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People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic.

The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, “changes in illicit opioid consumption,” was measured using the question “Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?” The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated.

A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14–8 vs 18–39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9–55 vs living alone) and 9% (95% CI 0–18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively.

The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.

To understand how the Take Home Naloxone (THN) program is implemented in two pilot correctional facilities in British Columbia (BC), Canada, in order to identify areas for program improvement and inform the expansion of the program to other Canadian correctional facilities The paper aims to discuss these issues.

Two focus groups and one interview were conducted with healthcare staff at two pilot correctional facilities. Sessions were audio recorded, transcribed verbatim and divergent and convergent experiences within and between the facilities were explored in an iterative process. Key themes and lessons learned were identified and later validated by focus group participants.

Key themes that emerged included: challenges and importance of the train-the-trainer program for healthcare staff conducting participant training sessions; potential for improved prison population engagement and awareness of the program; tailoring program resources to the unique needs of an incarcerated population; challenges connecting participants to community harm reduction resources following release; and clarifying and enhancing the role of correctional officers to support the program.

The correctional setting presents unique challenges and opportunities for the THN program that must be considered for program effectiveness.

This evaluation was conducted to inform program expansion amidst a historic opioid overdose epidemic in BC, and adds to the limited yet growing body of literature on the implementation and evaluation of this program in correctional settings globally.

This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia.

The authors conducted surveys with clients of the Unlocking the Gates Peer Health Mentoring program on their release. The authors compared the characteristics of people who had and had not heard of the GSDOA and who were in possession of a THN kit.

In this study, 71% people had heard of the GSDOA, and 55.6% were in possession of a THN kit. This study found that 99% of people who had heard of the GSDOA indicated that they would call 911 if they saw an overdose. Among people who perceived themselves to be at risk of overdose, 28.3% did not have a THN kit. Only half (52%) of participants had a mobile phone, but 100% of those with a phone said they would call 911 if they witnessed an overdose.

The authors found that people with knowledge of the GSDOA were likely to report that they would call 911 for help with an overdose. Education about the GSDOA should be a standard component of naloxone training in correctional facilities. More than one in four people at risk of overdose were released without a naloxone kit, highlighting opportunities for training and distribution. Access to a cellphone is important in enabling calls to 911 and should be included in discharge planning.

Currently, people leaving prisons face concurrent risks from the COVID-19 pandemic and the overdose public health emergency. The closure or reduction of community services people rely on after release such as treatment centres and shelters has exacerbated the risks of poor health outcomes and harms. This paper aims to learn from peer health mentors (PHM) about changes to their work during overlapping health emergencies, as well as barriers and opportunities to support people leaving prison in this context.

The Unlocking the Gates (UTG) Peer Health Mentoring Program supports people leaving prison in British Columbia during the first three days after release. The authors conducted two focus groups with PHM over video conference in May 2020. Focus groups were recorded and transcribed, and themes were iteratively developed using narrative thematic analysis.

The findings highlighted the importance of peer health mentorship for people leaving prisons. PHM discussed increased opportunities for collaboration, ways the pandemic has changed how they are able to provide support, and how PHM are able to remain responsive and flexible to meet client needs. Additionally, PHM illuminated ways that COVID-19 has exacerbated existing barriers and identified specific actions needed to support client health, including increased housing and recovery beds, and tools for social and emotional well-being.

This study contributes to our understanding of peer health mentorship during the COVID-19 pandemic from the perspective of mentors. PHM expertise can support release planning, improved health and well-being of people leaving prison and facilitate policy-supported pandemic responses.

The purpose of this paper is to describe the development, by incarcerated women who were members of a prison participatory health research team, of a survey tool regarding homelessness and housing, the survey findings and recommendations for policy.

A survey was developed by incarcerated women in a minimum/medium security women's prison in Canada. Associations were examined between socio‐demographic factors and reports of difficulty finding housing upon release, homelessness contributing to a return to crime, and a desire for relocation to another city upon release. Open‐ended questions were examined to look for recurrent themes and to illuminate the survey findings.

