Correlates of Imprisonment in Opioid-Dependent Men & Women in New South Wales, Australia

INTRODUCTION AND AIMS:

Involvement in the criminal justice system is common among opioid-dependent people. This study aimed to determine prevalence and adolescent-onset correlates of adult imprisonment among opioid-dependent men and women in New South Wales, Australia.

DESIGN AND METHODS:

Participants were recruited from opioid substitution therapy clinics and completed a face-to-face, structured interview. Data were collected on demographic characteristics, family history, substance dependence and psychiatric disorders. Adolescent-onset correlates of adult incarceration (including interactions with gender) were examined using logistic regression.

RESULTS:

Opioid-dependent men were significantly more likely than opioid-dependent women to report adult imprisonment (66% vs 40%; P < 0.001). In a multivariable logistic regression model, older age, male gender, having completed high school education only, having dependent children or living independently prior to age 18 years, a history of juvenile detention and adolescent-onset opioid dependence were all significantly associated with increased odds of adult imprisonment. Adolescent-onset depression was associated with a halving of odds of adult imprisonment. The only variable for which we observed an interaction with gender was juvenile detention, which had a significantly greater impact on the odds of imprisonment for men than women.

DISCUSSION AND CONCLUSIONS:

More than half of this sample of opioid dependent adults had a history of imprisonment. Variables that are associated with imprisonment in the general population, such as childhood maltreatment, were not important in predicting imprisonment in this sample. Further study is required to understand the interaction between sex and juvenile detention in predicting adult imprisonment.

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By:   Larney S1,2, Cama E1, Nelson E3, Larance B1, Degenhardt L1,4,5,6.

• 1National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
• 2Alpert Medical School, Brown University, Providence, USA.
• 3Department of Psychiatry, Washington University School of Medicine, St Louis, USA.
• 4School of Population and Global Health, University of Melbourne, Melbourne, Australia.
• 5Department of Global Health, School of Public Health, University of Washington, Seattle, USA.
• 6Murdoch Children's Research Institute, Melbourne, Australia. 

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Consensual Sex Between Men & Sexual Violence in Australian Prisons

Estimates of the incidence of sexual coercion in men's prisons are notoriously variable and fraught with conceptual and methodological problems. In 2006-2007, we conducted a computer-assisted telephone survey of a random sample of 2,018 male prisoners in New South Wales and Queensland. 

Of 2,626 eligible and available inmates, 76.8% consented and provided full responses. We asked about time in prison, sexual experience, attraction and (homo/bi/heterosexual) identity, attitudes, sexual contact with other inmates, reasons for having sex and practices engaged in, and about sexual coercion, including location and number of perpetrators. Most men (95.1%) identified as heterosexual. 

Of the total sample, 13.5% reported sexual contact with males in their lifetime: 7.8% only outside prison, 2.8% both inside and outside, and 2.7% only inside prison. Later in the interview, 144 men (7.1% of total sample) reported sexual contact with inmates in prison; the majority had few partners and no anal intercourse. Most did so for pleasure, but some for protection, i.e., to avoid assault by someone else. 

Before incarceration, 32.9% feared sexual assault in prison; 6.9% had been sexually threatened in prison and 2.6% had been sexually coerced ("forced or frightened into doing something sexually that [they] did not want"). Some of those coerced reported no same-sex contact. The majority of prisoners were intolerant of male-to-male sexual activity. 

The study achieved a high response rate and asked detailed questions to elicit reports of coercion and sex separately. Both consensual sex and sexual assault are less common than is generally believed.

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By:  Richters J1, Butler T, Schneider K, Yap L, Kirkwood K, Grant L, Richards A, Smith AM, Donovan B.

• 1School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. j.richters@unsw.edu.au 

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Factors Associated with Sexual Coercion in a Representative Sample of Men in Australian Prisons

Very little research has focused on men or prisoners as victims of sexual violence. This study provides the first population-based analysis of factors associated with sexual coercion of men in Australian prisons, and the first to use a computer-assisted telephone interview to collect this information in a prison setting. 

A random sample of men in New South Wales and Queensland prisons were surveyed using computer-assisted telephone interviewing. We asked participants about sexual coercion, defined as being forced or frightened into doing something sexually that was unwanted while in prison. Associations between sexual coercion in prison and sociodemographics, sexual coercion history outside of prison, and prison-related factors were examined. 

Logistic regression was used to estimate adjusted odds ratios in examining factors associated with sexual coercion in prisons. Of 2626 eligible men, 2000 participated. Participants identifying as non-heterosexual and those with a history of sexual coercion outside prison were found to be most at risk. Those in prison for the first time and those who had spent more than 5 years in prison ever were also more likely to report sexual coercion. 

Although prison policies and improving prison officer training may help address immediate safety and health concerns of those at risk, given the sensitivity of the issue and likely under-reporting to correctional staff, community-based organizations and prisoner peer-based groups arguably have a role too in providing both preventive and trauma-focused support.

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By:  Simpson PL1, Reekie J2, Butler TG2, Richters J3, Yap L2, Grant L4, Richards A5, Donovan B2,6.

• 1The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia. psimpson@kirby.unsw.edu.au.
• 2The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
• 3School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
• 4Corrective Services New South Wales, Sydney, Australia.
• 5Queensland Department of Health, Brisbane, Australia.
• 6Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.

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Was an Epidemic of Gonorrhoea among Heterosexuals Attending an Adelaide Sexual Health Services Associated with Variations in Sex Work Policing Policy?

BACKGROUND:

A review of historical trends in gonococcal diagnoses made at the Adelaide Sexual Health Clinic (ASHC), South Australia, identified a substantial rise in diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South Australia, regulated in Victoria and legal in New South Wales. This and other factors that could have influenced the epidemic were explored in this analysis.

