A day-by-day investigation of changes in criminal convictions before and after entering and leaving opioid maintenance treatment: a national cohort study

Abstract

Background: Opioid maintenance treatment (OMT) is associated with reduced crime among heroin users, but little is known about how crime changes during different phases of treatment. The aim of this study was to investigate changes in criminal convictions on a day-to-day basis before and after entry or discharge from OMT.

Methods: National cohort study of all patients (n = 3221) in OMT in Norway 1997-2003. Patients were followed over a 9-year period, before, during, and after treatment. Criminal convictions were studied on a day-to-day basis in relation to treatment status. A time-continuous estimate of the probability of convictions within the population for all days during observation was calculated.

Results: Changes in convictions were evident before changes of treatment status. During the 3 years prior to OMT, the convictions rate was approximately 0.4% per day. Prior to OMT, convictions decreased to about 0.2% per day on the day of treatment initiation. During the weeks before dropping out of treatment, convictions increased. The patterns during periods of transition were the same across gender, age and pre-treatment conviction-levels.

Conclusions: Changes in convictions often occurred prior to changes in treatment status. Reductions in criminal convictions were found in the period before entry (or re-entry) to OMT, and increases in criminal activity were found in the months prior to treatment interruption.

Figure 1

Day-to-day rates of criminal convictions. Day-to-day rates of criminal convictions (95% CI) for all patients (a) entering OMT for the first time, (b) leaving OMT and (c) re-entering OMT. a: X-axis; days before and days after first treatment entry (n=3221). Y-axis; the day-to-day rate of criminal convictions. b: X-axis; days before and days after treatment drop out (n=1175). Y-axis; the day-to-day rate of criminal convictions. c: X-axis; days before and days after treatment re-entry (n=515). Y-axis; the day-to-day rate of criminal convictions.