Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions (2016)

Incarceration is a relatively common experience among the estimated 15.6 million opioid-dependent adults in the world.1 In the US, it has been estimated that between 24% and 36% of opioid-dependent adults cycle in and out of jails each year.2,3 Incarceration of these individuals often results in opioid withdrawal syndrome, which, at a minimum, should be treated humanely.1,4 Beyond safe and effective opioid withdrawal treatment, there are three major opportunities to provide effective pharmacotherapy to inmates. First, inmates receiving opioid pharmacotherapy with either opioid agonists (eg, methadone or buprenorphine) or antagonists (naltrexone) in the community could be continued on their medications during brief incarceration. Second, inmates who experience withdrawal and who are either out of treatment at the time of incarceration or using contraband opioids during incarceration could be started and maintained on opioid pharmacotherapy. Finally, abstinent inmates with a long history of opioid dependence prior to incarceration and who are no longer physiologically dependent on opioids could be started on opioid agonist therapy (OAT) with either methadone or buprenorphine, or on the opioid antagonist extended-release naltrexone (XR-NTX) prior to discharge. Thus, incarceration presents a potentially important event for identifying and treating opioid-dependent adults.