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Background and aims Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. Design Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. Setting Publicly funded drug treatment facilities in California, USA (2006-10). Participants A total of 31 659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. Measurements Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. Findings Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17 550 ($16 840, $18 383). Conclusions In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment. [ABSTRACT FROM AUTHOR]

Background and Aims Criminal justice-involved individuals are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended-release naltrexone (XR-NTX; Vivitrol®) in preventing opioid relapse among criminal justice-involved US adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost-offsets. Our aims were to (1) estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence. Design Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks. Setting Five study sites in the US Northeast corridor. Participants A total of 308 participants were randomized to XR-NTX ( n = 153) or TAU ( n = 155). Measurements Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively. Findings The 25-week cost per QALY and abstinent-year figures were $162 150 and $46 329, respectively. The 78-week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered 'good value' at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks. Conclusions While extended-release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally accepted value thresholds for QALYs, due to the high price of the injection. [ABSTRACT FROM AUTHOR]

Background and Aims Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug-related death soon after release from prison. The NALoxone InVEstigation (N-ALIVE) pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone-on-release (NOR) to eligible prisoners in England. Design. Parallel-group randomized controlled pilot trial. Setting English prisons. Participants A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre-randomization, release due within 3 months and more than 6 months since previous N-ALIVE release. Intervention Using 1 : 1 minimization, prisoners were randomized to receive on release a pack containing either a single 'rescue' injection of naloxone or a control pack with no syringe. Measurements Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self-questionnaires (RPSQs: 207), NOR-carriage (75% in first 4 weeks) and overdose presence (80%). Findings Prisons (16) and prisoners (1685) were willing to participate [consent rate, 95% confidence interval (CI) = 70-74%]; 218 RPSQs were received; NOR-carriage (95% CI = 63-79%) and overdose presence (95% CI = 75-84%) were as expected. We randomized 842 to NOR and 843 to control during 30 months but stopped early, because only one-third of NOR administrations were to the ex-prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014. Conclusions Large randomized trials are feasible with prison populations. Provision of take-home emergency naloxone prior to prison release may be a life-saving interim measure to prevent heroin overdose deaths among ex-prisoners and the wider population. [ABSTRACT FROM AUTHOR]

Aims To examine gradual change in debt problems, divorce and income among men in Finland before and after a first conviction for driving under the influence ( DUI). Design and Setting A register-based longitudinal study conducted in Finland between 1999 and 2013. Participants A nationally representative sample of 70 659 Finnish males born between 1918 and 1983, and a subsample of males ( n = 1782) who had their first DUI conviction during 2005-2012. Measurements Descriptive statistics showing the socio-demographic and economic determinants of DUI. The main analysis was based on a longitudinal, within-individual setting. The impact of DUI on debt problems, divorce and income was analysed using random effects regression models. Findings DUI offenders were more likely to be younger and to have lower education and income than the non- DUI group. Criminal convictions were also more common among DUI offenders. Debt problems, divorce and loss of income were more likely after the DUI incident than before. The already increasing level of debt problems accelerated after the incident and divorce rates increased after the DUI incident, whereas the decrease in income was gradual over the whole observation period. Conclusions Among men in Finland, DUI offences are more common among vulnerable social groups. The first drunk-driving conviction among men in Finland constitutes a significant life event that appears to increase the likelihood of financial problems and divorce. [ABSTRACT FROM AUTHOR]

