Best practice portal main page
Opioid substitution therapy to reduce deaths in prison
Summary of the evidence
One cohort study (Larney et al., 2014) enrolling N=16 715 opioid dependent people who were in prison between 2000 and 2012 showed that:
- being in OST was associated with a 74% lower hazard of dying in prison (adjusted HR (AHR) 0.26; 95% CI 0.13 to 0.50), compared to time not in OST
- being in OST was associated with a 87% lower hazard of unnatural death (adjusted HR (AHR) 0.13; 95% CI 0.05 to 0.35), compared to time not in OST
- being in OST was associated with a 94% lower all-cause mortality hazard during the first 4 weeks of incarceration (adjusted HR (AHR) 0.06; 95% CI 0.01 to 0.48), compared to time not in OST
- being in OST was associated with a 93% lower hazard of unnatural death during the first 4 weeks of incarceration (adjusted HR (AHR) 0.07; 95% CI 0.01 to 0.59), compared to time not in OST
Opioid substitution therapies were found in a systematic review with meta-analysis (Strange et .a, 2022, 20 studies, N=30 119) to have a significant effect in:
- reducing nonfatal overdoses (OR = 0.41 [0.18, 0.91], SE = 0.41, p < 0.05).
The same review however found a non-significant effect of OST in reducing fatal overdoses, yet the overall results suggests that those receiving OST had nearly 60% reduced odds of a nonfatal overdose and confirming it to be a very effective harm reduction intervention.
