Investigators

Rebecca Winter


Supervisors

Professor Margaret Hellard, Associate Professor Stuart Kinner, Doctor Mark Stoové


Background

The relationship between substance use or dependence and offending has been well established, including the link between substance use and recidivism. However, the extent and types of health harms related to substance use among prisoners and ex-prisoners is less well documented. Australia’s prison population continues to grow and the number of individuals passing through the prison exceeds the prison population at any one time. This increasing population of ex-prisoners presents a considerable public health concern; imprisonment is associated with a high prevalence of blood-borne virus transmission, a high risk of unnatural death following release from custody, and significant mental health issues. Ongoing substance use and poor mental and physical health are also important predictors of recidivism.

Prisons provide a unique opportunity to address the health concerns of a profoundly disadvantaged group, yet currently little is done to maintain health once prisoners return to the community. Improving health outcomes for ex-prisoners is important from both a public health and a criminal justice perspective, yet little is known about the health-related experiences of ex-prisoners in Australia or elsewhere, limiting the capacity to develop evidence-based interventions.


Aims

The research will examine drug-related morbidity and mortality, and health service utilisation, among adults released from prison in two Australian states. Specific aims include:

1)  to describe the patterns and predictors of return to drug use following release;

2)  examine the patterns and predictors of drug-related harms;

3)  understand the experiences of, and barriers to, health service provision for ex-prisoners, and;

4)  to investigate the impact of drug treatment on risky drug use and related harms following release.


Methods

The research utilises datasets from two discrete longitudinal projects conducted in Victoria and Queensland. Extensive data produced from these studies will enable an in-depth exploration of drug-related health outcomes for ex-prisoners. A summary of these projects and their specific aims follows.

1) “Hit ‘n’ Miss”. An examination of post-prison release health and support services in Victoria.

This longitudinal study examines the Victorian post-prison release service system and the needs and experiences of ex-prisoners with a history of injecting drug use accessing services. It explores the individual, social and structural barriers and enablers to service access, through a prospective cohort study of 140 recently released (<4weeks) ex-prisoners with a history of injecting drug use, followed up at three and six months post-release.

2) Passports to advantage: a randomised controlled trial (RCT) of a health intervention for ex-prisoners in Queensland.

The Passports study is the first true RCT of a health intervention for ex-prisoners. Following a detailed pre-release health assessment, participants were randomly assigned to receive either a comprehensive information and support package (including community support in the first 4 weeks post-release) or basic feedback. Participants were re-interviewed at one, three and six months post-release and detailed risk behaviour data collected along with information on health status and health service utilisation. It will enable a detailed examination of post-release physical and mental health, and health risk behaviours, within the first six months of release, and access to and use of health services.


Significance

The proposed research will contribute to understanding the health and support needs of ex-prisoners, an area of significant public health need which has implications for broader public health. This research program offers an opportunity to integrate data from two studies of ex-prisoners in different states, and provide a more comprehensive understanding of the factors that contribute to poor or successful outcomes in this population. More specifically, the research will:

1)  Provide a detailed understanding of drug-related morbidity among recently released prisoners.

2)  Examine personal, social, and structural barriers and enablers to health and support service utilisation by ex-prisoners.

3)  Contribute to the development of appropriate and effective health interventions for prisoners and ex-prisoners, including models of care that support community reintegration.

Enable a comparison of ex-prisoner health outcomes between Queensland and Victoria


Progress

The analyses conducted to date have described the patterns and correlates of return to drug use among injectors leaving prison in Victoria, and the incidence and pre-release predictors of non-fatal illicit drug overdose following release from Queensland prisons. Current analysis is around the role of opioid substitution therapy in reducing drug-related harms post-release.


Presentations

Winter, R., Jenkinson, R., Degenhardt, L., Kinner, S. The incidence and risk factors of non-fatal overdose following release from prison in Queensland, Australia. Academic and Health Policy Conference on Correctional Health, Atlanta, GA, USA, 21-22 March 2012.

Winter, R., Jenkinson, R., Degenhardt, L., Kinner, S. The incidence and risk factors of non-fatal overdose following release from prison in Queensland, Australia. Public Health Association of Australia and Australian Epidemiological Association Student Conference, Melbourne, 9 Dec 2011.

Andrews, J., Winter, R., Jenkinson, R., Kinner, S. Understanding drug-related deaths in recently released ex-prisoners. The Australian Professional Society on Alcohol and Other Drugs 2010 Conference, National Convention Centre, Canberra, 29 Nov-1 Dec 2010.

Kirwan, A., Quinn, B., Winter, R., Stoove, M. Getting out and getting on….but not getting services. The Australian Professional Society on Alcohol and Other Drugs 2010 Conference, National Convention Centre, Canberra, 29 Nov-1 Dec 2010.

Stoove, M., Winter, R., Quinn, B., Kirwan, A. Intraprison injecting behaviours and post-release hepatitis C transmission risk. 8th Australasian Conference on Viral Hepatitis, 6-8 September 2010, The Sebel, Albert Park, Melbourne.

Winter, R., Quinn, B., Kirwan, A., Stoové, M. 2010. Back on the ‘horse’: injecting drug use in the immediate post-prison release period. Results from a prospective cohort study in Melbourne, Australia. International Conference on the Reduction of Drug Related Harm, 25-29 April, BT Convention Centre, Liverpool, United Kingdom.

Quinn, B., A Kirwan, R Winter and M Stoove. 2009. A prospective cohort study of ex-prisoners with a history of injecting drug use: overlapping methodological and population-based complexities. APSAD Conference 2009; "Living on the Edge", 1-4 November, [poster presentation], Darwin.


Timeline

2011 – 2014

Contact

For more information relating to this project, please contact Rebecca Winter:


Collaborators

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