Author: Schroeder S, Marshall AD, Lafferty L, Baldry E, Higgs P, Dietze P, Stoové M, Treloar C

Theme: Epidemiology & Public Health Research Year: 2019

Background: Globally, a substantial proportion of people who inject drugs (PWID) have a history of
incarceration. Upon release, PWID are at increased risk of poverty-related stressors, including
homelessness and unemployment, as well as drug-related harms. The post-release period is a key
timepoint for mitigating risk factors yet evidence from the PWID perspective is limited. The aim of
this study was to gain greater insight into the post-release experiences of PWID, particularly around
access and utilisation of health and welfare services.
Methods: Participants were recruited from the SuperMIX prospective cohort (n= 1,278) with indepth interviews conducted between September 2018 and February 2019 in Victoria, Australia.
Eligible participants had injection drug use histories, were recently incarcerated (sentence >3
months) and had been released from custody within the past year. Data were coded and analysed
Results: Of 19 PWID interviewed (aged 31-48 years), 17 were male, all had been incarcerated more
than once, 18 were unemployed, 10 had stable housing, and 17 were currently injecting drugs. Most
participants had abstained from injection drug use during incarceration partly for fear of HIV and/or
hepatitis C virus (HCV) transmission. Initiation of HCV treatment was hampered by frequent prison
transfers and uncertainties about re-incarceration. Return to injecting post-release was described as
inevitable due to inadequate accommodation, inconsistent use of opioid substitution therapy and
mental health concerns. Some participants felt ‘set up to fail’ and unworthy of services, and
therefore rationed their service use. Others received support from case workers or persons from the
community sector to navigate post-release challenges.
Conclusion: To achieve WHO HCV elimination targets, ‘drug user health’ must be addressed
holistically. Findings highlight a critical need for greater cross-sectoral collaboration between policy
and services to help enhance PWID agency, improve health outcomes, and reduce risks of social
exclusion during the post-release transition.
Disclosure of interest statement:CT has received speakers’ fees from Abbvie. PD has received
investigator-driven funding from Gilead Sciences and an untied educational grant from Indivior for
work unrelated to this study. PD has served as an unpaid member on an Advisory Board for a
naloxone product. PH received investigator driven funding from Gilead and Abbvie. MS has received
funding from Gilead Sciences Inc. and Bristol-Myers Squibb for investigator-driven grants. SS, ADM,
LL, and EB have nothing to declare.

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