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<p>Opioid use disorder (OUD) is often associated with criminality, with about 20–30% of male prison inmates being opioid users. The rates of female users may be even higher. While opioid maintenance treatment (OMT) and medications for opioid use disorder (MOUD) are the established first-line treatments in OUD, OMT in correctional settings has been somewhat controversial due to various legal and institutional barriers. There is some gradually emerging evidence of OMT being an effective and safe treatment for incarcerated individuals. This review was based on a&#xa0;Medline analysis with emphasis on meta-analyses, systematic reviews, relevant randomized controlled trials, and observational studies. A&#xa0;number of studies focusing on the evidence for OMT in correctional settings suggest a&#xa0;clear effect of OMT on opioid use and further participation in OMT after release from prison, as well as on all-cause and overdose mortality. The findings are less robust for the risk of criminality and hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infections, and evidence is lacking on the risk of diversion of the medication and on cost effectiveness. In sum, OMT use in prison can be recommended as a&#xa0;safe and effective treatment for imprisoned individuals with OUD. Legal and institutional barriers that limit the implementation of OMT in correctional settings should be removed.</p>

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Efficacy of opioid maintenance in prison settings—how strong is the evidence? A narrative review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年7月31日

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  • Michael Soyka,
  • Desiree Laber

摘要

Opioid use disorder (OUD) is often associated with criminality, with about 20–30% of male prison inmates being opioid users. The rates of female users may be even higher. While opioid maintenance treatment (OMT) and medications for opioid use disorder (MOUD) are the established first-line treatments in OUD, OMT in correctional settings has been somewhat controversial due to various legal and institutional barriers. There is some gradually emerging evidence of OMT being an effective and safe treatment for incarcerated individuals. This review was based on a Medline analysis with emphasis on meta-analyses, systematic reviews, relevant randomized controlled trials, and observational studies. A number of studies focusing on the evidence for OMT in correctional settings suggest a clear effect of OMT on opioid use and further participation in OMT after release from prison, as well as on all-cause and overdose mortality. The findings are less robust for the risk of criminality and hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infections, and evidence is lacking on the risk of diversion of the medication and on cost effectiveness. In sum, OMT use in prison can be recommended as a safe and effective treatment for imprisoned individuals with OUD. Legal and institutional barriers that limit the implementation of OMT in correctional settings should be removed.