RESUMEN
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.
Asunto(s)
Analgésicos Opioides , Trastornos Relacionados con Opioides , Analgésicos Opioides/uso terapéutico , Colombia Británica , Instalaciones Correccionales , Humanos , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/tratamiento farmacológicoRESUMEN
For more than two millennia, prison reformers and inmate advocates have lamented the ethical and humanitarian injustices experienced by persons with mental illness in correctional settings; yet, we continue to see mentally ill individuals stuck in limbo between health care and custody. Using a case study that exemplifies the challenges that can prevent the provision of efficient mental health care in correctional settings, we identify the gaps and failures in service delivery, and provide specific strategies for streamlining inmates' access to psychiatric assessment and treatment. As a backdrop, we present a brief overview of the reasons why correctional centres experience difficulties in ensuring expedient care (e.g., competence, mental health legislation, waitlists) as well as reviewing the prevalence of mental health needs in correctional settings. Using the partnership and strategic alignment that have been developed for several years between our forensic psychiatric system and our provincial correctional system, we provide a roadmap to successfully reducing wait times and enhancing service delivery to mentally ill inmates. In our view, custody admissions provide a rare opportunity to provide mental health (and other services) to marginalized individuals who often slip through the cracks. imPROVE and related programs and strategies have been found to be effective means of preventing these opportunities from being lost.