Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada.

INTRODUCTION: Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. METHODS: This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants' release. Data were thematically analyzed. RESULTS: The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of 'take-home' OAT medications were common barriers. CONCLUSIONS: Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

Opioid agonist treatment (OAT) experiences and release plans among federally incarcerated individuals with opioid use disorder (OUD) in Ontario, Canada: a mixed-methods study.

BACKGROUND: Incarcerated populations experience an elevated prevalence of opioid use disorder (OUD). Federal correctional institutions in Canada have increasingly treated OUD among correctional populations via opioid agonist treatment (OAT) - an evidence based pharmacotherapy that works to reduce drug use and related health harms. However, there is limited evidence regarding incarcerated individuals' experiences with institutional-based OAT, as well potential OAT-related community release prospects. This information is important for optimal treatment retention and improved health. To address this knowledge gap, we conducted a longitudinal follow-up study examining OAT-related experiences among federally incarcerated individuals before and after community release. This article focuses on the baseline (pre-release) data. METHODS: This mixed-methods study examined OAT-related experiences and release prospects among n = 46 individuals scheduled for community release, recruited from seven federal prisons located in Ontario, Canada. Participants underwent a comprehensive interviewer-administered on-site assessment, including quantitative and qualitative items. Assessment data was furthermore linked to administrative correctional data. Data were analyzed using thematic qualitative and descriptive quantitative approaches. RESULTS: Participants had complex histories with opioid use including related negative health outcomes. Experiences with institutional OAT were divergent and provision was not standardized; those with OAT engagement pre-admission did not experience many challenges, whereas those initiating OAT during incarceration experienced barriers such as treatment waitlists and adverse process experiences. Most participants expressed a preference for buprenorphine-naloxone over methadone, but described difficulties accessing it. Participants were keen to transition into community-based treatment, yet envisaged prospective barriers and facilitators concerning successful reintegration and treatment continuity. CONCLUSIONS: Major barriers towards the current administration of OAT in federal correctional systems in Canada exist, including extensive waitlists, non-standardized practices, and challenges accessing preferred OAT formulations; this contributes to sub-optimal treatment. Eliminating waitlists, standardizing OAT provision, providing additional OAT options, and more comprehensive release planning may be essential for treatment retention and positive outcomes.

Comparing characteristics and outcomes of different opioid agonist treatment modalities among opioid-dependent federal men correctional populations in Canada.

BACKGROUND: Limited evidence exists in Canada on outcomes related to Opioid Agonist Treatment (OAT) and/or differences between OAT modalities among persons in correctional institutions. This study addresses this knowledge gap by examining key characteristics and outcomes of men in Canadian federal correctional institutions across treatment modalities. METHODS: A retrospective cohort of men incarcerated in federal correctional institutions (N = 2833) were classified into four groups - three OAT participant groups: prescribed methadone (M-OAT), prescribed buprenorphine/naloxone (Suboxone®; S-OAT) and those who switched between the two OAT modalities at least once (X-OAT). The fourth group was a non-treatment comparison group (Non-OAT). Two-thirds of study participants were released and examined for post-release outcomes. Descriptive statistics and multi-variate Cox proportional hazards regression were used. RESULTS: The X-OAT group was more likely than the other study groups to have positive urinalysis tests, disciplinary charges, or institutional security or behavioral incidents. Survival analysis indicated that the X-OAT had an adjusted hazard of a return to custody that was 57% greater than the other groups. CONCLUSIONS: This study indicates that individuals switching OAT modalities are a more complex group needing additional supports, especially for community reintegration. Although few of the returns to custody were due to new offences, a third of participants in the OAT groups had their release revoked, indicating a high need population mostly due to their substance use.

Mental health needs of federal female offenders.

