Reducing Opioid Dependence Therapy risk in the prison system and the use of extended-release buprenorphine as an additional treatment option: a consensus statement (2021)

Prisons comprise a disproportionately high number of individuals with opioid use disorder (OUD), which can have substantial personal and societal impacts, and places significant demand on security and medical resources. Opioid dependence therapy (ODT) has been demonstrated to improve patient outcomes by enabling stability, quality of life and rehabilitation, as well as by reducing recidivism, overdose and mortality upon release. However, numerous barriers preclude its availability in many prison systems across Europe, including cultural acceptance, concerns over exacerbation of OUD and misuse, stigma and resource limitations. This article examines the evidence supporting ODT provision within prisons and key aspects underpinning effective ODT delivery, and explores how challenges to implementation can be addressed. It also discusses the use of injectable weekly or monthly extended-release buprenorphine (XRB) as an additional treatment option. Such formulations can potentially overcome barriers to ODT implementation by reducing opportunities for patient misuse/diversion, reducing demand on staffing resources, improving patient wellbeing and ensuring coverage for post-release periods when patients are most vulnerable. In conclusion, we recommend that provision of ODT is beneficial and should be available across all prison systems. Furthermore, given the additional opportunities to improve service delivery and patient health offered by XRB, this long-acting formulation of buprenorphine should be included as part of a treatment offering alongside current daily regimens.