Drugs-related death soon after hospital discharge among drug treatment clients in Scotland:record linkage, validation and investigation of risk factors.

We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29-90 days, 91 days-1 year, >1 year since most recent hospital discharge versus 'never admitted'. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0-1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients' high DRD-rate soon after hospital-discharge in 2006-2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006-2010, as in 1996-2006, especially for those with a history of injecting

Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use

Background: Take-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia. Methods: The sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison. Results: Most participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03-4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32-4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14-5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73-11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18-0.77) was associated with decreased odds of willingness to participate in a prison THN training. Conclusion: Our findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period

A record linkage study of hospital episodes for drug treatment clients in Scotland, 1996-2006

Despite drug users’ high mortality rates, their contacts with hospital and psychiatric treatment have received comparatively little quantification. We provide a comprehensive summary and characterisation of the hospital and psychiatric treatment episodes of a national cohort of drug treatment clients during 1996–2006. Drug treatment records were linked to national registers of deaths, hepatitis C virus (HCV) diagnoses and hospital and psychiatric episodes (hereafter hospital episode). Allowing for overdispersion, we calculated hospital episode rates (HERs) by main diagnosis at discharge; standardised hospital episode ratios (SHERs) during 2001/2002 to 2005/2006 only and Cox regression analyses of time-to-hospital-episode. The Scottish Drug Misuse Database (SDMD) cohort comprised 69,457 individuals and 350,317 person-years (pys) with 107,723 hospital episodes by 27,124 individuals: 70,094 hospital episodes occurred during 229,504 pys in 2001/2002 to 2005/2006. The five discharge-diagnoses with highest SHERs were: mental and behavioural disorders 40.3 (95% CI: 38.6–42.1), circulatory system disease 3.7 (3.5–4.0), infectious and parasitic diseases 3.7 (3.4–4.0), diseases of the skin and subcutaneous tissue 3.5 (3.4–3.7), injury, poisoning and other consequences of external causes 3.4 (3.3–3.5). HCV-diagnosed clients were at over twofold greater risk of hospital episode (hazard ratio (HR), for those without diagnosis, 0.41, 95% CI: 0.39–0.43) and alcohol misuse increased risk (HR: 1.69, 95% CI: 1.60–1.80). HERs and SHERs align with SDMD clients’ cause-specific mortality pattern. Interventions for drug treatment clients might incorporate preventive strategies to address the significantly elevated diagnosis-specific SHERs – in particular, dual diagnoses with mental illnes

A quantitative exploration of risk factors associated with drug-related deaths involving heroin, alcohol or methadone in the West of Scotland

A number of risk factors have been identified that increase the potential for overdose events to occur, however in-depth studies exploring multiple Drug-Related Death (DRD) risk factors simultaneously are less prevalent and mainly conducted among non-fatal OD populations. Using retrospective data from two Scottish NHS Board areas, this study looked at three main types of DRD in more depth, namely those involving heroin, alcohol or methadone, exploring the associations between personal and population DRD risk factors and attempting to predict their impact. Of a total of 291 DRDs across the two areas between 2006 and 2007; almost two-thirds (65%; n=190) involved heroin, one-third (34%; n=100) involved methadone and over a quarter (28%; n=80) involved alcohol. The direct involvement of benzodiazepines was much less prominent (4%; n=11). Age and geographical area were both significant predictors of DRDs involving both heroin and alcohol. Heroin-related DRDs were significantly more likely to affect males than females and prison release within the last 14 days a significant predictor. Gender and heroin involvement were both significant predictors of Methadone-related DRDs with females more likely to be affected than males and heroin less likely to be co-involved. These findings support previous research into DRD and overdose risk factors by revealing co-presences and predictors of DRD-subtypes. They suggest new areas where overdose prevention messages should be targeted; such as an increasing risk of alcohol involvement in DRD with age and an increased risk of Methadone-related DRD for females