Individuals who have a criminal history have high rates of opioid dependence and mortality risk. The fatality risk from substances such as heroin, for example, is much higher in the weeks following release from prison. Despite this risk, Medications for Opioid Use Disorder (MOUD) are critically underused among inmates. The objective of this study was to examine the association between adherence to methadone maintenance treatment (MMT) and fatal overdoses among individuals with criminal histories.
This study analyzed 14,530 administrative records of individuals in British Columbia with conviction histories who filled a methadone prescription between January 1st, 1998 and March 31st, 2015. Participants were followed from the date methadone was first dispensed, until a death certificate was issued and registered, or until March 31st, 2015. The average age of participants was 34.5, and 71.4% were male. The median follow-up time was 6.9 years, and 1,275 individuals died during that time. The overall all-cause mortality rate was 11.2 per 1,000 Person-Years (or 11.2 deaths per 1000 persons observed for one year). Looking at non-MMT compared to MMT periods, the all-cause mortality rate was significantly higher at 15 per 1,000 person-years compared to 5.9 per 1,000 PYs during MMT periods.
Methadone use was associated with a lower mortality rate among individuals with a criminal history and opioid dependence. It is worth considering that individuals adhering to MMT exhibit lifestyle changes that influence mortality. Despite the known benefits of MOUD, such as methadone, they are not routinely offered in prisons. Barriers to providing treatment include stigma, lack of knowledge, concerns about medication diversion, and lack of linkages between providers and correctional facilities. Inmates and those recently released would benefit from ongoing treatment, following detox while incarcerated.
Russolillo, A., Moniruzzaman, A., & Somers, J. M. (January 01, 2018). Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada. Plos Medicine, 15, 7.)