By Megan Grabenauer; Nichole Bynum

This report describes a project seeking to provide timely, evidence-based intelligence on criminal justice populations regarding growing rates of drug use and patterns of fentanyl and fentanyl-related compounds use; it presents a summary of goals and objectives, research questions, project design and methods, results, and applicability to criminal justice; and appendices include Hair Classification Descriptions, LC-MS/MS Method, Results of Fentanyl-Related Compounds and Other Compounds, and Most Common Drugs Detected in Oral Fluid Confirmation Testing and in Hair Confirmation Testing.

Abstract

This summary report discusses the research methods and results of a project that aimed to provide timely, evidence-based intelligence on growing rates of drug use and patterns of use of fentanyl and fentanyl-related compounds among incarcerated populations. The project is a response to the US opioid epidemic that has resulted in an increase in law enforcement drug seizures and opioid overdose deaths, which has led to court-ordered mandatory drug testing (COMDT) of hair samples. The testing is routinely done at large commercial laboratories but does not typically include testing for fentanyl or fentanyl-related compounds. The report describes the two project phases, which focus on determining the prevalence of fentanyl and a selection of fentanyl-related compounds in hair specimens submitted for COMDT over six months, and Phase II, which involved a retrospective analysis of COMDT data from a five-year period. The report presents actionable information from several, geographically diverse US jurisdictions, and represents the first large-scale drug prevalence study in a COMDT population

 Research Triangle Park, NC: RTI International, 2024. 24p.

By Louise Durand, Eamon Keenan, Deirdre O’Reilly, Kathleen Bennett, Andy O’Hara & Gráinne Cousins 

Background- Pharmacotherapy is essential for the delivery of an equivalent standard of care in prison. Prescribing can be challenging due to the complex health needs of prisoners and the risk of misuse of prescription drugs. This study examines prescribing trends for drugs with potential for misuse (opioids, benzodiazepines, Z-drugs, and gabapentinoids) in Irish prisons and whether trends vary by gender and history of opioid use disorder (OUD). Methods- A repeated cross-sectional study between 2012 and 2020 using electronic prescribing records from the Irish Prison Services, covering all prisons in the Republic of Ireland was carried out. Prescribing rates per 1,000 prison population were calculated. Negative binomial (presenting adjusted rate ratios (ARR) per year and 95% confidence intervals) and joinpoint regressions were used to estimate time trends adjusting for gender, and for gender specific analyses of prescribing trends over time by history of OUD. Results - A total of 10,371 individuals were prescribed opioid agonist treatment (OAT), opioids, benzodiazepines, Z-drugs or gabapentinoids during study period. History of OUD was higher in women, with a median rate of 597 per 1,000 female prisoners, compared to 161 per 1,000 male prisoners. Prescribing time trends, adjusted for gender, showed prescribing rates decreased over time for prescription opioids (ARR 0.82, 95% CI 0.80–0.85), benzodiazepines (ARR 0.99, 95% CI 0.98–0.999), Z-drugs (ARR 0.90, 95% CI 0.88–0.92), but increased for gabapentinoids (ARR 1.07, 95% CI 1.05–1.08). However, prescribing rates declined for each drug class between 2019 and 2020. Women were significantly more likely to be prescribed benzodiazepines, Z-drugs and gabapentinoids relative to men. Gender-specific analyses found that men with OUD, relative to men without, were more likely to be prescribed benzodiazepines (ARR 1.49, 95% CI 1.41–1.58), Z-drugs (ARR 10.09, 95% CI 9.0-11.31), gabapentinoids (ARR 2.81, 95% CI 2.66–2.97). For women, history of OUD was associated with reduced gabapentinoid prescribing (ARR 0.33, 95% CI 0.28–0.39). Conclusions - While the observed reductions in prescription opioid, benzodiazepine and Z-drug prescribing is consistent with guidance for safe prescribing in prisons, the increase in gabapentinoid (primarily pregabalin) prescribing and the high level of prescribing to women is concerning. Our findings suggest targeted interventions may be needed to address prescribing in women, and men with a history of OUD.

BMC Psychiatry, 2023. 12p.