In total, 83 women completed the survey, a 72 per cent response rate. Of the 71 who were previously incarcerated, 56 per cent stated that homelessness contributed to their return to crime. Finding housing upon release was a problem for 63 per cent and 34 per cent desired relocation to another city upon release. Women indicated that a successful housing plan should incorporate flexible progressive staged housing.

The present study focuses only on incarcerated women but could be expanded in future to include men.

Incarcerated women used the findings to create a housing proposal for prison leavers and created a resource database of the limited housing resources for women prison leavers.

Lack of suitable housing is a major factor leading to recidivism. This study highlights the reality of the cycle of homelessness, poverty, crime for survival, street‐life leading to drug use and barriers to health, education and employment that incarcerated women face.

Housing is a recognized basic determinant of health. No previous studies have used participatory research to address homelessness in a prison population.

Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The purpose of this paper is to describe a pilot nutrition and fitness program, which resulted from a unique prison participatory health research project.

Women in prison designed, led, and evaluated a six-week pilot fitness program in a minimum/medium security women's prison. Pre- and post-program assessments included a self-administered questionnaire and body measures. Open-ended questionnaire responses illuminated the quantitative findings.

Sixteen women in prison completed the program evaluation. Weight, body mass index, waist-to-hip ratio, and chest measurements decreased, and energy, sleep, and stress levels improved by the end of the program.

As a component of a participatory research project, incarcerated women designed and led a nutrition and fitness program, which resulted in improved body measures and self-reported health benefits.

Incarceration provides opportunities to engage women in designing their own health programs with consequent potential long-term “healing” benefits.

This participatory health research project of researchers and women prisoners examined housing and homelessness as perceived by incarcerated women to understand this public health concern and help guide policy. The paper aims to discuss these issues.

A participatory research team designed and conducted a survey of 83 incarcerated women in BC, Canada. Using descriptive statistics, the authors examined socio-demographic factors related to social support networks and family housing and women’s housing preference upon release.

In total, 44 percent of participants reported no family home upon release while 31 percent reported lost family ties due to their incarceration. Most vulnerable subpopulations were women aged 25-34, aboriginal women and those with multiple incarcerations. Housing preferences differed between participants suggesting needs for varied options. Further implementation, evaluation and appraisal of social programs are required.

This study surveyed one correctional facility: future research could utilize multiple centers.

Addressing housing instability among released incarcerated individuals is important fiscally and from a public health lens. Improved discharge planning and housing stability is needed through policy changes and social programs. A social support network, “Women in2 Healing,” has developed from the research group to address these issues.

Housing stability and recidivism are closely linked: providing stable housing options will lessen the social, fiscal and medical burden of individuals returning to crime, substance abuse, illness and poverty.

Housing instability addresses an important social determinant of health and focussing on incarcerated women builds upon a small body of literature.

The purpose of this paper is to describe the patient level characteristics of government-assisted refugees (GARs) who had acquired family doctors after leaving specialized refugee clinics (RC).

A cross-sectional telephone survey of GARs households, three to six years after arrival to British Columbia, that used logistic regression to identify GAR characteristics associated with having a family doctor compared to having no family doctor or remaining at a RC.

Contact rate was 52 percent. Of 177 interviewed GARs who spoke 24 languages, only 61 percent had secured a family doctor. Only 57 percent were educated; 46 percent spoke English and 40 percent worked consistently. Central Asian or African origin was associated with having a family doctor (OR 10.6 (95 percent CI 3.1-36.8) for RC; OR 10.3 (95 percent CI 2.2-47.8) for no family doctor). Other significant characteristics in the comparison with GARs at a RC included English proficiency (OR 15.6 (95 percent CI 4.3-56.9)), and female sex (OR 4.0 (95 percent CI 1.4-1.1)). When compared to those with no family doctor, additional significant characteristics included Health Authority A compared to B (OR 8.9, 95 percent CI 1.4-55.6) and having recently visited a doctor (OR 7.7 (95 percent CI 1.9-30.7)).

The results of this study are limited to a specific environment and the low contact rate may have resulted in bias.

This study described characteristics of GARs who had successfully transitioned to a family doctor and those who had not. This population is rarely captured in studies because they are difficult to contact, ethnically diverse and not proficient in English.