METHODS:

Retrospective analyses of gonorrhoea diagnoses made by sexual health services between 1990 and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales) were undertaken.

RESULTS:

At the ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women (0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%, p<0.001) compared with other years. This relationship was not seen at the Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual Health Centre showed that FSWs were less likely to have gonorrhoea between 2006 and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010 (OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in 2007/2008.

CONCLUSIONS:

A substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is vital to the prevention of HIV and STI transmission.

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By:  Li B1, Bi P2, Waddell R3, Chow EP4, Donovan B5, McNulty A6, Fehler G7, Loff B8, Shahkhan H8, Fairley CK4.

• 1School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia Adelaide Sexual Health Clinic (ASHC, known as Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia Australia.
• 2School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
• 3Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia Microbiology and infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia.
• 4Central Clinical School, Monash University, Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
• 5The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia.
• 6Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia.
• 7Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
• 8School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 

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Exploring Patterns of Offending by Juvenile Offenders in Australia: What Is the Evidence for a Specialist Violent Offender?

The question of whether there are offenders who specialise in violent offences is one that has been of considerable interest to life course developmental criminology as well as policy makers and the public. 

The current study investigated this using an administrative dataset of juvenile offenders from New South Wales, Australia. Specifically, it asked whether offenders convicted of a serious violent offence differed in their demographic, criminal history and reoffending profiles and whether there were further differences in these factors across gender and cultural identity. 

Overall, the findings indicated that violence is more likely to occur in the context of an extensive criminal career. Indigenous male individuals were the most frequent and chronic offenders in the sample. The policy and theoretical implications of these findings are discussed.

Table 5

Descriptive statistics, ‘persistently’ violent offenders compared to non-violent offenders

	Non-violent (N = 1369)	Persistently violent offender (N = 69)	Pvalue	Effect size
Indigenous status	556 (40.6 %)	26 (37.7 %)	0.628	0.01
Gender (male)	1369 (86 %)	58 (84 %)	0.617	0.01
Age	16.46 (1.58)	16.49 (1.13)	0.450	<0.01
Socio-economic disadvantage	2.47 (1.00)	2.58 (1.16)	0.181	0.05
Remoteness index	2.02 (1.05)	1.54 (0.87)	0.001	0.19
Prior conviction	2.14 (1.83)	3.03 (2.86)	0.001	0.20
Age at first offence	15.13 (1.71)	14.88 (1.75)	0.112	0.06
Prior imprisonment	110 (8.0 %)	9 (13 %)	0.141	0.04
Prior suspended sentence	73 (5.30 %)	6 (8.7 %)	0.232	0.03
Prior breach offence	179 (13.1 %)	15 (21.7 %)	0.040	0.05
Prior juvenile offence	1245 (91 %)	69 (100 %)	0.009	0.07

For the categorical variables, differences were tested using Χ 2 and t tests were used to compare means of the continuous variables

Full article at:  http://goo.gl/k5YmZK

By:  Andrew McGrath 

 

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Excess Mortality among Opioid-Using Patients Treated with Oral Naltrexone in Australia

To estimate the number of deaths that would have occurred among patients receiving oral naltrexone for opioid use under the Special Access Scheme if these patients had received methadone.

We analysed mortality in cohorts treated with oral naltrexone and methadone. Data were from 1097 patients of in WA providing oral naltrexone for opioid use under the SAS,1998-2000, and all participants in WA (n = 2520) and New South Wales (NSW) (n = 11,174) methadone programs over the same period. We calculated mortality rates among patients receiving naltrexone and methadone, and excess mortality among patients receiving naltrexone.

Oral naltrexone patients had higher mortality than those treated with methadone, even when favourable assumptions were made about the effects of naltrexone on mortality. Total oral naltrexone mortality was significantly greater than for methadone in WA (rate ratio 3.5; 95% confidence interval 2.2-5.8) and NSW (rate ratio 3.5; 95% confidence interval 2.4-5.0). Among 1097 oral naltrexone patients we estimate that there were 25-29 deaths over two years that would probably not have occurred if these patients had received methadone. The major reason was higher mortality rate post-treatment cessation.

Large-scale use of oral naltrexone to treat opioid users may not have, as intended, saved lives. Implant naltrexone continues to be prescribed under the SAS in the absence of reliable efficacy and safety data. There is a need to review widespread use of unregistered medications under the SAS, particularly with vulnerable patient groups.

Full article at:  http://goo.gl/URGh5z

By:  Degenhardt L1, Larney S, Kimber J, Farrell M, Hall W.

• 1National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Global Health, School of Public Health, University of Washington, Seattle, USA. 

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A Cost-Effectiveness Analysis of Opioid Substitution Therapy Upon Prison Release in Reducing Mortality among People with a History of Opioid Dependence

Although opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6 months post-release.

Design: Population-based, retrospective data linkage study using records of OST entrants (1985-2010), charges and court appearances (1993-2011), prison episodes (2000-11) and death notifications (1985-2011).

Participants: A cohort of 16 073 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011.

Intervention: OST treatment compared to no OST treatment at prison release.

Measurements: Mortality and costs (treatment, criminal justice system-court, penalties, prison-and the social costs of crime) were evaluated at 6 months post-release. Analyses included propensity score matching, bootstrapping and regression.

A total of 13 468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14 356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.

Opioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6 months of release.

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By:  Gisev N1, Shanahan M1, Weatherburn DJ2, Mattick RP1, Larney S1,3, Burns L1, Degenhardt L1,4.

• 1National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
• 2New South Wales Bureau of Crime Statistics and Research (BOCSAR), Sydney, New South Wales, Australia.
• 3Alpert Medical School, Brown University, Providence, Rhode Island, USA.
• 4School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia. 

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