The Prison and Transition Health (PATH) Cohort Study: Study Protocol and Baseline Characteristics of a Cohort of Men with a History of Injecting Drug Use Leaving Prison in Australia

Amy Kirwan,Tony Butler,Mark Stoové,Campbell Aitken,Shelley Walker,Emma Woods,James Ogloff,Paul Dietze,Stuart Kinner,Michael Curtis

doi:10.1007/s11524-019-00353-5

Abstract

People who inject drugs (PWID) are disproportionately represented among individuals who experience imprisonment and often have more complex physical and mental health needs than people in prison without injecting histories. The trajectories of PWID after prison release are poorly understood, hampering the development of effective strategies to address their distinct health needs. The Prison and Transition Health (PATH) Cohort Study is characterising the post-release trajectories of incarcerated male PWID in Victoria, Australia. We outline study methodology and baseline characteristics of participants prior to their release. Four hundred participants were recruited from three prisons and completed researcher-administered baseline interviews covering socio-demographics, social supports, physical health, mental health, alcohol and other drug use, and pre-release and transitional service utilisation. The median age among participants was 36 years (IQR 30–42), and they reported a median of five (IQR 3–9) previous adult incarcerations. Almost half (49%) were reliant on government payments prior to incarceration. One quarter (25%) of participants reported removal from their parents’ care as children and 64% reported being a parent or primary caregiver to children. Most participants (81%) reported a previous mental health diagnosis and 44% reported three or more diagnoses. The most common drugs injected prior to incarceration were crystal methamphetamine (80%) and heroin (62%), and most (85%) reported being under the influence of drugs at the time of committing offences for which they were currently incarcerated. Injecting drug use during their current sentence was reported by 40% of participants, and 48% reported engaging with some form of drug treatment during their current sentence. Study participants are characterised by significant mental health and substance use morbidities, social disadvantage and criminogenic histories that present challenges for the provision of post-release support services. Data from the PATH Cohort Study will help inform strategies to improve the health and social outcomes of this population.

Highlights

People who inject drugs (PWID) are disproportionately represented among those who experience imprisonment [1]
40% of all people released from prison in Australia return within 2 years [21], with 2-year reincarceration rates among those with injecting drug use (IDU) histories estimated to be as high as 84% [22]
Our lack of understanding of individual, social and service access factors associated with patterns of drug use, health and criminogenic outcomes after release from prison impedes the development of effective policies and practices

Summary

Introduction

People who inject drugs (PWID) are disproportionately represented among those who experience imprisonment [1]. Challenges associated with transitioning from prison to the community, including financial and relationship stress, social isolation and stigma, can be heightened for people with histories of drug dependence and mental and physical health comorbidities [15,16,17] and contribute to post-release service access barriers [18]. For those with drug dependence histories, return to drug use [19] and recidivism [20] following release and reincarceration are common. 40% of all people released from prison in Australia return within 2 years [21], with 2-year reincarceration rates among those with IDU histories estimated to be as high as 84% [22]

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