meeting, Kuala Lumpur, Malaysia, November 21-232013.

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D., Gibson, A., Mattick, R.P., Butler, T., Burns, L. (2014) The impact of opioid substitution therapy on mortality following release from prison. Oral presentation at the Academic and Health Policy Conference on Correctional Health. March 20-24, 2014. Houston, USA.

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D.J., Gibson, A., Mattick, R., Butler, T., Burns, L. (2014) The impact of opioid substitution therapy on mortality post-release from prison. College on Problems of Drug Dependence 76th Annual Meeting. 14-19 June 2014. San Juan, Puerto Rico.

Larney, S., Gisev, N., Farrell, M., Dobbins, T., Burns, L., Gibson, A., Kimber, J., Degenhardt, L. (2014) Opioid substitution therapy as a strategy to reduce deaths in prison: Retrospective cohort study. College on Problems of Drug Dependence 76th Annual Meeting. 14-19 June 2014. San Juan, Puerto Rico.

Gisev ,N., Degenhardt, L., Larney, S., Dobbins, T., Larance, B., Gibson, A., Kimber, J., Butler, T., Mattick, R.P., Burns, L. (2014) Treatment utilisation and retention with opioid substitution therapy between 2001 and 2010: A comparison of buprenorphine and methadone users. Presented at the 30th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. 24-27 October. Taipei, Taiwan.

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D.J., Gibson, A., Mattick, R., Butler, T., Burns, L. (2014) The impact of opioid substitution therapy on mortality post-release from prison: A retrospective data linkage study. Presented at the 30th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. 24-27 October. Taipei, Taiwan.

Gisev, N., Degenhardt, L., Larney, S., Dobbins, T., Larance, B., Gibson, A., Kimber, J., Butler, T., Mattick, R., Burns, L. (2014) Treatment utilisation and retention with opioid substitution therapy: comparison of buprenorphine and methadone users. Presented at the 2014 Australasian Professional Society on Alcohol and Other Drugs Conference. 9-12 November. Adelaide, Australia. 

Degenhardt, L., Gisev, N., Larney, S., Kimber, J., Gibson, A., Butler, T., Mattick, R.P., Burns, L., Weatherburn, D. (2015). Examining treatment, crime, imprisonment and mortality among people with a history of treatment for opioid dependence: OST reduces crime and mortality risks.Presented at The NSW Bureau of Crime Statistics and Research Applied Research in Crime and Justice Conference 2015. 18-19 February 2015. Sydney, Australia.

Larney, S. (2015). Opioid substitution therapy and mortality in and out of prison. Invited presentation, Justice Health and Forensic Mental Health Drug and Alcohol Annual Symposium, Sydney.

Gisev, N. (2015). Determining the impact of opioid substitution therapy on crime and mortality: A 22-year data linkage study. Invited seminar at the Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, 11 March.

Gisev, N. (2015). Determining the impact of opioid substitution therapy on crime and mortality: Findings from a 22-year data linkage study. Invited seminar at the Faculty of Pharmacy, The University of Sydney, Sydney, 15 May.

Larney, S.(2015). Opioid substitution therapy following release from prison. St. Vincent’s Hospital Alcohol and Drug Service Active Learning Network, Sydney, Australia.

Larney, S. (2015). Impacts of opioid substitution therapy in prisons on health and criminal justice outcomes. Connecticut Department of Corrections, New Haven, USA. 

Larney, S. (2015). Opioid substitution therapy in prisons: Re-offending and mortality outcomes. Compulsory Drug Treatment Correctional Centre, Sydney, Australia.

Degenhardt, L. (2015). Determining the impact of opioid substitution therapy upon mortality: the use of OST in prison, immediately post-release, and the potential utility of switching opioid medications to reduce in-treatment mortality risk. National Conference on Overdose Prevention. 31 August-1 September. Bergen, Norway.

Gisev, N., Larney, S., Dobbins, T., Gibson, A., Kimber, J., Butler, T., Mattick, R., Burns, L., Degenhardt, L. (2015). The effect of treatment and retention with opioid substitution therapy in reducing crime among opioid-dependent people.Presented at the 31st International Conference on Pharmacoepidemiology & Therapeutic Risk Management. 22-26 August 2015. Boston, USA. Proceedings published in Pharmacoepidemiology and Drug Safety24(Suppl.S1),28-29.

Larney, S.(2015). Opioid substitution therapy following release from prison. St. Vincent’s Hospital Alcohol and Drug Service Active Learning Network, Sydney, Australia.

Larney, S. (2015). Impacts of opioid substitution therapy in prisons on health and criminal justice outcomes. Connecticut Department of Corrections, New Haven, USA. 

