TY - JOUR
T1 - Illicit substance use after release from prison among formerly incarcerated primary care patients
T2 - a cross-sectional study
AU - Chamberlain, Adam
AU - Nyamu, Sylviah
AU - Aminawung, Jenerius
AU - Wang, Emily A.
AU - Shavit, Shira
AU - Fox, Aaron D.
N1 - Funding Information:
The authors thank our participants and the staff of our respective Transitions Clinic Network programs. We thank members of the Substance Use Affinity Group of the Division of General Internal Medicine at Montefiore Medical Center for feedback on this project. ADF was supported by NIH K23DA03454.
Funding Information:
The project described was supported by Langeloth Foundation and Grant Numbers 1CMS331071-01-00 and 1C1CMS331300-01-00 from the Department of Health and Human Services, Centers for Medicare and Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.
PY - 2019/2/19
Y1 - 2019/2/19
N2 - BACKGROUND: More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. RESULTS: Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73-8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20-9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89-0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03-1.10), being on parole (aOR = 0.58, 95% CI: 0.34-0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40-3.68). CONCLUSIONS: Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.
AB - BACKGROUND: More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. RESULTS: Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73-8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20-9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89-0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03-1.10), being on parole (aOR = 0.58, 95% CI: 0.34-0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40-3.68). CONCLUSIONS: Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.
KW - Illicit substance use
KW - Incarceration
KW - Primary care
KW - Transitions Clinics
UR - http://www.scopus.com/inward/record.url?scp=85061844758&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061844758&partnerID=8YFLogxK
U2 - 10.1186/s13722-019-0136-6
DO - 10.1186/s13722-019-0136-6
M3 - Article
C2 - 30782211
AN - SCOPUS:85061844758
SN - 1940-0632
VL - 14
SP - 7
JO - Addiction science & clinical practice
JF - Addiction science & clinical practice
IS - 1
ER -