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Introduction and Aims: Opioid substitution treatment (OST) reduces drug-related harms in custody and after release. However, OST providers in prisons have reported that some patients prefer to cease treatment prior to release, placing them at risk of fatal overdose. We aimed to examine reasons for seeking OST in custody, and intentions regarding continuation or cessation of treatment prior to and following release.Design and Methods: This qualitative study employed semi-structured interviews with opioid-dependent people currently incarcerated in New South Wales, Australia.Results: Of 46 participants, 27 were currently in OST. Reported benefits of OST included withdrawal management and avoidance of high-risk injecting. Over a third of participants in OST stated their intention to withdraw from OST prior to release. Reasons included concerns that attending community OST clinics could lead to drug use or offending, family opposition, inconvenience of clinic attendance, stigma and a perception that prison provided an opportunity to withdraw from OST more easily than in the community. Nineteen participants had already ceased OST in custody or had declined it, citing preferences to 'be clean' and the long-term nature of OST.Discussion and Conclusions: Balancing the preference of many patients to cease OST prior to release against patient safety post-release is a substantial challenge for opioid treatment providers in correctional settings. These findings indicate the need for research on how best to attract and retain opioid-dependent prisoners in treatment and the need to provide other interventions for prisoners uninterested in post-release OST, such as take-home naloxone. [Larney S, Zador D, Sindicich N, Dolan K. A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia. Drug Alcohol Rev 2017;36:305-310]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Around 65% of people incarcerated in prisons in Australia, America and Europe have a history of drug dependence, sometimes treated with opioid substitution treatment (OST) medications. Studies report that those in treatment in prison do engage in some level of diversion to others, whether on a voluntary or coerced basis. We aimed to examine the use of prescribed and non-prescribed OST medications by those in prisons, especially buprenorphine-naloxone film (BNX-F); the extent of non-adherence and diversion and reasons for such practices; and the impact of the introduction of BNX-F into the prison system.Design and Methods: Mixed methods study drawing on: (i) structured interviews with current OST clients (n = 60) who reported being incarcerated in the 12 months prior to being interviewed and (ii) qualitative interviews with key experts working in corrections and prison (or justice) health settings.Results: The majority were prescribed OST medications in prison, with 25% removing all or part of their supervised dose on at least one occasion, and 44% reporting use of non-prescribed medications. Some reported intravenous use (14% injected). One-third of OST recipients reported selling/sharing OST medications with others in prison. The introduction of BNX-F into the prison system saw different diversion methods used and removal from dosing within prison.Discussion and Conclusions: Despite prison being a highly regulated and controlled environment, some level of diversion and sharing of psychoactive medication occurs among prisoners. The buprenorphine formulations used in OST present particular challenges with respect to supervised dosing in this setting. [White N, Ali R, Larance B, Zador D, Mattick RP, Degenhardt L. The extramedical use and diversion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine-naloxone film. Drug Alcohol Rev 2015;●●:●●-●●]. [ABSTRACT FROM AUTHOR]

The aims of this study were to describe the causes of death in cases found positive for methadone post-mortem, the proportion of cases involving methadone syrup, and of this group, the proportion not registered in methadone maintenance treatment (MMT) at time of death, and the number of deaths during induction into MMT in New South Wales in 1996. Coronial files of cases were reviewed. Data on file with the Pharmaceutical Services Branch, NSW Health Department on number of people admitted to and discharged from MMT in 1996, and details of methadone treatment for cases in MMT, were examined. Eighty-seven methadone positive cases were identified, of which 62 (71%) died of drug-related causes. Of 9835 people inducted into MMT in 1996, seven died within the first 7 days (21% of all deaths in MMT), for an overall mortality rate (MR) of 7.1 deaths per 10 000 inductions (95% CI 1.8-12.4). Fifty-one per cent (51%) of methadone syrup-related cases occurred in people not registered in MMT. This high proportion of diversion related deaths continues to be of concern. The findings reinforce to providers of MMT the necessity of careful procedures for initiation of treatment and support the need for ongoing surveillance of methadone related deaths both in and out of MMT. [ABSTRACT FROM AUTHOR]

Answers questions pertaining to methadone-related deaths. Identification of cases positive for blood or tissue methadone at autopsy; Number of death cases due to the harm of methadone; Analysis of cases of accidental drug-related death by pathologists.

The aim of this study was to determine the number, and to describe the circumstances, of accidental methadone syrup-related deaths (MSRDs) in New South Wales (NSW), Australia from 1990 to 1995. Coronial files of all cases positive for methadone at autopsy between July 1990 and December 1995 in NSW were reviewed to determine methadone syrup-related cases. One hundred and thirty-four cases of MSRD were identified, of which 72 (54%) were registered in methadone maintenance treatment (MMT) at time of death. Diverted sources were implicated in the remaining 62 cases (46%) not registered in MMT. The majority of all cases were single (60%), unemployed (80%) males (75%), with a mean age of 31 years. Intravenous injection of methadone prior to death was evident in 35% of cases not in MMT, and in 10% in MMT. Polydrug use was detected in 89% of cases, most commonly benzodiazepines (52%), followed by morphine (37%) and alcohol (28%). However, forensic authorities did not implicate other drugs detected at autopsy in the cause of death in 34% of cases. The large proportion of deaths involving diverted sources of methadone may be indicative of high-risk behaviour among some injecting drug users, who abuse methadone in combination with other drugs to enhance the effects of intoxication. Alternatively, heroin users who use illicit methadone may be doing so to medicate opioid withdrawal symptoms, which could suggest a high unmet demand for MMT. Failure to implicate other drugs detected at autopsy in the cause of death may result in over-reporting of methadone-detected cases as methadone-caused deaths. The findings from this study support an urgent review of the current classification and reporting mechanisms for methadone-related deaths. [ABSTRACT FROM AUTHOR]