Effect of initiating drug treatment on the risk of drug-related poisoning death and acquisitive crime among offending heroin users

Background: A recent Cochrane review of randomised trials identified a lack of evidence for interventions provided to drug-using offenders. We use routine data to address whether contact with treatment services reduces heroin users’ likelihood of a future acquisitive offence or drug-related poisoning (DRP) death.

Methods: Heroin-users were identified from probation assessments and linked to drugtreatment, mortality and offending records. The study cohort was selected to ensure that the subject was not: in prison, in treatment or had recently left treatment. Subjects were classed as initiators if they attended a triage appointment within two weeks of their assessment; noninitiators otherwise. Initiator and non-initiators were compared over a maximum of one year, with respect to their risk of recorded acquisitive offence or DRP-death. Balance was sought using propensity score matching and missing data were accounted for using multiple imputation.

Results: Nine percent of assessments identified for analysis were classed as initiators. Accounting for observed confounding and missing data, there was a reduction in DRPs associated with initiator assessments, however there was uncertainty around this estimate such that a null-effect could not be ruled out (HR: 0·42, 95% CI 0·17 to 1·04). There was no evidence of a decrease in the recidivism risk, in fact the analysis showed a small increase (HR: 1·10, 95% CI 1·02 to 1·18).

Conclusion: For heroin-using offenders, initial contact with treatment services does not appear to reduce the likelihood of a future acquisitive offence.