Illicit substance use after release from prison among formerly incarcerated primary care patients

a cross-sectional study

Adam Chamberlain, Sylviah Nyamu, Jenerius Aminawung, Emily A. Wang, Shira Shavit, Aaron D. Fox

Research output: Contribution to journalArticle

Abstract

BACKGROUND: More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. RESULTS: Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73-8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20-9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89-0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03-1.10), being on parole (aOR = 0.58, 95% CI: 0.34-0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40-3.68). CONCLUSIONS: Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.

Original languageEnglish (US)
Number of pages1
JournalAddiction science & clinical practice
Volume14
Issue number1
DOIs
StatePublished - Feb 19 2019

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Prisons
Primary Health Care
Cross-Sectional Studies
Substance-Related Disorders
Alcohols
Drug Overdose
Hallucinogens
Amphetamines
N-Methyl-3,4-methylenedioxyamphetamine
Infectious Disease Transmission
Heroin
Cannabis
Cocaine
Hispanic Americans
Opioid Analgesics
Prescriptions
Longitudinal Studies
Mental Health
Cohort Studies
Logistic Models

Keywords

  • Illicit substance use
  • Incarceration
  • Primary care
  • Transitions Clinics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Illicit substance use after release from prison among formerly incarcerated primary care patients : a cross-sectional study. / Chamberlain, Adam; Nyamu, Sylviah; Aminawung, Jenerius; Wang, Emily A.; Shavit, Shira; Fox, Aaron D.

In: Addiction science & clinical practice, Vol. 14, No. 1, 19.02.2019.

Research output: Contribution to journalArticle

Chamberlain, Adam ; Nyamu, Sylviah ; Aminawung, Jenerius ; Wang, Emily A. ; Shavit, Shira ; Fox, Aaron D. / Illicit substance use after release from prison among formerly incarcerated primary care patients : a cross-sectional study. In: Addiction science & clinical practice. 2019 ; Vol. 14, No. 1.
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abstract = "BACKGROUND: More than 80{\%} of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. RESULTS: Among 751 participants, median age was 47; participants were mostly male (85{\%}), non-white (47{\%} black, 30{\%} Hispanic), and on parole (80{\%}). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18{\%} and 23{\%}, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95{\%} CI: 1.73-8.81), housing with friends or family (aOR = 3.33, 95{\%} CI: 1.20-9.28), years incarcerated during latest prison term (aOR = 0.93, 95{\%} CI: 0.89-0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95{\%} CI: 1.03-1.10), being on parole (aOR = 0.58, 95{\%} CI: 0.34-0.99), and having a drug use disorder (aOR = 2.27, 95{\%} CI: 1.40-3.68). CONCLUSIONS: Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.",
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AU - Nyamu, Sylviah

AU - Aminawung, Jenerius

AU - Wang, Emily A.

AU - Shavit, Shira

AU - Fox, Aaron D.

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N2 - BACKGROUND: More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. RESULTS: Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73-8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20-9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89-0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03-1.10), being on parole (aOR = 0.58, 95% CI: 0.34-0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40-3.68). CONCLUSIONS: Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.

AB - BACKGROUND: More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. RESULTS: Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73-8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20-9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89-0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03-1.10), being on parole (aOR = 0.58, 95% CI: 0.34-0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40-3.68). CONCLUSIONS: Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.

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KW - Incarceration

KW - Primary care

KW - Transitions Clinics

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