Injecting drug use is an independent risk factor for reincarceration after release from prison: A prospective cohort study

Abstract

Introduction and Aims: Once involved in the criminal justice system, people who inject drugs (PWID) have a high probability of multiple system encounters. Imprisonment typically fails to rehabilitate PWID, who upon return to the community are at considerable risk of returning to injecting drug use (IDU) and poor health and social outcomes. We examined the effect of IDU resumption, and a suite of other sociodemographic, criminogenic, health and behavioural indicators, on the timing of reincarceration among adults with a history of IDU following release from prison. Design and Methods: Structured interviews were conducted with 561 PWID in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post-release. Data were linked prospectively with correctional records and the National Death Index. Data collected at multiple time-points were treated as time-varying covariates. Kaplan–Meier survival estimates and Cox proportional hazards models were used to estimate the rate and hazards of reincarceration. Results: Sixty-eight percent of participants (n = 350) were reincarcerated over a combined observation time of 1043.5 years, representing a rate of 33.5 per 100 person-years (95% confidence interval [CI] 30.2–37.2). Time-invariant predictors of reincarceration in PWID were: male gender (adjusted hazard ratio [AHR] = 1.62, 95% CI 1.19–2.21), older age at release (AHR = 0.97, 95% CI 0.95–1.00), previous adult (AHR = 2.00, 95% CI 1.41–2.84) or juvenile (AHR = 1.78, 95% CI 1.27–2.49) imprisonment, shorter imprisonment (≤90 days vs. >365 days, AHR = 2.09, 95% CI 1.30–3.34), release on parole (AHR = 2.29, 95% CI 1.82–2.88) and drug-related sentence (AHR = 1.84, 95% CI 1.34–2.53). Time-varying predictors included resumption of IDU (AHR = 2.04, 95% CI 1.60–2.61), unemployment (AHR = 1.53, 95% CI 1.07–2.19) and low perceived social support (AHR = 1.41, 95% CI 1.05–1.90). Very-high psychological distress at the most recent interview was protective against reincarceration (AHR = 0.65, 95% CI 0.44–0.95). Discussion and Conclusions: Efforts to prevent resumption of IDU and address disadvantage, social inclusion and health service access in ex-prisoners through the scale-up and integration of prison-based and post-release interventions are likely to reap both public health and criminal justice benefits.