Aims To compare the incidence, timing and risk factors for substance-related death between Indigenous and non-Indigenous ex-prisoners in Queensland, Australia. Design Retrospective cohort study. Setting All adult prisons in the state of Queensland, Australia, linked to deaths registered in Australia. Participants/cases We obtained records for all adults released from prison in Queensland, Australia from 1 January 1994 to 31 December 2007. Among this cohort of 42 015 individuals we observed 82 315 releases from prison and 2158 deaths in the community by the end of 2007, of which 661 were substance-related deaths. Measurements Incarceration data were obtained from Queensland Corrective Services and linked probabilistically with deaths recorded in the Australian National Death Index. Findings In the first year after release, Indigenous ex-prisoners were more likely to die from alcohol-related causes [hazard ratio ( HR) = 1.9, 95% confidence interval ( CI) = 1.1-3.1)] but less likely to die of drug-related causes ( HR = 0.34, 95% CI = 0.21-0.53) than were non-Indigenous ex-prisoners. Among non-Indigenous prisoners only, the risk of substance-related death was significantly higher in the first 4 weeks [relative risk ( RR) = 5.1, 95% CI = 3.7-6.9] when compared with the risk after 1 year post-release. Most evaluated risk factors for substance-related death were similar for Indigenous and non-Indigenous ex-prisoners; however, the hazard of death increased with age more for Indigenous ex-prisoners ( HR = 1.7 per decade of age, 95% CI = 1.4-2.1) than for non-Indigenous ex-prisoners ( HR = 1.3, 95% CI = 1.2-1.4). Conclusions In Australia, patterns of substance-related death in ex-prisoners differ markedly according to Indigenous status. Efforts to prevent substance-related deaths in ex-prisoners should consider heterogeneity in the target population and tailor responses accordingly. [ABSTRACT FROM AUTHOR]

Aims Studies of offending among people who use drugs typically focus upon small and potentially unrepresentative samples. We examined an entire population of opioid-dependent clients' contact with the criminal justice system to develop more accurate population-wide measures of offending among opioid-dependent people in Australia. Design Retrospective data linkage study. Setting All entrants to opioid substitution therapy ( OST) for opioid dependence in New South Wales, Australia, between 1985 and 2010, with data on court appearances from 1 December 1993 to 31 March 2011. Participants All 48 069 valid cohort members who received OST between 1985 and 2010. Measurements Person-years ( PY) of observation and charge rates for major crime categories estimated by sex, age and time. Findings A total of 638 545 charges were laid against cohort members between 1993 and 2011. Eight in 10 males (79.7%) and 67.9% of females had at least one charge; rates were 94.15 per 100 PY [95% confidence interval ( CI) = 93.89-94.41] among males, and 53.19 per 100 PY (95% CI = 52.91-53.46) among females, and highest at 15-19 years [175.74/100 PY males (95% CI = 174.45-177.03), 75.60/100 PY females (95% CI = 74.46-76.76)] and 20-24 years [144.61/100 PY males (95% CI = 143.70-145.53), 84.50/100 PY females (95% CI = 83.53-85.48)]. The most frequent charges were theft (24.5% of charges), traffic/vehicle (16.3%), offences against justice (10.5%), illicit drug (10.0%), intentional injury (9.9%) and public order offences (8.9%). Overall, 20.8% of the cohort accounted for 67.4% of charges. The most frequently appearing 5.6% of the cohort accounted for 24.3% of costs ($75.5 million). Conclusions Among opioid-dependent people in Australia, a minority account for the majority of the criminal justice contact and levels of offending are not consistent over time, sex or age. [ABSTRACT FROM AUTHOR]

Aims World-wide, more than 30 million people move through prisons annually. Record linkage studies have identified an increased risk of death in ex-prisoners. In order to inform preventive interventions it is necessary to understand who is most at risk, when and why. Limitations of existing studies have rendered synthesis and interpretation of this literature difficult. The aim of this study was to describe methodological characteristics of existing studies and make recommendations for the design, analysis and reporting of future studies. Methods Systematic review of studies using record linkage to explore mortality in ex-prisoners. Based on analysis of these studies we illustrate how methodological limitations and heterogeneity of design, analysis and reporting both hamper data synthesis and create potential for misinterpretation of findings. Using data from a recent Australian study involving 42 015 ex-prisoners and 2329 observed deaths, we quantify the variation in findings associated with various approaches. Results We identified 29 publications based on 25 separate studies published 1998-2011, mainly from the United Kingdom, United States and Australia. Mortality estimates varied systematically according to features of study design and data analysis. A number of common, avoidable and significant methodological limitations were identified. Substantial heterogeneity in study design, methods of data analysis and reporting of findings was observed. Conclusions Record linkage studies examining mortality in ex-prisoners show widely varying estimates that are influenced substantially by avoidable methodological limitations and reducible heterogeneity. Future studies should adopt best practice methods and more consistent methods of analysis and reporting, to maximize policy relevance and impact. [ABSTRACT FROM AUTHOR]

