By Donata Favretto, Cindi Visentin, Anna Aprile, Claudio Terranova, Alessandro Cinquetti

The most effective therapy for people with opioid use disorder (OUD) involves the use of Food and Drug Administration-approved medications—methadone, buprenorphine, and naltrexone. Despite evidence that this approach, known as medications for opioid use disorder (MOUD), reduces relapse and saves lives, the vast majority of jails and prisons do not offer this treatment. This brief examines what policymakers should consider when exploring how to best manage OUD in incarcerated populations.

It helps to first answer this question: How common is OUD in incarcerated populations? Data from 2007-2009 (the most recent available) showed that more than half of individuals in state prisons or those with jail sentences met the criteria for a non-alcohol and nicotine-related substance use disorder (SUD), meaning a problematic pattern of using a drug that results in impairment in daily life or noticeable distress, compared with only 5 percent of adults in the general population.

The gold standard of care is MOUD. In community-based settings, such as opioid treatment programs and primary care facilities, methadone and buprenorphine have been proved to reduce overdose deaths and illicit opioid use as well as the transmission of infectious diseases such as HIV and hepatitis C. A growing body of literature also exists on the benefits of naltrexone, the third Food and Drug Administration-approved medication.

Philadelphia: Pew Charitable Trusts, 2020. 22p.

By Pew Trust

The most effective therapy for people with opioid use disorder (OUD) involves the use of Food and Drug Administration-approved medications—methadone, buprenorphine, and naltrexone. Despite evidence that this approach, known as medications for opioid use disorder (MOUD), reduces relapse and saves lives, the vast majority of jails and prisons do not offer this treatment. This brief examines what policymakers should consider when exploring how to best manage OUD in incarcerated populations.

It helps to first answer this question: How common is OUD in incarcerated populations? Data from 2007-2009 (the most recent available) showed that more than half of individuals in state prisons or those with jail sentences met the criteria for a non-alcohol and nicotine-related substance use disorder (SUD), meaning a problematic pattern of using a drug that results in impairment in daily life or noticeable distress, compared with only 5 percent of adults in the general population.

The gold standard of care is MOUD. In community-based settings, such as opioid treatment programs and primary care facilities, methadone and buprenorphine have been proved to reduce overdose deaths and illicit opioid use as well as the transmission of infectious diseases such as HIV and hepatitis C. A growing body of literature also exists on the benefits of naltrexone, the third Food and Drug Administration-approved medication.

By Tammy Ayres, Ruth Hatcher and Emma Palmer

The Drug Recovery Prison (DRP) at HMP Holme House began in 2017 as a three-year pilot, jointly funded by NHS England (NHSE) and MOJ/HMPPS. The DRP aimed to address the supply of and demand for alcohol and illegal substances, improve treatment outcomes, and support ongoing recovery. The DRP process evaluation, jointly commissioned by MOJ and NHSE, aimed to understand how the pilot had been implemented, providing evidence on the roll out and capturing the perceptions and experiences of staff and prisoners.

Ministry of Justice Analytical Series, 2023. London: Ministry of Justice, 2023. 107p.

By Avik Chatterjee; Michelle Weitz; Alexandra Savinkina, et al

Key Points - Question: Is provision of medications for opioid use disorder (MOUD) during incarceration associated with fewer overdose deaths? Findings: This economic evaluation of a model of the natural history of OUD in Massachusetts found that a strategy offering buprenorphine, methadone, and naltrexone during incarceration was associated with 192 fewer overdose deaths (a 1.8% reduction) and was less costly than a naltrexone-only strategy averting 95 overdose deaths (a 0.9% reduction). The 3-MOUD strategy was also cost-effective at $7252 per quality-adjusted life-year gained. Meaning These findings suggest that offering 3 MOUDs during incarceration is a life-saving, cost-effective intervention

JAMA Network Open. 2023;6(4):e237036. doi:10.1001/jamanetworkopen.2023.7036

By Caitlyn Norman

  Prisoners have significantly greater levels of drug use than the general population, which is related to many adverse outcomes both during and post-imprisonment. Reducing the availability of drugs in prison can lead to a reduction in the drug use of prisoners but requires knowledge of the different drug smuggling routes and the implementation of effective security measures. The main smuggling routes identified in the literature are through visitors; mail; prisoners on reception, remand, or work release; staff; and perimeter throwovers, but they differ between prisons depending on various contextual factors and security measures in place. Based on a total of 81 studies from 22 different countries, the average prevalence of drug use during incarceration is 32.0% with a range from 3.4% to 90%. The types of drugs used in prisons vary among geographical regions, countries, and even regions within countries. The most common drug reported to be used by prisoners in most studies was cannabis, except in South Asia and Scotland, where heroin was more prevalent. The drugs used in prison tend to reflect the prevalence of drugs in the local community, except where a drug has advantages unique to use in prison. It is vital to examine the prevalence of drug use and different types of drugs used during incarceration to help inform drug treatment services, assist prison staff in identifying potential drug use or intoxicated prisoners, and advise prisons about the most prevalent drug smuggling routes so new security measures can be considered  

  WIREs Forensic Sci. 2022;e1473  

By The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA): Linda Montanari, Luis Royuela, Ines Hasselberg and Liesbeth Vandam

This European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Insights report provides a comprehensive overview of the current knowledge and latest developments in the field of drug use and prison in the 30 countries reporting to the EMCDDA up to the end of 2020: the 27 EU Member States, Norway, Turkey and the United Kingdom. It also identifies important gaps in our knowledge, challenges for better provision of interventions and implications for policy and practice. The report provides an overview of the current situation in the field of drugs and prison in the following areas: drug use and drug-related problems among the prison population; the availability of drug-related services in prison; the evidence available for effective interventions in the prison setting; drug supply and supply reduction interventions; and future challenges relating to prison and drugs.

People in prison report high levels of lifetime prevalence of substance use before imprisonment and increased levels of consumption, especially of heroin, cocaine and amphetamines, compared with the general population. Although many people will stop injecting drugs when they enter prison, for those that continue, the use and reuse of contaminated equipment is not uncommon, contributing to an increased risk of transmission of infectious diseases in these settings.

Lisbon: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2022. 124p.

Edited by M.J.M.Brand-Koolen.

This reader on the prison system was edited by Maria Brand-Koolen. Two chapters have been written especially for this volume - the introductory chapter, written by the editor, and the chapter on temporary release, written by a researcher with the RDC and a member of the Prison Department. Three contributions by Tony Vinson of Australia, who explored the Dutch correctional system in some detail during his visit to the Centre in 1985, are slightly revised versions of chapters from a recent RDC publication. The remaining contributions are the work of (former) RDC researchers and have been published earlier in the Dutch language. Some of these previously published papers have been slightly revised to provide more recent data.The general studies in the first part of the two-part volume provide an overview of the main characteristics of Dutch correctional policy and research. The first chapter aims to give the non-Dutch reader a general idea of the criminal justice system in The Netherlands (in particular the correctional system) and to facilitate understanding of the other contributions. In the second part of the book the authors deal with a variety of special topics, among others the mentally abnormal offender, drug users, ethnic minorities and prison leave.

Deventer: Kugler Publications, 1987. 194p.