Larney, S. (2015). Opioid substitution therapy in prisons: Re-offending and mortality outcomes. Compulsory Drug Treatment Correctional Centre, Sydney, Australia.

Larney, S.(2015). Opioid dependence and substitution therapies in the criminal justice system. Invited keynote presentation, Forensic Psychology Research Conference, Sydney, 27-28 October 2015.

Larney, S.(2015). Opioid substitution therapy in prisons and post-release. Invited panellist, Rhode Island Overdose Prevention Strategic Plan community meeting, Providence, USA.

Gisev, N., Shanahan, M., Weatherburn, D.J., Mattick, R.P., Larney, S., Burns, L., Degenhardt, L. (2015). A cost-effectiveness analysis of opioid substitution therapy upon release from prison. Presented at the 2015 Australasian Professional Society on Alcohol and Other Drugs Conference. 8-11 November. Perth, Australia. Proceedings published in Drugand AlcoholReview34(Suppl.1),29.

Larney, S., Gisev, N., Farrell, M., Dobbins, T., Burns, L., Gibson, A., Kimber, J., Degenhardt, L. (2015). Opioid substitution therapy reduces deaths in prison. International Harm Reduction Conference, Kuala Lumpur, 18-21 October.

Gisev, N. Opioid substitution therapy among prisoners: Longitudinal findings from a data linkage study. Invited symposium presentation at the 2015 Australasian Pharmaceutical Science Association/Australasian Society of Clinical and Experimental Pharmacologist and Toxicologists Scientific Meeting, Hobart, 29 November-2 December. 

 
Posters:
 
Degenhardt, L., Trevena, J, Larney, S., Kimber, J., Butler, T., Mattick, R.P., Weatherburn, D., Burns, L. (2013) Epidemiology of engagement with the criminal justice system among opioid dependent people: Retrospective cohort study. College on Problems of Drug Dependence, San Diego, United States, 15-20 June.

Gisev, N., Degenhardt, L., Dobbins, T., Larney, S., Larance, B., Kimber, J., Gibson, A., Burns, L. (2013) Opioid substitution therapy in New South Wales 2001-2012: Comparison between buprenorphine and methadone users. NDARC Annual Symposium, Sydney, 4 September.

Gisev, N., Burns, L., Larney, S., Doyle, M., Clifford, A., Williams, M., Gibson, A., Kimber, J., Butler, T., Mattick, R., Degenhardt, L. (2013) Engagement with the criminal justice system among opioid-dependent people: Comparison between Indigenous and non-Indigenous offenders. NDARC Annual Symposium, Sydney, 4 September.

Burns, L., Gisev, N., Degenhardt, L., Larney, S. Opioid substitution therapy in New South Wales 2001-2012: Comparison between buprenorphine and methadone. (2014) College on Problems of Drug Dependence 76th Annual Meeting. 14-19 June 2014. San Juan, Puerto Rico.

Gisev, N., Degenhardt, L., Larney, S., Larance, B., Gibson, A., Kimber, J., Burns, L. (2014) Opioid substitution therapy utilisation among opioid-dependent men and women: A population-based comparative study. NDARC Annual Symposium, Sydney, 8 September.

Gisev, N., Shanahan, M., Weatherburn, D.J., Mattick, R.P., Larney, S., Burns, L., Degenhardt, L. (2015). A cost-effectiveness analysis of opioid substitution therapy upon release in reducing mortality among prisoners with a history of opioid dependence. Presented at the 31st International Conference on Pharmacoepidemiology & Therapeutic Risk Management. 22-26 August 2015. Boston, USA. Proceedings published in Pharmacoepidemiology and Drug Safety24(Suppl.S1),481-482.

Gisev, N., Shanahan, M., Weatherburn, D.J., Mattick, R.P., Larney, S., Burns, L., Degenhardt, L. (2015). A cost-effectiveness analysis of opioid substitution therapy upon release in reducing mortality among prisoners with a history of opioid dependence. NDARC Annual Research Symposium, Sydney, 15 September.

Benefits: 

This project will fill a critically important gap in the literature with respect to identifying strategies to improve the health and welfare of Australian prisoners - a marginalised group that places considerable costs on society. Specifically, use of linked data over a 22 year period, with almost 600,000 person years of follow-up - presents a unique opportunity to determine the effectiveness of OST in reducing premature mortality and criminal behaviour among opioid dependent prisoners. This evidence cannot be obtained with accuracy from small studies or randomised controlled trials. This study will have clear implications for the health of this population and will provide evidence of potential health and crime reduction gains and the cost savings that might result. 

Drug Type: 
Project Status: 
Current