Effectiveness of prison-based opioid substitution treatment: a systematic review

Abstract

Opioid substitution treatment (OST) is the most effective treatment for opioid dependence and plays critical role in HIV/Hepatitis C (HCV) prevention. Despite its proven effectiveness, OST is still significantly less available in prisons than in community setting. The aim of this systematic review is to review and evaluate evidence of the effectiveness of prison-based OST with regard to both in-prison and post-release outcomes. Systematic review was conducted of experimental and observational studies that reported effects of prison-based OST on heroin and crack use, injecting drug use, drug paraphernalia sharing, HIV/HCV seroconversion, treatment retention, criminal activity, arrests, re-incarceration and mortality. PsycINFO, Medline and Science Direct databases were searched for relevant studies, published between 2003 and 2017. In total, 647 references were screened, with 19 studies selected and included in the review. Eleven observational and eight experimental studies were identified. Prison-based OST was shown to be significantly correlated with improved treatment uptake and retention and reduction of heroin use, injecting drug use, drug paraphernalia sharing and HIV/HCV seroconversion. Partial evidence emerged for its effectiveness in reduction of cocaine use, criminal activity and mortality. There was weak evidence for its impact on re-incarceration and no evidence for its reduction of arrests. Prison-based OST was shown to be effective in improvement of treatment uptake and retention and reduction of illicit drug use, injecting behaviour, drug paraphernalia sharing, HIV/HCV seroconversion, criminal activity and mortality. Prison-based OST is an opportunity to engage in drug treatment one of the most high-risk and hard-to-reach groups. Whilst further research is needed to explore its long-term outcomes, existing studies provide evidence for its effectiveness and strong argument for its wider implementation.