Long-acting injectable buprenorphine – ‘best practice’ opioid agonist therapy for Australian prisoners

Scott, Russ; Aboud, Andrew; Thomas, O'Gorman

doi:10.1177/10398562211059086

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…Finally, our sample was recruited more than a decade ago. Changes in AOD treatment practice in Queensland prisons since study recruitment include the introduction of medication‐assisted treatment (MAT) for opioid dependence in some prisons; however, coverage remains poor, and ‘best practice’ injectable buprenorphine [ 67 , 68 ] is not currently used, to the best of our knowledge. Given evidence that MAT has a modest protective effect, that rates of return to substance use after release from prison remain high even among those receiving MAT in prison [ 69 , 70 ] and that the vast majority of our sample reported moderate/high‐risk use of substances other than opioids, we are confident that our findings remain relevant.…”

Section: Discussionmentioning

confidence: 99%

The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate‐ to high‐risk cannabis, methamphetamine and opioid use after release from prison

et al. 2023

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Background and aims Illicit substance use is common among people entering prisons, as is returning to substance use after release from prison. We aimed to assess the predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for returning to substance use after release from prison. Design A longitudinal design with baseline survey conducted between 2008 and 2010 in the 6 weeks before expected prison release and up to three follow‐up surveys in the 6 months after release. Setting Prisons in Queensland, Australia. Participants A total of 1054 adults within 6 weeks of expected release from prison. Measurements The ASSIST was used to assess problematic use of cannabis, methamphetamine, heroin and other non‐prescribed opioids in the 3 months before incarceration. Post‐incarceration substance use was measured at 1, 3 and 6 months after release. We calculated the area under the receiver operating characteristic curve (AUROC) and the optimal ASSIST cut‐off score for each substance, using Youden’s index (J). Findings Forty‐one per cent (n = 434) of the cohort reported any substance use during follow‐up: 33% (n = 344) used cannabis, 20% (n = 209) methamphetamine, 10% (n = 109) heroin and 9% (n = 97) illicit other opioids. The optimal ASSIST cut‐off score was ≥ 4 for heroin, methamphetamine and cannabis and ≥ 1 for other opioids. Using these cut‐offs, the AUROC was highest for heroin in predicting both any use (AUROC = 0.82) and weekly use (AUROC = 0.88) in the past 4 weeks. AUROCs for other drugs ranged from 0.73 to 0.79. Conclusions The ASSIST shows promise as an accurate and potentially scalable tool that may be useful for predicting a return to substance use after release from prison and could inform service delivery. The substantial rates of returning to substance use after release from prison suggest that prison serves to interrupt rather than cease substance use.

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Section: Discussionmentioning

confidence: 99%

The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate‐ to high‐risk cannabis, methamphetamine and opioid use after release from prison

et al. 2023

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“…It could also possibly be because of the higher mortality rate observed for this group during follow‐up, although this result should be interpreted with caution, because our groups were not mutually exclusive. Long‐acting injectable buprenorphine is the current gold standard for treating opioid dependence and is strongly recommended for use in custodial settings [ 58 , 59 ] to help prevent poor opioid‐related health outcomes during incarceration and after release. The ASSIST may be a useful tool for informing service providers who is most in need of this treatment.…”

Section: Discussionmentioning

confidence: 99%

“…To date, opioids have been a major focus of research, policy and treatment for those in prison [ 58 , 59 , 60 ]. However, the high rates of methamphetamine‐related hospitalisation we observed throughout follow‐up echo evidence elsewhere that methamphetamine use is now also an important driver of poor outcomes such as hospitalisation [ 61 , 62 ] and deaths [ 63 ] in different parts of the world.…”

Section: Discussionmentioning

confidence: 99%

Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance‐related hospitalisation after release from prison: A cohort study

Cumming,

Kinner,

McKetin

et al. 2023

Addiction

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Background and AimsPoor substance use‐related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post‐release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance‐related hospitalisation post‐release is unestablished. We measured whether screening for moderate/high‐risk substance use on the ASSIST was associated with increased risk of substance‐related hospitalisation.DesignA prospective cohort study.SettingPrisons in Queensland and Western Australia.ParticipantsParticipants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days.MeasurementsBaseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high‐risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance‐related hospitalisations during follow‐up. We compared rates of substance‐related hospitalisation between those classified as low/no‐risk and moderate/high‐risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures.FindingsDuring follow‐up, 158 (6%) participants had cannabis‐related, 178 (7%) had opioid‐related and 266 (10%) had methamphetamine‐related hospitalisation. The hazard rates of substance‐related hospitalisation after prison were significantly higher among those who screened moderate/high‐risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60).ConclusionsIncarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high‐risk substance use appear to have a significantly higher risk of post‐release substance‐related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.

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“…Sadly, in some Australian jurisdictions, there are still large numbers of prisoners who cannot access long-acting opioid agonist therapy during their imprisonment. 7…”

Section: Substance Misuse In Prisonsmentioning

confidence: 99%

A prison mental health network in the RANZCP

Scott¹,

Aboud²,

Das³

et al. 2023

Australas Psychiatry

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Long-acting injectable buprenorphine – ‘best practice’ opioid agonist therapy for Australian prisoners

Abstract: Objective To consider opioid agonist therapy in prisons. Conclusions Given the substantial risks of substance misuse by prisoners, long-acting injectable buprenorphine should be adopted as ‘best practice’ treatment in Australian prison populations.

Cited by 6 publications

References 31 publications

The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate‐ to high‐risk cannabis, methamphetamine and opioid use after release from prison

The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate‐ to high‐risk cannabis, methamphetamine and opioid use after release from prison

Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance‐related hospitalisation after release from prison: A cohort study

A prison mental health network in the RANZCP

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