Reductions in convictions for violent crime during opioid maintenance treatment: A longitudinal national cohort study

Havnes, Ingrid Amalia; Bukten, Anne; Gossop, Michael; Waal, Helge; Stangeland, Per; Clausen, Thomas

doi:10.1016/j.drugalcdep.2012.02.005

Cited by 28 publications

(27 citation statements)

References 138 publications

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“…Previous analyses have focused on simple incidence rates and subgroup analyses [18]. We refine these results by replacing simple cohort averages with estimates from regression models in prospective time, adjusting for individual covariate information and timing of events.…”

Section: Discussionmentioning

confidence: 99%

“…The last study day was 31 December 2003, thus being the censoring time for all patients, besides the 135 patients who died before this, who were censored at their time of death. The data has been analyzed previously, and a full description on the study settings and participants can be found elsewhere [8,12,18]. …”

Section: Methodsmentioning

confidence: 99%

“…Focus has been on simple cohort counts and incidence rates, and criminal events grouped based on retrospectively defined criteria conditioned on the termination date of the study [12,18]. This is problematic for several reasons.…”

Section: Introductionmentioning

confidence: 99%

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Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users

Røislien

Clausen

Gran

et al. 2014

BMC Med Res Methodol

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BackgroundThe reduction of crime is an important outcome of opioid maintenance treatment (OMT). Criminal intensity and treatment regimes vary among OMT patients, but this is rarely adjusted for in statistical analyses, which tend to focus on cohort incidence rates and rate ratios. The purpose of this work was to estimate the relationship between treatment and criminal convictions among OMT patients, adjusting for individual covariate information and timing of events, fitting time-to-event regression models of increasing complexity.MethodsNational criminal records were cross linked with treatment data on 3221 patients starting OMT in Norway 1997–2003. In addition to calculating cohort incidence rates, criminal convictions was modelled as a recurrent event dependent variable, and treatment a time-dependent covariate, in Cox proportional hazards, Aalen’s additive hazards, and semi-parametric additive hazards regression models. Both fixed and dynamic covariates were included.ResultsDuring OMT, the number of days with criminal convictions for the cohort as a whole was 61% lower than when not in treatment. OMT was associated with reduced number of days with criminal convictions in all time-to-event regression models, but the hazard ratio (95% CI) was strongly attenuated when adjusting for covariates; from 0.40 (0.35, 0.45) in a univariate model to 0.79 (0.72, 0.87) in a fully adjusted model. The hazard was lower for females and decreasing with older age, while increasing with high numbers of criminal convictions prior to application to OMT (all p < 0.001). The strongest predictors were level of criminal activity prior to entering into OMT, and having a recent criminal conviction (both p < 0.001). The effect of several predictors was significantly time-varying with their effects diminishing over time.ConclusionsAnalyzing complex observational data regarding to fixed factors only overlooks important temporal information, and naïve cohort level incidence rates might result in biased estimates of the effect of interventions. Applying time-to-event regression models, properly adjusting for individual covariate information and timing of various events, allows for more precise and reliable effect estimates, as well as painting a more nuanced picture that can aid health care professionals and policy makers.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users

Røislien

Clausen

Gran

et al. 2014

BMC Med Res Methodol

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“…Reductions in acquisitive and drug-related crime during opioid maintenance treatment (OMT) are widely reported [27-29]. Violent crime is found to be relatively uncommon among heroin users [30-32] and to decrease during OMT [33,34]. However, one group of individuals in OMT who had been convicted of violent crime prior to enrollment was found to have a higher risk of both violent and non-violent criminal convictions during OMT [34].…”

Section: Introductionmentioning

confidence: 99%

The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment

Havnes

Clausen

Brux

et al. 2014

Harm Reduction Journal

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BackgroundOpioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions.MethodsTwenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach.FindingsPrior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes.ConclusionsSubstances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.

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“…Data from the national OMT register and the Norwegian crime register were linked using the unique person identification number, assigned by the Norwegian state to all citizens. A full description of the study cohort can be found elsewhere [30][31][32].…”

Section: Methodsmentioning

confidence: 99%

Driving under the influence (DUI) among patients in opioid maintenance treatment (OMT): a registry-based national cohort study

et al. 2013

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Reductions in convictions for violent crime during opioid maintenance treatment: A longitudinal national cohort study

Cited by 28 publications

References 138 publications

Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users

Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users

The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment

Driving under the influence (DUI) among patients in opioid maintenance treatment (OMT): a registry-based national cohort study

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