High-risk drug-use practices among a large sample of Australian prisoners

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Abstract

Background: Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia. Methods: Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination. Results: We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR = 3.07, 95%CI 1.83–5.12), being unemployed prior to incarceration (ARR = 1.34, 95%CI 1.01–1.76), use of three or more drug types prior to incarceration (ARR = 1.80, 95%CI 1.40–2.31), a history of needle/syringe sharing (ARR = 5.00, 95%CI 3.06–8.16), receiving a tattoo during the current prison sentence (ARR = 2.19, 95%CI 1.67–2.86) and HCV exposure (ARR = 1.47, 95%CI 1.08–2.02). Older age was protective (ARR = 0.90 per 5 years older, 95%CI 0.83–0.99). Conclusion: Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings.

Introduction

Incarceration is a common experience among individuals who inject drugs (IDU); as a corollary, a substantial proportion of prisoners report a history of injection drug use (Abiona et al., 2009, Butler et al., 2003, Miller et al., 2008). In Australia, 55% of adult prison receptions report having injected drugs at some point and 34% report having done so in the month prior to incarceration (Butler and Papanastasiou, 2008).

Internationally, sharing of injecting equipment is a key driver of blood-borne viral (BBV) infections including HIV (Jürgens et al., 2009) and hepatitis C (HCV; Vescio et al., 2008). It is therefore not surprising that the prevalence of these infections is elevated among prisoners, particularly those with a history of IDU (Dolan et al., 2007, Macalino et al., 2004).

Despite intensive and costly efforts to restrict the flow of drugs into prison settings (Black et al., 2004), a substantial proportion of IDU continue to inject drugs in prison (Dolan et al., 1996, Dolan et al., 2010, Hellard et al., 2004, Milloy et al., 2008). Estimates of the prevalence of in-prison injecting drug use (P-IDU) vary widely from as low as 3% (Calzavara et al., 2003) to as high as 53% (Hellard et al., 2004), with most estimates based on small and/or convenience samples (Carpentier et al., 2012). Although most studies find that the frequency of injection is lower in prison than in the community (Shewan et al., 1982), sharing of injecting equipment among prisoners remains common (Dolan et al., 1996, Dolan et al., 2010); a recent Canadian study found that rates of injection with used needles remained the same prior to and in prison (Calzavara et al., 2003).

Therefore, although imprisonment is associated with a reduction in both the prevalence and frequency of IDU, the risks associated with P-IDU remain high, due to the substantial baseline prevalence of BBV infection and, in many contexts including Australia, the unavailability of sterile injecting equipment (Ryan et al., 2010). Consistent with this, there is emerging Australian evidence that P-IDU is an independent risk factor for HCV transmission (Hellard et al., 2004, Miller et al., 2008).

The aims of this study were to (a) estimate the prevalence of lifetime IDU, lifetime P-IDU and recent (during current sentence) P-IDU among adult prisoners in Queensland, Australia, and (b) among those with a lifetime history of IDU, identify health-related correlates of recent P-IDU.

Section snippets

Participants and methods

Data were collected via face-to-face administration of a structured questionnaire in confidential interviews conducted by trained researchers in seven adult correctional centers in Queensland, Australia, between August 2008 and July 2010. The questionnaire provided baseline data for a randomized controlled trial of a re-entry intervention (Kinner et al., 2009); randomization occurred after baseline interview.

Potentially eligible participants were identified from prison records and included

Prevalence of injecting

The sample consisted of 1,322 participants, of whom 737 (55.7%) reported a lifetime history of IDU, 286 (21.6%) reported a lifetime history of P-IDU, and 163 (12.3%) reported P-IDU during their current prison sentence. Correcting for the oversampling of women, the estimated population prevalence of lifetime IDU was 55.1% (95%CI 52.3–57.9%), of lifetime P-IDU 23.0% (95%CI 20.7–25.4%) and of recent P-IDU 13.2% (95%CI 11.3–15.1%). Among those reporting recent P-IDU, 87.1% reported using a needle

Discussion

Among adult prisoners in Queensland, Australia we robustly estimated that more than half (55.1%) have a history of injection drug use, that almost one in four (23.0%) has injected drugs in prison and that more than one in eight (13.2%) has injected drugs during their current prison sentence. Among these, the vast majority reported receptive sharing of needles and other injecting equipment. These findings are consistent with those of previous studies in Australia and internationally, and add

Conclusions

A growing number of studies have documented drug injection among prisoners, in the context of intensive efforts to prevent the flow of drugs into prisons. In this study around 13% of participants, and 22% of those with a lifetime history of IDU, injected during their current prison sentence. Those injecting were typically young, disadvantaged males who had engaged in a range of risk behaviors both in the community and in prison. Not surprisingly, injection in prison was independently associated

Role of funding source

The Passports study is funded by the Australian National Health and Medical Research Council (NHMRC Strategic Award #409966). Stuart Kinner is supported by a Career Development Fellowship from the NHMRC (#1004765). Rebecca Jenkinson is supported by the NHMRC-funded Centre for Research Excellence into Injecting Drug use (#1001144). M.-J. Milloy is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research.

Contributors

Authors Kinner and Jenkinson designed the study. Author Gouillou undertook the statistical analyses. Author Kinner wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

No conflict declared.

Acknowledgements

The Passports project is funded by National Health and Medical Research Council (NHMRC) grant #409966. Stuart Kinner is supported by NHMRC Career Development Fellowship #1004765. Rebecca Jenkinson is supported by the NHMRC-funded Centre for Research Excellence into Injecting Drug Use (#1001144). M.-J. Milloy is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. The authors wish to thank Passports participants for

References (35)

  • T. Butler et al.

    Drug use and its correlates in an Australian prison population

    Addict. Res. Theor.

    (2003)
  • T. Butler et al.

    National Prison Entrants’ Bloodborne Virus and Risk Behaviour Survey Report 2004 and 2007

    (2008)
  • L.M. Calzavara et al.

    Prior opiate injection and incarceration history predict injection drug use among inmates

    Addiction

    (2003)
  • C. Carpentier et al.

    Ten years of monitoring illicit drug use in prison populations in Europe: issues and challenges

    Howard J. Crim. Justice

    (2012)
  • K. Dolan et al.

    Prison-based syringe exchange programmes: a review of international research and development

    Addiction

    (2003)
  • K. Dolan et al.

    Incidence and risk for acute hepatitis C infection during imprisonment in Australia

    Eur. J. Epidemiol.

    (2010)
  • K. Dolan et al.

    HIV risk behaviour of IDUs before, during and after imprisonment in New South Wales

    Addict. Res.

    (1996)
  • Cited by (0)

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