Assessing diversionary approaches for drug misusers in police custody in London: engagement and treatment outcomes as part of the Drug Intervention Programme

摘要

Aims:To describe detainee engagement with the Drug Intervention Programme (DIP) and to assess the efficacy of operational practice models on treatment outcomes in London. Methods:A prospective data linkage study matching 9910 detainees who tested positive for opiates and/or cocaine in 2017 to diversion services and to community or prison-based treatment. Logistic regression models examined factors associated with engagement and to understand prognostics correlated to a successful treatment outcome. Results:Opiate users (adjusted odds ratio (AOR) 1.48, 95% confidence interval (CI) 1.14-1.92) and detainees with housing needs (AOR 1.32, 95% CI 1.05-1.66) were associated with initial engagement following a positive test. Detainees who tested positive for both opiates and cocaine (AOR 0.38, 95% CI 0.16-0.91), with severe housing needs (AOR 0.53, 95% CI 0.29-0.99) and who were female (AOR 0.41, 95% CI 0.22-0.77) were more likely to report an unsuccessful treatment outcome. Case-managed approaches were more likely to engage detainees into treatment and utilization of this model is significantly associated with positive treatment outcomes (AOR 1.60, 95% CI 1.07-2.38). Conclusions:Pretrial diversionary schemes for drug misusers should consider enhancing existing case-managed approaches although the model remains geared toward opiate rather than stimulant users. The importance of housing was highlighted. Tailored packages of care are required to support individuals from the point of arrest through to treatment, for those with complex needs especially for female detainees, poly-drug users and those with acute housing needs.