MR1214 - An Evaluation of the Integrated Drug Treatment System in English Prisons: A Case Control Study

This study is part of an evaluation of the Integrated Drug Treatment System (IDTS), which has recently been introduced to prisons in England. The primary purpose of the study is to assess whether differences occur in relation to short-term mortality rates, engagement with treatment services, and offending behaviour between 10,000 IDTS clients released from prison while still receiving Opiate Substitution Treatment (OST) (e.g. methadone or buprenorphine) and 10,000 IDTS clients released after detoxification from opiate dependence.

We aim to recruit a total of 20,000 adult opiate dependent participants from 42 prisons in England, over a period of 13 months: 10,000 cases released from prison opiate tolerant due to Opiate Substitution Therapy (OST) and 10,000 controls released from prison detoxified.

Each prisoner entering a participating prison who is triaged as being opiate dependent will be invited to participate in the study by a member of the prison’s Health Care or Psychosocial team. Once a prisoner signs the study consent form or refuses to participate, that is the end of his / her active participation. The consent will allow information to be collected about a participant from a number of national databases.

An individual’s participation in the study will be confirmed upon his / her release from prison, at which time his / her opiate tolerance status (detoxified / still in receipt of OST and therefore opiate tolerant) will be recorded, based on the prison’s OST dispensing data. These data will be collected and conveyed to the researchers using either encrypted data disks or sealed hard copy transferred using a secure parcel service. Participant prison release dates will be confirmed from dispensing data and the Local Inmate Database System (LIDS).

Data will be collected from various databases one year after recruitment and again at ten years, and linked to the participant identifying information. Mortality data provided by the MRIS is crucial, a comparison of short-term mortality rates between cases and control participants being our primary outcome. This mortality data will be modelled using multivariable regressions, adjusting for baseline covariates available to us from the Drug Intervention Record (DIR), completed on entry to prison. In addition, we will examine the prevalence of different causes of death within prison or in the first year after prison release. As such, we also require information on causes of deaths from the MRIS.

Our other analyses will rely on data from other sources, including the Police National Computer (PNC) and National Drug Treatment Monitoring System (NDTMS). Of particular interest in addition to mortality is a comparison of re-conviction rates / time to re-conviction between cases and controls and also of rates of engagement with community drug services.

Research in the UK and elsewhere has repeatedly shown that drug users have an increased risk of death immediately following release from prison, most commonly due to overdose after loss of a previous tolerance to opiates. The IDTS aims to provide a more integrated and comprehensive system of treatment for drug users. A significant aspect of this has been the increased use of OST in prisons, the aims of which are to lessen the likelihood of illegal drug use in prison, opiate related overdose upon release, and disengagement from community services upon release. We have been funded by the English Department of Health and the Ministry of Justice to evaluate the effectiveness of this aspect of the IDTS.

Yielded Benefits is not a requirement for new applications.