Medication assisted Treatment (MAT) is an evidence-based treatment that can help prisoners reduce their use of illicit opioids and avoid risky health behaviors such as injection drug use.
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This study investigated whether the implementation of this program caused a decrease in drug-related deaths within the first 12 weeks after prison release with a focus on the first 2 weeks following release, a particularly vulnerable period where prisoners are most likely to resume drug use and experience accidental overdose.
The study included 150,517 prison releases from 131,472 Scottish prisoners occurring between January 1, 1996 and December 31, 2007. In order to be included in the study, a period of imprisonment prior to release had to be at least 2 weeks in length, chosen because this time frame was deemed sufficient for an individual to experience a loss of opioid tolerance.
For individuals with multiple periods of imprisonment, a prison release was only included in the study if it occurred at least 14 weeks after a prior release. This was to allow for 12 weeks of follow-up during which a drug-related death may have occurred and additional 2 weeks which was the minimum length of stay needed to be included in the study. Death records were obtained to determine if a drug-related death occurred in the 12 weeks after release.
The authors then compared drug-related deaths following prison release by age group and by periods before and after widespread OST implementation (1996-2002 and 2003-2007).
Drug-related deaths accounted for a larger percent of all deaths for the younger age group of 15-34 years (70%) than the older age group of 35+ years (32%).
When examining early drug deaths (i.e., within the first 2 weeks of release), this decline was not apparent. Prior to the Medication assisted Treatment (MAT) policy change, 57% of deaths from the 12 week period occurred in the first two weeks versus 56% after the policy change. This finding was similar when deaths were restricted to opioid-related deaths, though data was only available on specific drug-related deaths from 2000-2007.
The period following the change in Medication assisted Treatment (MAT) policy in Scottish prisons saw a decrease in drug-related deaths in the first 12 weeks after release from prison. However, this study did not show support for this policy in reducing the number of deaths occurring in the first 2 weeks after release.
This is contrary to other studies that point toward a short-term protective effect of Medication assisted Treatment (MAT) following release from prison (see here) where people on MAT in the 4 weeks after release experienced a 75% lower risk of death.
For prisoners with a history of injection heroin use, risk of overdose and drug-related death is increased following release from prison with the highest risk occurring in the first 2 weeks following release.
While there was a decrease in drug-related deaths after the implementation of the Medication assisted Treatment (MAT) policy, this result cannot be attributed to the policy change alone. As authors note, for example, country-wide trends in increased access to and safe prescribing of methadone could help explain this decrease. Moreover, there simply may be lower proportions of prisoners with opioid use disorder following this policy change.
More research is needed to determine the best methods for addressing drug-related deaths immediately following release from prison.
Bird, S. M., Fischbacher, C. M., Graham, L., & Fraser, A. (2015). Impact of opioid substitution therapy for Scotland’s prisoners on drug-related deaths soon after prisoner release. Addiction, 110(10), 1617-1624. doi:10.1111/add.12969
l
This study investigated whether the implementation of this program caused a decrease in drug-related deaths within the first 12 weeks after prison release with a focus on the first 2 weeks following release, a particularly vulnerable period where prisoners are most likely to resume drug use and experience accidental overdose.
The study included 150,517 prison releases from 131,472 Scottish prisoners occurring between January 1, 1996 and December 31, 2007. In order to be included in the study, a period of imprisonment prior to release had to be at least 2 weeks in length, chosen because this time frame was deemed sufficient for an individual to experience a loss of opioid tolerance.
For individuals with multiple periods of imprisonment, a prison release was only included in the study if it occurred at least 14 weeks after a prior release. This was to allow for 12 weeks of follow-up during which a drug-related death may have occurred and additional 2 weeks which was the minimum length of stay needed to be included in the study. Death records were obtained to determine if a drug-related death occurred in the 12 weeks after release.
The authors then compared drug-related deaths following prison release by age group and by periods before and after widespread OST implementation (1996-2002 and 2003-2007).
Drug-related deaths accounted for a larger percent of all deaths for the younger age group of 15-34 years (70%) than the older age group of 35+ years (32%).
