The Rikers Island Hot Spotters: Defining the Needs of the Most Frequently Incarcerated

We used "hot spotting" to characterize the persons most frequently admitted to the New York City jail system in 2013.

We used our Correctional Health Services electronic health record to identify 800 patients admitted in 2013 who returned most since November 2008. We compared them to a randomly selected control group of 800 others admitted in 2013, by using descriptive statistics and cross-tabulations, including data through December 2014.

The frequently incarcerated individuals had a median of 21 incarcerations (median duration 11 days), representing 18 713 admissions and $129 million in custody and health costs versus $38 million for the controls. The frequently incarcerated were: 

• significantly older (42 vs 35 years), 
• and more likely to have serious mental illness (19% vs 8.5%) 
• and homelessness (51.5% vs 14.7%) in their record. 
• Significant substance use was highly prevalent (96.9% vs 55.6%). 
• Most top criminal charges (88.7%) for the frequently incarcerated were misdemeanors; assault charges were less common (2.8% vs 10.4%). 

Frequently incarcerated persons have chronic mental health and substance use problems, their charges are generally minor, and incarceration is costly. Tailored supportive housing is likely to be less costly and improve outcomes.

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By: MacDonald R1, Kaba F1, Rosner Z1, Vise A1, Weiss D1, Brittner M1, Skerker M1, Dickey N1, Venters H1.

• 1All of the authors are with the New York City Department of Health and Mental Hygiene, Bureau of Correctional Health Services, Queens, NY.

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Factors Associated with Illicit Methadone Injecting in a Canadian Setting

Background And Objectives:  While methadone is well established as an evidence-based treatment for opioid use disorder, safety concerns persist regarding its diversion. The authors examine the prevalence of and risk factors associated with injection of methadone in an urban population.

Methods: Between December 2005 and November 2013, data were derived from two open prospective studies of persons who inject drugs (PWID) in Vancouver, Canada. Generalized estimating equations (GEE) logistic regression was used to determine factors independently associated with illicit methadone injecting.

Results: During the study, 1911 individuals (34% women) were recruited; 134 (7%) participants reported methadone injecting at least once. In multivariable analysis, Caucasian ethnicity; homelessness; drug dealing ; ≥daily heroin injection; ≥daily crack smoking; being a victim of violence; and non-fatal overdose were independently and positively associated with methadone injection; female gender was negatively associated.

Discussion and Conclusions: The diversion of methadone for illicit injection in this urban setting was associated with several markers of addiction severity and other health and social vulnerabilities.

Scientific Significance: These findings underscore the need to ensure methadone accessibility while limiting diversion-related risk.

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How Should Network-Based Prevention for Homeless Youth Be Implemented?

Below:  Sociometric data on life-time methamphetamine use (in grey) among homeless youth, Holllywood, CA, 2008 (n = 136)

There is a great desire both among academics [2-11] and our community-based collaborators to utilize network-based prevention programs to reduce risk taking among homeless youth. This interest is driven by the relatively low cost of these programs, coupled with an understanding that such programs might engage homeless youth who are transient, hidden and distrustful of adults. This represents an exciting convergence around the desirability and probable acceptability of network based prevention. What remains unclear is how and with whom to implement these programs.

RAND present fascinating results indicating that opinion leaders and popular peers are among those with whom youth are most likely to drink and use drugs. RAND recognize the complexity of recruiting substance using opinion leaders for interventions to reduce substance use, but suggest that these peers may still be appropriate people to train as peer leaders. We respectfully question this interpretation. It is entirely possible that these popular and respected peers are popular and respected because of their participation in risky behaviors. Being popular and respected often requires adhering to the norms and values of a network—in this case a network for whom risk-taking is normative. Thus, it is possible that asking youth to curb or abandon risk behaviors could compromise the popularity and respect they hold. As an illustrative example, Fig. 1 shows that substance-using youth are not only popular within egocentric networks of youth (as RAND have shown), but also occupy central positions within sociometric networks of homeless youth, lending further evidence to the hypothesis that risky behavior might be an important component of popularity for homeless youth. Given the often tenuous nature of social standing among homeless youth, we are wary of the practical efficacy of attempting to change norms that may confer status among this population.

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