Clinical Case 13 of 15 · ~891 words
Clinical Case No. 13. Depression and Opioid Dependence During Incarceration and After Release
Admission to the institution
Leah is 39. Before incarceration, she worked as a cleaner, then lost her job and moved between temporary accommodations. Between placements, she spent some time sleeping in a small tent in a city park, trying each evening to keep her bedding dry. In recent years she used illicit opioids, mainly a substance sold as fentanyl; two months before her arrest, she started methadone treatment. She is serving a sentence in a BC provincial correctional institution. This is an ordinary criminal proceeding, without an NCRMD finding.
At the initial medical assessment, Leah fears two things most: that methadone will be stopped and that reporting low mood will automatically cost her all privacy. The nurse explains what information is needed for treatment and what safety circumstances may require disclosure to other staff. The assessment is a medical conversation, although the institution's regime is apparent in every organizational detail.
PHSA/BC Mental Health and Substance Use Services organizes health care in provincial correctional institutions. The team verifies pharmacy records, the last methadone dose actually taken, missed doses, and current tolerance. Leah is able to continue treatment without interruption. [147, 53]
A depressive episode
Suicide risk is assessed at first contact. At the same time, insomnia, anxiety, and tearfulness are explored: the experience of arrest, fear about housing, pain, changes in routine, and possible substance withdrawal.
The history reveals that persistent low mood, anhedonia, early waking, appetite loss, hopelessness, and thoughts that others would be better off without her had already lasted over two months before arrest. These symptoms persist after opioid treatment stabilizes. No periods of mania or hypomania are identified in the available history. Leah has no current intention to harm herself, but risk is reviewed when her condition changes, during conflicts, and as release approaches.
The clinical picture is consistent with a depressive episode in the context of opioid use disorder. The physician agrees on sertraline treatment with gradual dose increases, checks interactions, tolerability, and other medical factors. Brief structured psychological sessions are discussed separately. Their focus is practical: sleep, guilt, rebuilding contacts, and asking for help before a situation becomes critical. [40]
After several weeks, Leah sleeps better, reads, and concentrates on a letter to her sister. The institutional schedule helps with regular medication. Her greatest concerns are future housing and reconnecting after release.
Preparing for release
Release planning begins early. Her former room is lost; her sister can stay in touch. Together with Leah, the nurse and social worker clarify documents, health coverage, pharmacy, transport, prescriptions, and a place for the first night.
Community Transition Teams support the transition from provincial institutions to community care. BC Corrections' public description notes an extension of their support from 30 to 90 days. Leah agrees to this support and meets the worker who will help her after release. [148]
Before release, the team arranges contact with the physician who will continue methadone prescribing, a pharmacy, and the time of the first contact. A supply of other medication is arranged, and clinical information is transferred. Leah receives naloxone and refresher training on opioid poisoning. [114, 53]
The first week outside
On release day, a transition worker helps her reach temporary accommodation. The next morning, Leah receives methadone at the agreed pharmacy. However, the referral for ongoing depression treatment reaches a different service than expected; her old phone card no longer works. The appointment is delayed until the team worker establishes contact and confirms who is temporarily managing prescriptions.
A study by Erickson and colleagues describes transition difficulties: 19 women living with HIV after incarceration in Metro Vancouver and six service providers discussed barriers to safe housing, addiction treatment, and rebuilding social connections. The interviews show how simultaneously seeking housing and care burdens the first days after release. [149]
Leah worries that one unsuccessful appointment means losing all help. The transition worker explains what happened and arranges another contact. For the physician, this means a few calls and correcting the handover; for her, it is the difference between continuing treatment and returning to her former circle to obtain illicit substances.
Three months and the following year
At three months, Leah receives methadone regularly, and depressive symptoms have decreased. Housing remains temporary. Before transition support ends, the team confirms the appointment date with an ongoing provider and transfer of prescriptions.
In a cohort of 1,535 people with 4,738 incarceration episodes in BC during 2015 to 2018, OAT during incarceration was associated with a lower hazard of non-fatal overdose in the first 30 days after release: adjusted hazard ratio 0.55 (95% CI 0.41 to 0.74). The association appeared both when previous OAT was continued and when it began in the institution: 0.49 and 0.58, respectively. [150]
Over the following year, Leah returns to part-time work. Anxiety increases during a housing move. Appointments monitor depression, sleep, treatment tolerability, and cravings; her sister remains a source of closeness and support.
In Ukraine, as of January 1, 2026, the Public Health Centre recorded 742 OAT recipients in branches of the criminal justice system's medical service. For a patient with the same course, the next step would be a coordinated transition to a civilian OAT site: confirmation of the dose, receiving facility, and dispensing date. [151]