When examining early drug deaths (i.e., within the first 2 weeks of release), this decline was not apparent. Prior to the Medication assisted Treatment (MAT) policy change, 57% of deaths from the 12 week period occurred in the first two weeks versus 56% after the policy change. This finding was similar when deaths were restricted to opioid-related deaths, though data was only available on specific drug-related deaths from 2000-2007.
The period following the change in Medication assisted Treatment (MAT) policy in Scottish prisons saw a decrease in drug-related deaths in the first 12 weeks after release from prison. However, this study did not show support for this policy in reducing the number of deaths occurring in the first 2 weeks after release.
This is contrary to other studies that point toward a short-term protective effect of Medication assisted Treatment (MAT) following release from prison (see here) where people on MAT in the 4 weeks after release experienced a 75% lower risk of death.
For prisoners with a history of injection heroin use, risk of overdose and drug-related death is increased following release from prison with the highest risk occurring in the first 2 weeks following release.
While there was a decrease in drug-related deaths after the implementation of the Medication assisted Treatment (MAT) policy, this result cannot be attributed to the policy change alone. As authors note, for example, country-wide trends in increased access to and safe prescribing of methadone could help explain this decrease. Moreover, there simply may be lower proportions of prisoners with opioid use disorder following this policy change.
More research is needed to determine the best methods for addressing drug-related deaths immediately following release from prison.
Bird, S. M., Fischbacher, C. M., Graham, L., & Fraser, A. (2015). Impact of opioid substitution therapy for Scotland’s prisoners on drug-related deaths soon after prisoner release. Addiction, 110(10), 1617-1624. doi:10.1111/add.12969
l
This study investigated whether the implementation of this program caused a decrease in drug-related deaths within the first 12 weeks after prison release with a focus on the first 2 weeks following release, a particularly vulnerable period where prisoners are most likely to resume drug use and experience accidental overdose.
The study included 150,517 prison releases from 131,472 Scottish prisoners occurring between January 1, 1996 and December 31, 2007. In order to be included in the study, a period of imprisonment prior to release had to be at least 2 weeks in length, chosen because this time frame was deemed sufficient for an individual to experience a loss of opioid tolerance.
For individuals with multiple periods of imprisonment, a prison release was only included in the study if it occurred at least 14 weeks after a prior release. This was to allow for 12 weeks of follow-up during which a drug-related death may have occurred and additional 2 weeks which was the minimum length of stay needed to be included in the study. Death records were obtained to determine if a drug-related death occurred in the 12 weeks after release.
The authors then compared drug-related deaths following prison release by age group and by periods before and after widespread OST implementation (1996-2002 and 2003-2007).
Drug-related deaths accounted for a larger percent of all deaths for the younger age group of 15-34 years (70%) than the older age group of 35+ years (32%).
When examining early drug deaths (i.e., within the first 2 weeks of release), this decline was not apparent. Prior to the Medication assisted Treatment (MAT) policy change, 57% of deaths from the 12 week period occurred in the first two weeks versus 56% after the policy change. This finding was similar when deaths were restricted to opioid-related deaths, though data was only available on specific drug-related deaths from 2000-2007.
The period following the change in Medication assisted Treatment (MAT) policy in Scottish prisons saw a decrease in drug-related deaths in the first 12 weeks after release from prison. However, this study did not show support for this policy in reducing the number of deaths occurring in the first 2 weeks after release.
This is contrary to other studies that point toward a short-term protective effect of Medication assisted Treatment (MAT) following release from prison (see here) where people on MAT in the 4 weeks after release experienced a 75% lower risk of death.
For prisoners with a history of injection heroin use, risk of overdose and drug-related death is increased following release from prison with the highest risk occurring in the first 2 weeks following release.
While there was a decrease in drug-related deaths after the implementation of the Medication assisted Treatment (MAT) policy, this result cannot be attributed to the policy change alone. As authors note, for example, country-wide trends in increased access to and safe prescribing of methadone could help explain this decrease. Moreover, there simply may be lower proportions of prisoners with opioid use disorder following this policy change.
More research is needed to determine the best methods for addressing drug-related deaths immediately following release from prison.
Bird, S. M., Fischbacher, C. M., Graham, L., & Fraser, A. (2015). Impact of opioid substitution therapy for Scotland’s prisoners on drug-related deaths soon after prisoner release. Addiction, 110(10), 1617-1624. doi:10.1111/add.12969
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