Exploring the Association between Race and Health among Older Adults Who Are Incarcerated.

One of the little known ironies in the field of prison health is the notion that prison may actually have health-stabilizing effects for some groups. This study contributes to this line of inquiry by examining a variety of physical and mental health indicators among an older cohort of prisoners. Furthermore, this study's focus on race addresses a notable gap in the growing literature on older prisoner health. A cross-section of 625 males who were incarcerated residing in a northeastern state prison system was surveyed and data on self-reported health status and stress and individual demographics characteristics were collected. Univariate and multivariate logistic regressions were used to quantify racial differences with respect to self-reported stress after adjusting for potential confounders. Results suggest that Black men who are older and incarcerated appear to be more resilient than White men who are older. An association was found between race and self-reported stress though not statistically significant. Health status is a significant predictor of self-reported stress in univariate and multivariate analyses. Having ever committed a violent offense and having received mental health services (in and out patient) are statistically associated with self-reported stress. Black men who were older in this study appear to cope better with stress related to incarceration than White men who were older, which may in turn affect other physical and mental health outcomes. Future research is needed to address factors that stabilize health and reduce stress among a racially diverse, aging prison population.

"It's Russian roulette": adulteration, adverse effects and drug use transitions during the 2010/2011 United Kingdom heroin shortage.

BACKGROUND: Between late 2010 and mid 2011 there was a significant heroin shortage in the United Kingdom (UK), resulting in a rapid drop in street heroin purity and increase in price. The most well documented event of this kind is the 2000-2001 Australian heroin shortage, with little published research addressing the UK context. In this paper we draw on qualitative data to explore the impact of, and responses to, the 2010/2011 shortage among London-based heroin users. METHODS: Data collection comprised longitudinal life history and narrative interviews with 37 PWID in 2010-2011. The average age of participants was 40, with a 20-year average duration of injecting. Heroin was the drug of choice for the majority of participants (25), with 12 preferring to inject a crack-cocaine and heroin mix. Recruitment took place through London drug and alcohol services and peer networks. RESULTS: The majority of participants continued to source and inject heroin despite reported decline in purity and increased adulteration. Transitions to poly-drug use during the heroin shortage were also common, increasing vulnerability to overdose and other drug related harms. Participants enacted indigenous harm reduction strategies in attempting to manage changes in drug purity and availability, with variable success. CONCLUSION: Epidemiological data gathered during periods of heroin shortage is often drawn on to emphasise the health benefits of reductions in supply. Our findings highlight the importance of understanding the ways in which heroin shortages may increase, as well as reduce, harm. There is a need for enhanced service provision during periods of drug shortage as well as caution in regard to the posited benefits of supply-side drug law enforcement.