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. 2022 May;117(5):1353-1362.
doi: 10.1111/add.15737. Epub 2021 Nov 19.

Opioid agonist treatment uptake within provincial correctional facilities in British Columbia, Canada

Megan Kurz  1 , Laura M Dale  1 , Jeong Eun Min  1 , Natt Hongdilokkul  2 , Leigh Greiner  3 , Maureen Olley  3 , Katherine E McLeod  4   5 , Amanda Slaunwhite  4   5 , Bohdan Nosyk  1   6
Affiliations

Opioid agonist treatment uptake within provincial correctional facilities in British Columbia, Canada

Megan Kurz et al. Addiction. 2022 May.

Abstract

Background and aims: Multiple interventions and policy changes related to opioid agonist treatment (OAT) have been introduced in British Columbia, Canada to increase engagement and retention in OAT. We aimed to estimate the impact of policy changes and the announcement of the opioid overdose-related public health emergency on the use of OAT for incarcerated individuals with opioid use disorder.

Design: Interrupted time-series analysis. Events of interest included the expansion of buprenorphine/naloxone into provincial health-care insurance coverage in October 2015 and the public health emergency declared in April 2016.

Setting and participants: Our study included 9220 incarcerated individuals from 12 provincial corrections facilities in British Columbia, Canada for a total of 75 649 calendar months of incarceration.

Measurements: Monthly measures of OAT use during incarceration from 1 January 2013 to 30 September 2017. We estimated changes in OAT use, controlling for individual and facility-level factors, using a general estimating equation, specified with a logit link and an autoregressive correlation matrix.

Findings: After the provincial health insurance coverage expansion, a sharp increase in OAT use during incarceration was observed [adjusted odds ratio (aOR) = 1.16, 95% confidence interval (CI) = 1.13, 1.19]. The public health emergency coincided with an immediate but temporary increase in OAT receipt (aOR = 1.34, 95% CI = 1.22, 1.47). During the entire study period, we estimated a 10-fold increase in the adjusted odds of OAT use during incarceration (aOR = 10.10, 95% CI = 8.98, 11.37).

Conclusion: Following an expansion of health-care insurance coverage to include buprenorphine/naloxone, receipt of opioid agonist treatment (OAT) within correctional facilities in British Columbia, Canada increased, largely driven by an increase in buprenorphine/naloxone prescriptions among individuals without recent OAT experience.

Keywords: incarceration; interrupted time series; opioid agonist treatment; opioid use disorder.

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Conflict of interest statement

DECLARATION OF INTERESTS

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flow-chart of eligibility criteria to be included in the study using data from the British Columbia opioid use disorder population
FIGURE 2
FIGURE 2
The monthly percentage of incarcerated individuals with an OAT dispensation stratified by the drug type received during incarceration; (a) considers the entire population regardless of OAT status; (b,c,d) separated the population by their OAT status defined at incarceration admission. Line ‘A’ represents the month of the policy change that covered buprenorphine/naloxone under PharmaCare, and ‘B’ represents the month when a provincial health emergency was called over the rise in opioid-related overdose deaths. OAT = opioid agonist treatment
See this image and copyright information in PMC

References

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