Correctional populations are a unique and marginalized population who are among those with the highest prevalence of substance use and mental health problems, and bear a disproportionately elevated risk for related morbidity and mortality (e.g., overdose). As many as 50% or more of correctional inmates, including in Canadian correctional systems, feature opioid misuse and related problems. While some prevention and treatment interventions (e.g., opioid pharmacotherapy programs) for opioid misuse and harms have been selectively implemented in correctional settings, major intervention and knowledge gaps exist. A further challenge relates to post-release intervention and care, where care transition (e.g., addiction treatment) commonly breaks down, and released offenders often return to substance use which leaves them extremely vulnerable for health and social problems, including re-offending and mortality due to overdose. In order to better understand opioid use and related harms among correctional populations, this implementation science project will consist of several sub-projects which will focus and generate evidence on opioid use-related interventions for correctional systems/offenders in Canada.
The Ontario Node is coordinating 4 different projects under the Corrections Umbrella:
- Evaluating the Impact of Strategies to Prevent Opioid-Related Harms in People who Experience Imprisonment in Provincial Prisons in Ontario
PI: Fiona Kouyoumdjian, McMaster University (ONT)
There is a substantial burden of opioid-related morbidity and mortality in people who experience imprisonment in Canada. In the context of a national opioid overdose crisis, the Ontario provincial government is implementing strategies to reduce opioid-related harms. Initiatives that have been implemented in provincial prisons to date are overdose prevention training for people in custody and naloxone distribution on release, policies to support opioid agonist treatment (OAT) initiation, correctional staff training on overdose, and providing naloxone access through correctional staff. Planned strategies will address barriers to OAT, including training for health care workers and establishing referral pathways to community-based treatment.
- Follow-Up Study of Quebec Federal Offenders on Opioid Substitution Treatment (OST)
PI: Serge Brochu, University of Montreal (Quebec/Atlantic)
An increasing number of studies have demonstrated that OST among incarcerated individuals is associated with improved health and criminogenic indicator outcomes post-release into the community. While releases into community care are generally challenging events on several fronts, the transition of treatment for chronic diseases (e.g. HIV, diabetes) into community care and services is known to be difficult, and may not occur smoothly or effectively; these challenges are documented to be distinct for offenders enrolled in OST. In order to better understand issues related to the transition of federal offenders enrolled in OST in Canada, this project will uniquely examine these issues/questions by utilizing a combination of quantitative and qualitative data collected from Quebec-based offender participants during three different assessments (one pre-release and two post-release).
- Examining the Opioid Landscape Within Federal Prisons in Alberta
PI: Kevin Haggerty, University of Alberta (Prairies)
This project will examine: 1) How has fentanyl/carfentanyl impacted policy responses to security concerns in Alberta's prisons, and how does this development impact correctional officers and prisoners? 2) Which measures might be most effective to address this problem in a prison environment? 3) What is the level of appetite for different forms of harm reduction strategies in federal jails among correctional officers, prisoners and correctional staff? Which of these strategies are feasible from a security, legality, and safety perspective? 4) What organizational, security, occupational or cultural barriers might have to be addressed in order to introduce measures to effectively reduce the various risks related to opiates in prison. The findings from these inquiries will a) raise awareness about the extent of the opioid situation in Alberta's prisons, b) inform correctional officers about possible harm reduction measures, c) help shape opioid-related training, and d) suggest policies for a safer environment for prisoners and COs.
- An Evaluation of the use of Community Transition Teams to Improve Health Outcomes for Individuals Recently Released from British Columbia Corrections
PI: Seonaid Nolan, University of British Columbia (BC)
The period following release from a correctional facility is one of heightened vulnerability, as individuals re-immerse into their communities, search for housing and employment and attempt to access health care services. Accordingly, many newly-released clients feel ill-equipped to navigate this process and, in the absence of proper support, are at high-risk for relapse to substance use, recidivism and a host of other negative outcomes. To address this, the British Columbia Provincial Health Services Auhority (PHSA) Correctional Health Services (CHS) program is planning on implementing and scaling-up the use of Community Transition Teams (CTTs). CTTs adopt a client-centred approach to care, whereby a case manager works closely with an individual to help them identify their priorities and subsequently takes an active role in supporting a client to achieve their treatment goals following release from provincial corrections.