Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Harm Reduct J. 2023 Mar 28;20(1):42. doi: 10.1186/s12954-023-00773-2.
A precipitous decline in health status among people recently released from prison is common. In Victoria, Australia, opioid agonist treatment (OAT) in the community involves frequent contact with primary care, potentially facilitating broader use of primary healthcare services. Among a cohort of men who injected drugs regularly pre-imprisonment, we estimated differences in rates of primary healthcare use and medication dispensation between people who did and did not receive OAT post-release.
Data came from the Prison and Transition Health Cohort Study. Three-month post-release follow-up interviews were linked with primary care and medication dispensation records. Generalised linear models were fit with one exposure (OAT: none/partial/complete) for 13 outcomes relating to primary healthcare use, pathology testing, and medication dispensation, adjusted for other covariates. Coefficients were reported as adjusted incidence rate ratios (AIRR).
Analyses included 255 participants. Compared to no OAT use, both partial and complete OAT use were associated with increased rates of standard (AIRR: 3.02, 95%CI: 1.88-4.86; AIRR: 3.66, 95%CI: 2.57-5.23), extended (AIRR: 2.56, 95%CI: 1.41-4.67; AIRR: 2.55, 95%CI: 1.60-4.07) and mental health-related (AIRR: 2.71, 95%CI: 1.42-5.20; AIRR: 2.27, 95%CI: 1.33-3.87) general practitioner (GP) consultations, total medication (AIRR: 1.88, 95%CI: 1.19-2.98; AIRR: 2.40, 95%CI: 1.71-3.37), benzodiazepine (AIRR: 4.99, 95%CI: 2.81-8.85; AIRR: 8.30, 95%CI: 5.28-13.04) and gabapentinoid (AIRR: 6.78, 95%CI: 3.34-13.77; AIRR: 4.34, 95%CI: 2.37-7.94) dispensations, respectively. Partial OAT use was also associated with increased after-hours GP consultations (AIRR: 4.61, 95%CI: 2.24-9.48) and complete OAT use? with increased pathology utilisation (e.g. haematological, chemical, microbiological or immunological tissue/sample testing; AIRR: 2.30, 95%CI: 1.52-3.48).
We observed higher rates of primary healthcare use and medication dispensation among people who reported partial and complete OAT use post-release. Findings suggest that access to OAT post-release may have a collateral benefit in supporting broader health service utilisation, underscoring the importance of retention in OAT after release from prison.
最近刚出狱的人群健康状况急剧下降是很常见的。在澳大利亚维多利亚州，社区中的阿片类药物替代治疗（OAT）需要与初级保健频繁接触，这可能会促进更广泛地使用初级保健服务。在一组在入狱前经常注射毒品的男性中，我们评估了在出狱后接受和未接受 OAT 的人群在使用初级保健和药物配给方面的差异。
数据来自监狱和过渡健康队列研究。对 3 个月的出狱后随访访谈进行了链接，并与初级保健和药物配给记录进行了链接。使用广义线性模型对与初级保健使用、病理学检测和药物配给相关的 13 个结果进行了分析，调整了其他协变量。系数以调整后的发病率比（AIRR）报告。
分析纳入了 255 名参与者。与未使用 OAT 相比，部分和完全使用 OAT 与标准（AIRR：3.02，95%CI：1.88-4.86；AIRR：3.66，95%CI：2.57-5.23）、扩展（AIRR：2.56，95%CI：1.41-4.67；AIRR：2.55，95%CI：1.60-4.07）和心理健康相关（AIRR：2.71，95%CI：1.42-5.20；AIRR：2.27，95%CI：1.33-3.87）的一般执业医师（GP）咨询、总药物（AIRR：1.88，95%CI：1.19-2.98；AIRR：2.40，95%CI：1.71-3.37）、苯二氮卓类药物（AIRR：4.99，95%CI：2.81-8.85；AIRR：8.30，95%CI：5.28-13.04）和加巴喷丁类药物（AIRR：6.78，95%CI：3.34-13.77；AIRR：4.34，95%CI：2.37-7.94）的配给分别增加。部分 OAT 用药还与下班后 GP 咨询增加有关（AIRR：4.61，95%CI：2.24-9.48），完全 OAT 用药与增加的病理学使用有关（例如血液、化学、微生物或免疫组织/样本检测；AIRR：2.30，95%CI：1.52-3.48）。
我们观察到在出狱后报告部分和完全 OAT 使用者中，初级保健的使用和药物配给率更高。研究结果表明，出狱后获得 OAT 可能对支持更广泛的卫生服务利用有附带益处，突出了出狱后继续接受 OAT 的重要性。