Mental health problems are increasingly being recognized as one of the greatest challenges faced by correctional systems in the effective management of their populations. Over the past decade, the number of federally sentenced female offenders in Canada presenting with mental health problems has risen significantly, from 13% in 1996/1997 to 29% in 2008/2009 (Correctional Service of Canada, 2009a). This research used the screener version of the Computerized Diagnostic Interview Schedule (C-DIS-IV; n = 88) to outline the mental health needs of federally sentenced females in Canada. Results provide evidence for extremely elevated rates for certain diagnoses and confirm substance dependence as a significant area of need in this sample. Moreover, alcohol dependence emerged as an area of particular concern for Aboriginal women. Furthermore, all individuals experiencing a lifetime substance dependence disorder have also suffered from an additional psychiatric diagnosis at some point in their lives; thereby highlighting the possible levels of concurrent disorders among this population. This research highlights the critical importance of comprehensive and ongoing mental health assessment, and treatment, for the successful management and reintegration of female offenders.

Demographic survey of veterinarians employed in western Canada.

The objective of this study was to generate demographic data on veterinarians working in western Canada. A sample of 551 veterinarians was randomly selected from a population of 2474 veterinarians employed in western Canada, 425 (77.1%) of whom responded to the survey. The respondents were evenly split between males (53.1%) and females (46.9%). More than half (58.0%) of the private practitioners practised exclusively on companion animals (small animals and horses), while 2.9% devoted 100% of their time to food animals. There were 351 respondents who had had > or = 2 employers since graduation; 80% of those who had begun their careers in companion animal (CA) practice had remained in this type of practice, while 54.3% of those who had begun their careers in mixed animal practice had switched to CA practice. Analyses of wage and workload data from 85 full-time veterinary employees showed that CA practitioners worked the fewest hours/week (47.0), had the least number of evenings on-call/month (3.7), and earned the highest hourly wage (35.79 dollars) as compared with non-CA practitioners.

Factors associated with the career path choices of veterinarians in western Canada.

This second of 2 articles, relating to the veterinary profession in western Canada, explores the factors associated with veterinarians' career path choices. Among other factors, companion animal (small animal and equine) (CA) practitioners were less likely to have been raised in, or near to, a small center (< or = 10 000), were more concerned with their workload (hours of work and number of nights on-call), and preferred to work in progressive practices. Food animal (FA) practitioners were more likely to be male, have been raised in a small center, have been raised in the Province of Saskatchewan, and to have self-assessed themselves as having an above average knowledge of agriculture at the time they applied for admission to veterinary college. Mixed animal (MA) practitioners had more factors in common with FA than with CA practitioners. Three main factors were associated with leaving mixed or food animal practice: hours of work and too many nights on-call, the level of remuneration, and lack of support and mentorship.

The multiple dimensions of sustained attention.

Sustained counting (or temporal numerosity judgements) has been one of the key means of investigating anterior attentional processes. Forty-three patients with localised lesions to the frontal lobes were assessed on two tests of the ability to count the number (8-22) of stimuli presented at either a slow (roughly one per 3 sec) or fast (roughly three per sec) rate. Patients with lesions to the Superior Medial (SM) region (particularly Brodmann areas 24, 32, and 9) were impaired both in the Slow condition and also in the Fast condition, where they underestimated the number of stimuli. Patients with Right Lateral (RL) lesions (8, 45, and 46) also had difficulties in the Fast condition, especially when the number of targets was greater than 15. The results are considered from the perspectives of alternative positions on anterior attentional processes developed by Posner and Petersen (1990) and by Stuss et al. (1995). The most plausible interpretation is in terms of energising processes which involve the SM frontal cortex and monitoring processes which involve the RL frontal cortex.

Factors affecting the career path choices of graduates at the Western College of Veterinary Medicine.

The objective of this study was to describe the demographics of the Class of 2006, Western College of Veterinary Medicine, and to determine which factors influenced the graduates' career path choices. Data were collected via an on-line survey and the response rate was 95.7% (67/70). The majority (57%) of graduates were starting their veterinary career in a food animal-related (FAR) job. Two factors were significantly associated with this choice: 1) those raised in, or near, a small center (population < 10 000) were 3.4 times (P = 0.03) more likely to accept a FAR position than were those raised in a large center (> 10 000), and 2) graduates with a bachelor of science in agriculture (BSc Ag) were 4.5 times (P = 0.04) more likely to begin their career as a FAR practitioner than were those without such a degree. However, 9 of the 16 graduates having a BSc Ag had an urban upbringing.