Access to opioid agonist treatments in prisons saves lives, researchers say

A new study shows that treatment with opioid agonists (OATs) in prison and after release from prison significantly reduces the risk of death among drug addicts.

Researchers led by the National Drug and Alcohol Research Center (NDARC) say their findings, published in The Lancet – Public Healthsuggest that high coverage of OAT is critical for reducing drug-related harm.

OAT interventions such as methadone and buprenorphine can reduce opioid cravings and prevent withdrawal symptoms in opioid addicts.

“This report supports a considerable amount of evidence showing that OAT is instrumental in significantly reducing deaths both in prison and after release,” said Christel Macdonald, NDARC research associate and lead author of the study.

“We know that incarceration is associated with significant harms, including higher rates of substance misuse, mortality and self-harm than in the general population. It is therefore vital that effective measures to reduce these harms are implemented in prisons.”

This world-first review of 126 studies (with a total of 586,000 participants) includes 18 interventions to reduce drug-related harm among incarcerated people and also shows that therapeutic interventions in the community reduce re-arrest and imprisonment.

While previous studies have mostly focused on specific interventions or only examined their effects on drug use and recidivism, none of the studies examined the benefits of interventions implemented after release from prison.

The researchers found that access to OAT among incarcerated people reduced the risk of death – both in prison and after release – by about 75%, and this effect was particularly pronounced in the first four weeks after release.

There was also evidence that community-based therapeutic interventions reduced the risk of re-arrest after 6–12 months by 28% and the risk of re-incarceration by 34%.

The authors said the findings have significant public health implications and demonstrate the importance of such interventions in reducing drug-related harm.

“Prisoners may include people who are difficult to identify and treat in society. Therefore, imprisonment represents an important opportunity to improve the health of those affected before they return to society,” they wrote.

“In addition, reducing drug use has important public health implications, including reducing drug-related harm and recidivism.”

They also said that OAT supply “should be increased in prison settings, including achieving optimal dosing, and should be continued after release.”

However, there was little evidence that either OAT or needle and syringe programs were effective in reducing risky injecting behavior or needle sharing, although the authors said this was due to significant gaps in research.

“One of the key points of the review is the need for further research into interventions delivered during detention and evaluated while people are still incarcerated,” Macdonald said.

“It is important to understand how to reduce drug-related harm while people are still in prison and how to continue to reduce those harms and maintain positive outcomes after they are released into the community.”

She added that her findings were limited by the variability of interventions, making it difficult to evaluate and compare their effectiveness.

“For example, therapeutic communities or psychosocial interventions are often used in this area, which can differ greatly from one another, for example in terms of program duration or specific program characteristics,” she said.

“It is therefore difficult to determine which features of these interventions might lead to positive outcomes such as lower recidivism or reduced drug use.”

Provided by the National Drug and Alcohol Research Centre (NDARC)