Aims This retrospective study compared drinking histories of 283 men and 413 women convicted of driving while impaired ( DWI) in New Mexico and interviewed 15 years following a first conviction and screening referral. Design We characterized drinking course and plotted drinking status (stable abstainers, abstainers, moderate or risky drinkers) from age 15 to 60 years. Setting Pacific Institute for Research and Evaluation, Albuquerque, New Mexico. Participants Community sample of previously convicted DWI offenders. Measurements Psychiatric disorders from the Comprehensive International Diagnostic Interview; drinking histories from the Cognitive Lifetime Drinking History. Findings Risky drinking was prevalent at all ages for both genders. Almost half the population reported either a life-time drinking course of risky drinking (19%) or resumed risky drinking after at least one interval of abstinence or moderate drinking (25%), while about one-fifth followed a never risky or risky to moderate drinking course. Offenders with a life-time diagnosis of substance dependence more often transitioned to risky drinking, and those with life-time alcohol dependence were more prone to transition to abstinence. Across time, those who began risky drinking at age 15 years or later quit at double the rate of those who began before age 15 years. Women's and men's drinking courses were similar, but women began risky drinking at a later age and moved to abstinence more often. Conclusions Among people convicted of driving while impaired in the United States, younger age of initiation of drinking and co-occurrence of psychiatric and substance use appear to be associated with a poorer trajectory of subsequent risky drinking behaviour. Women who are convicted of driving while impaired appear to start drinking later in life and be more likely to subsequently become abstainers. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To determine whether collaborative behavioral management (CBM) reduces substance use, crime and re-arrest among drug-involved parolees. Design Step'n Out was a randomized behavioral trial of CBM versus standard parole (SP) during 2004-08. CBM adapted evidence-based role induction, behavioral contracting and contingent reinforcement to provide parole officer/treatment counselor dyads with positive tools in addition to sanctions to manage parolees' behavior over 12 weeks. Setting Six parole offices in five states in the USA. Participants Parolee volunteers with a mandate for addiction treatment and a minimum of 3 months of parole ( n = 476). Follow-up was 94% at 3 months and 86% at 9 months. Measurements Drug use and crime in a given month from calendar interviews 3 and 9 months after parole initiation, and re-arrests from criminal justice administrative data. Findings The CBM group had fewer months in which they used their primary drug [adjusted risk ratio (ARR) 0.20, 95% confidence interval (CI): 0.05, 0.78, P = 0.02] and alcohol (ARR 0.38, 95% CI: 0.22, 0.66, P = 0.006) over follow-up. CBM had its greatest effects among parolees who reported marijuana or another 'non-hard' drug as their primary drug; parolees who preferred stimulants or opiates did not benefit. No differences were seen in total crime, re-arrests or parole revocations. Conclusions Collaborative behavioral management may reduce substance use among primary marijuana or other 'non-hard' drug-using parolees without increasing revocations. Because the majority of drug violation arrests in the United States are for marijuana, these findings have important implications for the management of a substantial proportion of the US community correctional population. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. Design, setting and participants Treatment data on all patients who started OMT in Norway between 1997 and 2003 ( n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment. Findings During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly ( P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment. Conclusions Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment. [ABSTRACT FROM AUTHOR]