TY - JOUR
T1 - Fifteen years of heroin-assisted treatment in a Swiss prison - A retrospective cohort study
AU - Liebrenz, Michael
AU - Gamma, Alex
AU - Buadze, Anna
AU - Schleifer, Roman
AU - Baggio, Stéphanie
AU - Schwartz, Bruce
AU - Schneeberger, Andres
AU - Uchtenhagen, Ambros
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/10/13
Y1 - 2020/10/13
N2 - Background: In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved. Aims: Little has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning. Design: Retrospective cohort study Setting: An open prison with 120 places Subjects: Data on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group). Measurements: Mortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned). Findings: Inmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group. Conclusions: This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.
AB - Background: In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved. Aims: Little has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning. Design: Retrospective cohort study Setting: An open prison with 120 places Subjects: Data on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group). Measurements: Mortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned). Findings: Inmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group. Conclusions: This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.
KW - Heroin-assisted treatment
KW - Incarceration
KW - Jail
KW - Opioid crisis
KW - Opioid-using individuals
KW - Prison
KW - Social functioning
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U2 - 10.1186/s12954-020-00412-0
DO - 10.1186/s12954-020-00412-0
M3 - Article
C2 - 33046103
AN - SCOPUS:85092486911
SN - 1477-7517
VL - 17
JO - Harm Reduction Journal
JF - Harm Reduction Journal
IS - 1
M1 - 67
ER -