Winter R J, Young J T, Stoové M, Agius P A, Hellard M E, Kinner S A
Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; Centre for Health Services Research, School of Population Health, The University of Western Australia, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
Drug Alcohol Depend. 2016 Nov 1;168:104-111. doi: 10.1016/j.drugalcdep.2016.08.640. Epub 2016 Sep 8.
Ex-prisoners with a history of injecting drug use (IDU) experience disproportionate drug-related harm. Rapid resumption of substance use following prison release is common and evidenced in high rates of overdose mortality. However, few studies have documented the rate of IDU resumption following prison release or identified risk factors for relapse.
Structured interviews were conducted with 533 adults with a history of IDU in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post-release. Incidence of self-reported IDU resumption was calculated overall and for each follow-up interval. Risk factors associated with time to resumption of IDU were estimated using discrete-time survival analysis.
IDU resumption was reported by 41% of participants during a median of 98days of follow-up (IQR=94-121), an overall crude incidence of 1.06 per person-year. The highest rate was observed in the first month (23%; crude incidence 2.24 per person-year). In adjusted discrete-time survival analyses, being unemployed at the previous interview (AHR=1.59; 95%CI:1.10-2.30), shorter incarceration (≤90days vs. >365days; AHR=2.20; 95%CI:1.33-3.65), and IDU during the index incarceration (AHR=2.80; 95%CI:1.92-4.09) were significantly associated with time to IDU resumption; parole was protective (AHR=0.66; 95%CI:0.47-0.92).
Evidence-based efforts to prevent IDU in prison and IDU resumption after release are important for both prisoner and public health. Enhancing opportunities for employment and capitalising on the short-term benefits of parole for ex-prisoners may delay resumption of IDU after release from prison. These strategies should complement rather than replace harm reduction efforts for this high-risk population.
有注射吸毒史的刑满释放人员遭受着不成比例的与毒品相关的伤害。刑满释放后迅速恢复吸毒的情况很常见，且有很高的过量用药死亡率为证。然而，很少有研究记录刑满释放后恢复注射吸毒的比例，或确定复发的风险因素。
对澳大利亚昆士兰州533名有注射吸毒史的成年人在出狱前以及出狱后约1个月、3个月和6个月进行了结构化访谈。计算了自我报告的恢复注射吸毒的总体发生率以及每个随访间隔的发生率。使用离散时间生存分析估计与恢复注射吸毒时间相关的风险因素。
在中位随访98天（四分位间距=94-121）期间，41%的参与者报告恢复了注射吸毒，总体粗发病率为每人年1.06。第一个月的发病率最高（23%；粗发病率为每人年2.24）。在调整后的离散时间生存分析中，上次访谈时失业（风险比=1.59；95%置信区间：1.10-2.30）、监禁时间较短（≤90天与>365天；风险比=2.20；95%置信区间：1.33-3.65）以及在本次监禁期间注射吸毒（风险比=2.80；95%置信区间：1.92-4.09）与恢复注射吸毒的时间显著相关；假释具有保护作用（风险比=0.66；95%置信区间：0.47-0.92）。
基于证据的预防监狱内注射吸毒和出狱后恢复注射吸毒的努力对囚犯和公众健康都很重要。增加就业机会并利用假释对刑满释放人员的短期益处可能会延迟出狱后恢复注射吸毒的时间。这些策略应补充而非取代针对这一高风险人群的减少伤害措施。
