Correctional populations are a unique and marginalized population who are among those with the highest prevalence of substance use and mental health problems, and bear a disproportionately elevated risk for related morbidity and mortality (e.g., overdose). As many as 50% or more of correctional inmates, including in Canadian correctional systems, feature opioid matters and related problems. While some prevention and treatment interventions (e.g., opioid pharmacotherapy programs) for opioid matters and harms have been selectively implemented in correctional settings, major intervention and knowledge gaps exist. A further challenge relates to post-release intervention and care, where care transition (e.g., addiction treatment) commonly breaks down, and released offenders often return to substance use which leaves them extremely vulnerable for health and social problems, including re-offending and mortality due to overdose. In order to better understand opioid use and related harms among correctional populations, this implementation science project will consist of several sub-projects which will focus and generate evidence on opioid use-related interventions for correctional systems/offenders in Canada.
The Ontario Node is coordinating 4 different projects under the Corrections Umbrella:
Evaluating the Impact of Strategies to Prevent Opioid-Related Harms in People who Experience Imprisonment in Provincial Prisons in Ontario
PI: Fiona Kouyoumdjian, McMaster University (ONT)
There is a substantial burden of opioid-related morbidity and mortality in people who experience imprisonment in Canada. In the context of a national opioid overdose crisis, the Ontario provincial government is implementing strategies to reduce opioid-related harms. Initiatives that have been implemented in provincial prisons to date are overdose prevention training for people in custody and naloxone distribution on release, policies to support opioid agonist treatment (OAT) initiation, correctional staff training on overdose, and providing naloxone access through correctional staff. Planned strategies will address barriers to OAT, including training for health care workers and establishing referral pathways to community-based treatment. 
Owusu-Bempah et al. 2023.pdf
Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study. Amanda Butler, Ruth Croxford, Claire Bodkin, Hanaya Akbari, Ahmed M Bayoumi, Susan J Bondy, Dale Guenter, Katherine E McLeod, Tara Gomes, Tharsan Kanagalingam, Lori A Kiefer, Aaron Michael Orkin, Akwasi Owusu-Bempah, Leonora Regenstreif,
The impact of COVID-19 on opioid toxicity deaths for people who experience incarceration compared to the general population in Ontario: A whole population data linkage study. Amanda Butler, Ruth Croxford, Katherine E. McLeod, Tara Gomes, Aaron M. Orkin, Susan J. Bondy, Fiona G. Kouyoumdjian
Opioid toxicity deaths in Black persons who experienced provincial
incarceration in Ontario, Canada 2015–2020: A population-based study.
Akwasi Owusu-Bempah, Harvey L. Nicholson Jr, Amanda Butler Ruth Croxford, Fiona G. Kouyoumdjian
Summary of Results
Follow-Up Study of Quebec Federal Inmates on Opioid Agonist Treatment (OAT)
PI: Serge Brochu, University of Montreal (Quebec/Atlantic)
An increasing number of studies have demonstrated that opioid agonist treatment (OAT) among incarcerated individuals is associated with improved health and criminogenic indicator outcomes post-release into the community. While releases into community care are generally challenging events on several fronts, the transition of treatment for chronic diseases (e.g. HIV, diabetes) into community care and services is known to be difficult, and may not occur smoothly or effectively; these challenges are documented to be distinct for offenders enrolled in OAT. In order to better understand issues related to the transition of federal inmates enrolled in OAT in Canada, this project will uniquely examine these issues/questions by utilizing a combination of quantitative and qualitative data collected from Quebec-based inmate participants during three different assessments (one pre-release and two post-release).
Examining the Opioid Landscape Within Federal Prisons in Alberta
PI: Kevin Haggerty, University of Alberta (Prairies)
This project will examine: 1) How has fentanyl/carfentanyl impacted policy responses to security concerns in Alberta's prisons, and how does this development impact correctional officers and prisoners? 2) Which measures might be most effective to address this problem in a prison environment? 3) What is the level of appetite for different forms of harm reduction strategies in federal jails among correctional officers, prisoners and correctional staff? Which of these strategies are feasible from a security, legality, and safety perspective? 4) What organizational, security, occupational, or cultural barriers might have to be addressed in order to introduce measures to effectively reduce the various risks related to opiates in prison. The findings from these inquiries will a) raise awareness about the extent of the opioid situation in Alberta's prisons, b) inform correctional officers about possible harm reduction measures, c) help shape opioid-related training, and d) suggest policies for a safer environment for prisoners and COs.
See the following for more information:
Giffin, L., Berardi, L., Bucerius, S. M., & Haggerty, K. (2023). Sticking points: Incarcerated women's views on barriers to a prison needle exchange program. Incarceration, 4, 26326663231157196.
An Evaluation of the use of Community Transition Teams to Improve Health Outcomes for Individuals Recently Released from British Columbia Corrections
PI: Seonaid Nolan, University of British Columbia (BC)
The period following release from a correctional facility is one of heightened vulnerability, as individuals re-immerse into their communities, search for housing and employment and attempt to access health care services. Accordingly, many newly-released clients feel ill-equipped to navigate this process and, in the absence of proper support, are at high-risk for relapse to substance use, recidivism, and a host of other negative outcomes. To address this, the British Columbia Provincial Health Services Authority (PHSA) Correctional Health Services (CHS) program is planning on implementing and scaling up the use of Community Transition Teams (CTTs). CTTs adopt a client-centred approach to care, whereby a case manager works closely with an individual to help them identify their priorities and subsequently takes an active role in supporting a client to achieve their treatment goals following release from provincial corrections.OPAC Corrections.Final Report.pdf