Aims Release from prison is a high-risk period for mortality. We examined the impact of opioid substitution therapy (OST), for opioid dependence during and after incarceration, upon mortality post-release. Design A cohort was formed of all opioid-dependent people who entered OST between 1985 and 2010 and who, following first OST entry, were released from prison at least once between 2000 and 2012. We linked data on OST history, court and prison records and deaths. Setting New South Wales (NSW), Australia. Participants A total of 16 453 people released from prison 60 161 times. Measurements Crude mortality rates (CMRs) were calculated according to OST retention; multivariable Cox regressions for post-release periods were undertaken to examine the association between OST exposure (a time-dependent variable) and mortality post-release, for which covariates were updated per-release. Findings There were 100 978 person-years (PY) post-release; 1050 deaths occurred. Most received OST while incar- cerated (76.5%); individuals were receiving OST in 51% of releases. Lowest post-release mortality was among those continuously retained in OST post-release CMR 4 weeks post-release = 6.4 per 1000 PY; 95% confidence interval (CI) = 5.2, 7.8, highest among those with no OST (CMR = 36.7 per 1000 PY; 95% CI = 28.8, 45.9). Multi-factorial models showed OST exposure in the 4 weeks post-release reduced hazard of death by 75% (adjusted hazard ratio 0.25; 95% CI = 0.12, 0.53); OST receipt in prison had a short-term protective effect that decayed quickly across time. Conclusion In New South Wales, Australia, opioid substitution therapy in prison and post-release appears to reduce mortality risk in the immediate post-release period.

The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study

Australia, with other OECD countries, has experienced a rapid rise in numbers of prison releasees. With this, there is heightened interest in the social impact of more prisoners returning to the community. International research has consistently indicated that suitable housing is a vital factor in ex-prisoners’ social integration. This project investigated whether and to what extent ex-prisoner housing and associated social factors are important to integration in Australia, specifically New South Wales and Victoria, where no reliable prior research on this matter had been done. Analyses indicated significant differences between states; chronic homelessness, poverty and lack of support in the participants’ lives; and that accommodation instability is a predictor of return to prison. Justice system policy implications are discussed.

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Ex-prisoners, Homelessness and the State in Australia

Six broad domains were identified as influencing reintegration of ex-offenders including personal conditions, social network/environment, accommodation, criminal justice system, rehabilitation and counselling support, and employment and training support. Semi-structured interviews were conducted with 12 offenders and 22 professionals from criminal justice, accommodation, employment support, and rehabilitation program sectors. Participants were asked to identify variables within each domain that affect success or failure of offenders in making a positive life transition. Identified variables included a readiness to change, achieving stable housing and obtaining employment, avoiding illegal activity and complying with mandatory reporting, remaining free of dependency, and addressing basic education and training needs.

Variables Affecting Successful Reintegration as Perceived by Offenders and Professionals

Aims People who use heroin are frequently incarcerated multiple times. Reducing re-incarceration of this group is important for reducing both health risks associated with incarceration and the costs of correctional administration. Opioid substitution treatment (OST) in prisons may help to reduce re-incarceration, but research findings on this topic have been mixed. In this study, we examined the effect of OST in prison and after release on re-incarceration.



Design  Longitudinal cohort study.



Setting, participants and measurements  Data on OST and incarceration were linked for a cohort of 375 male heroin users recruited originally in prisons in New South Wales, Australia. Data were linked for the period 1 June 1997–31 December 2006. Re-incarceration was examined using recurrent-event survival analysis models. Model 1 examined the effect of OST status at release from prison (i.e. in treatment versus out of treatment on the day of release) on re-incarceration. Model 2 considered the effect of remaining in OST after release on risk of re-incarceration.



Findings  Ninety per cent of participants were re-incarcerated following their first observed release. Pre-incarceration cocaine use was associated with a 13% increase in the average risk of re-incarceration. There was no significant association between simply being in OST at the time of release and risk of re-incarceration; however, in the model taking into account post-release retention in treatment, the average risk of re-incarceration was reduced by 20% while participants were in treatment.



Conclusions  In New South Wales, Australia, opioid substitution treatment after release from prison has reduced the average risk of re-incarceration by one-fifth.

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Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration

Community reintegration of ex-prisoners is an important issue in efforts to reduce recidivism. The present study examined the multiple, complex, and dynamic nature of variables influencing successful reintegration by assessing the type and degree of change in reintegration variables over time. Participants were 79 adult prisoners (54 male, 25 female) who completed a prerelease questionnaire 1 month before their release, which focused on prison-related variables, participant background, and anticipated conditions upon release. A postrelease questionnaire was administered to the same participants at 1-4 weeks and 3-4 months postrelease, focusing on the quality of life conditions experienced following release. Results indicate that current health ratings and several indicators of drug use were significantly different over the three measurement phases. Ratings of employment and housing stability, finance, and social support were unchanged over the postrelease period. Theoretical implications of the present investigation for reintegration theory are discussed, together with practical applications.

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Community Reintegration of Ex-Prisoners: Type and Degree of Change in Variables Influencing Successful Reintegration

Ex-prisoners and accommodation: what bearing do different forms of housing have on social reintegration?

(2003). Australian Prisoners' Post-release Housing. Current Issues in Criminal Justice: Vol. 15, No. 2, pp. 155-169.

Manu Peeters

Papers

Ex-prisoners, Homelessness and the State in Australia

Ex-prisoners and accommodation: what bearing do different forms of housing have on social reintegration?

Australian Prisoners' Post-release Housing

Ex-prisoners and accomodation: what bearing do different forms of housing have on social reintegration for ex-prisoners

The role of housing in preventing re-offending