Follow-up study of inmates under opioid agonist treatment before and after release

What we are doing

Semi-structured interviews were conducted at two time periods (6 months prior to release and 2 to 6 months after release) with seven inmates recruited from five Quebec institutions in February 2020^{Footnote 2} . A thematic content analysis of all the available data was performed to identify convergent, divergent and emergent elements.

What we have found so far

Three major themes were identified from the participants' interviews: (1) opioid addiction; (2) access to OAT services; and (3) OAT compliance. Here is a brief overview of those sections.

With regard to the first theme, initiation to opioids had occurred in a variety of contexts, including experimenting, seeking to alleviate suffering following a traumatic experience or following a prescription for a medical condition. According to participants, two factors in particular appear to contribute to continued use despite the negative impacts: the substance's high addiction factor and the fear of experiencing a painful withdrawal.

The second theme covers the OAT application process. Although most participants reported that access to services in the correctional setting was simple and quick, others experienced obstacles in this area. In contrast, awareness of the existence of services and how to access them in the community seemed to remain an active challenge at the time of the study. Most participants also found the waiting time for OAT in a correctional setting to be reasonable, but some noted that there was room for improvement given the withdrawal and relapse issues that could arise in the process.

The third theme was maintenance of and compliance to OAT. According to participants, an OAT that is properly administered and tailored to the individual helps to achieve long-term opioid abstinence. In terms of obstacles to maintenance, some participants perceived that they had been given too low a dose, which led to withdrawal symptoms, and some participants on methadone treatment had reported unpleasant side effects (loss of libido, drowsiness, etc.) With respect to the elements that favour OAT compliance, two aspects were identified: training of workers on the goals of treatment and service delivery tailored to and centred on the person. In addition, program maintenance and continuation are a challenge during the transition period. Some factors that appear to facilitate this transition are: the free flow of communication between Correctional Service of Canada staff and community health services staff, employer and work schedule flexibility, and pharmacy proximity to the various living environments.

What it means

Preliminary findings suggest that OAT fosters the achievement of pro-social goals during community reintegration. The initial interviews indicated the importance of maintaining timely OAT access, raising awareness among the various corrections and health services stakeholders regarding the harm reduction approach to prevent relapse and maintain treatment compliance, ensuring service consistency and continuity in the institutional and community environments, and taking a holistic view of reintegration that places the person's interests front and centre.

Continuing this work will make it possible to obtain more information about the transition process and make recommendations to boost treatment compliance.

For more information   

For questions and/or more information, please email the Research Branch. You can also visit the Research Publications section for a full list of reports and one-page summaries.

Prepared by: Christophe Huỳnh^{Footnote 3}  , Jean-Philippe Galipeau, Dena Derkzen, Shanna Farrell MacDonald, Valérie Aubut, Ervane Kamngang and Serge Brochu