Perceived access to opioid agonist treatment in prison among people with a history of injection drug use: A qualitative study

Alison D Marshall; Sophia E Schroeder; Lise Lafferty; Kerryn Drysdale; Eileen Baldry; Mark Stoové; Paul Dietze; Peter Higgs; Carla Treloar

doi:10.1016/j.josat.2023.209066

Perceived access to opioid agonist treatment in prison among people with a history of injection drug use: A qualitative study

J Subst Use Addict Treat. 2023 Jul:150:209066. doi: 10.1016/j.josat.2023.209066. Epub 2023 May 6.

Authors

Alison D Marshall¹, Sophia E Schroeder², Lise Lafferty³, Kerryn Drysdale⁴, Eileen Baldry⁵, Mark Stoové⁶, Paul Dietze⁷, Peter Higgs⁸, Carla Treloar⁴

Affiliations

¹ The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, Australia; Centre for Social Research in Health, University of New South Wales (UNSW) Sydney, Sydney, Australia. Electronic address: amarshall@kirby.unsw.edu.au.
² Disease and Elimination Program, Burnet Institute, Melbourne, Australia.
³ The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, Australia; Centre for Social Research in Health, University of New South Wales (UNSW) Sydney, Sydney, Australia.
⁴ Centre for Social Research in Health, University of New South Wales (UNSW) Sydney, Sydney, Australia.
⁵ Law and Justice, University of New South Wales (UNSW) Sydney, Sydney, Australia.
⁶ Disease and Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.
⁷ Disease and Elimination Program, Burnet Institute, Melbourne, Australia; National Drug Research Institute, Curtin University, Melbourne, Australia.
⁸ Disease and Elimination Program, Burnet Institute, Melbourne, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia.

PMID: 37156422
DOI: 10.1016/j.josat.2023.209066

Abstract

Introduction: Opioid agonist treatment (OAT) is associated with a reduced likelihood of hepatitis C incidence, nonfatal overdose, and (re)incarceration among people who inject drugs (PWID), yet factors underpinning decisions to access OAT in prison and postrelease are not well understood. The aim of the qualitative study was to explore the perspectives of OAT access while in prison among PWID recently released from prison in Australia.

Methods: Eligible participants enrolled in the SuperMix cohort (n = 1303) were invited to take part in a semi-structured interview in Victoria, Australia. Inclusion criteria were informed consent, aged ≥18 years, history of injection drug use, incarcerated for ≥3 months, and released from custody <12 months. The study team analysed data via a candidacy framework to account for macro-structural influences.

Results: Among 48 participants (33 male; ten Aboriginal), most injected drugs in the prior month (n = 41) with heroin the most frequently injected (n = 33) and nearly half (n = 23) were currently on OAT (primarily methadone). Most participants described the navigation and permeability of OAT services in prison as convoluted. If not on OAT pre-entry, prison policies often restricted access, leaving participants to withdraw in cells. In turn, some participants commenced OAT postrelease to ensure OAT continuity of care if reincarcerated. Other participants who experienced delayed access to OAT in prison stated no need to initiate while in prison or postrelease as they were now "clean". Last, implementation of OAT delivery in prison (e.g., lack of confidentiality) frequently led to changes in OAT type to avoid peer violence (pressure to divert OAT).

Conclusion: Findings draw attention to simplistic notions of OAT accessibility in prisons, illuminating how structural determinants influence choice in PWID decision-making. Suboptimal access and acceptability of OAT delivery in prisons will continue to place PWID at risk of harm postrelease (e.g., overdose).

Keywords: Accessibility; Opioid agonist treatment; People who inject drugs; Prisons.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Analgesics, Opioid / therapeutic use
Drug Overdose* / drug therapy
Humans
Male
Methadone / therapeutic use
Prisons
Substance Abuse, Intravenous* / drug therapy
Victoria / epidemiology

Substances

Analgesics, Opioid
Methadone