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The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

Since the early 1990s, various countries have introduced HIV prevention programmes in prisons. Such programmes include education on HIV/AIDS, HCV and on drug use for prisoners and for staff, voluntary testing and counselling, the distribution of condoms, bleach, and needles and syringes, and substitution therapy for injecting drug users. Other forms of drug‐dependence treatment, as well as drug demand reduction and drug supply reduction measures may also be relevant to managing HIV/AIDS and HCV in prisons, and may facilitate HIV prevention measures ‐ or have unintended negative consequences for such measures. Prison systems in a growing number of countries are implementing such programmes. However, many of them are small in scale and restricted to a few prisons. Provision of care and treatment for people living with HIV or AIDS has become a priority worldwide, and it is considered to be a basic human right. This includes the provision of antiretroviral therapy (ARV) in the context of comprehensive HIV/AIDS care. Providing access to ARV for those in need in the context of correctional facilities is a challenge, but it is necessary and feasible. Studies have documented that, when provided with care and access to medications, prisoners respond well to ARV. Part 3 of the select annotated bibliography on HIV/AIDS and HCV in prisons contains selected “essential” articles and reports that provide information about (1) substitution treatment and other forms of drug‐dependence treatment; (2) other drug demand and drug supply reduction measures; and (3) care, treatment, and support for prisoners living with HIVor AIDS and/or HCV. Each section also contains a brief review of the evidence, based on recent work undertaken by the World Health Organization (WHO).

Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder (OUD) in most of the developed world. However, its application in Lebanon remains mainly as a community-based intervention. The purpose of this paper is to highlight the need of its implementation within the Lebanese correctional system.

The work is a pilot cross-sectional study that compares two groups: 30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the patients’ general perception and satisfaction of the treatments available. OUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was measured by “Treatment Perceptions Questionnaire (TPQ).”

The prison group reported significantly lower satisfaction when compared to the community group (total TPQ mean scores: M=34.73, SD =4.12 and M=16.67, SD =4.78, respectively, with t (56.76) =15.68, p=0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no significant interactions with the total TPQ score.

The major principles of the ethics of care and evidence-based safe practices will be proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for the expansion of the Lebanese OST program and consequently other countries in the region could benefit from this experience.

Electronic medical case files of male prisoners in a category B prison in London were studied to establish a prevalence during an eight-month period of the use of and the reasons for prescribing gabapentinoids in prison and also to establish prescribing standards in prison and compliance with these. In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants, particularly tricyclic antidepressants such as amitriptyline, was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. The paper aims to discuss these issues.

A retrospective, SystmOne case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1,500 prisoners; Average turnover of prisoners up to 6,000 per year), to establish practice standards related to the prescription of Gabapentinoids in the prison and determine compliance with these.

In total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. In 51 cases (47 per cent) gabapentinoids were prescribed with an opioid substitute. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.

The initiation of gabapentinoids in prison should be avoided. For prisoners who are also receiving opioid substitutes or are abusing opiates, it may be unsafe to continue on gabapentinoids. Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.

Risk of dependance on gabapentinoids including risk of mortality when taken with opioids and opioid substitutes.

This is an original study conducted at a category B prison in London.

The United Nations General Assembly Special Session on drugs has provided countries with internationally agreed recommendations to adapt their drug policies for more efficiency and better outcomes. This chapter focusses on the Russian Federation’s role in international drug policy, through an analysis of its national approaches and their design, as well as on its diplomatic efforts at the bilateral and multilateral levels to oppose drug policy reform. A systematic review of peer-reviewed, grey literature, policy documents, UN reports and news reports on the country’s response to drugs internally and externally was conducted between September and December 2017. Despite its efforts to oppose drug policy reform and the prioritisation of public health, the Russian Federation faces major epidemics of imprisonment and HIV. Internationally, while it has not been successful in addressing the ongoing reforms in Europe and the Americas, it has been effective in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm at the multilateral level.

People living with opioid use disorder (OUD) disproportionately encounter the criminal justice system. Although incarcerated individuals with OUD face higher risk for withdrawals, relapses and overdoses, most jails fail to offer comprehensive medications for OUD (MOUD), including recovery support services and transition of care to a community provider. The purpose of this paper is to describe the development and implementation of a comprehensive MOUD program at a large county jail system in Maricopa County, Arizona.

The authors used the Sequential Intercept Model (SIM) to develop a community-based, multi-organizational program for incarcerated individuals with OUD. The SIM is a mapping process of the criminal justice system and was applied in Maricopa County, Arizona to identify gaps in services and strengthen resources at each key intercept. The program applies an integrated care framework that is person-centered and incorporates medical, behavioral and social services to improve population health.

Stakeholders worked collaboratively to develop a multi-point program for incarcerated individuals with OUD that includes an integrated care service with brief screening, MOUD and treatment; a residential treatment program; peer support; community provider referrals; and a court diversion program. Recovery support specialists provide education, support and care coordination between correctional and community health services.

OUD is a common problem in many correctional health centers. However, many jails do not provide a comprehensive approach to connect incarcerated individuals with OUD treatment. The Maricopa County, Arizona jail system opioid treatment program is unique because of the ongoing support from recovery support specialists during and after incarceration.

As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs.

This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution.

A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community.

Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations’ rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.

The study aims to assess reentry challenges faced by Ukrainian prisoners and to determine the factors associated with having a greater number of challenges in order to suggest pre‐ and post‐release interventions with the aim of facilitating community reintegration.

A representative national cross‐sectional study with a sample size of 402 prisoners was conducted among imprisoned adults within six months of release. The study consisted of interviews and biological testing for infectious diseases. Anticipated reentry challenges were assessed using a structured questionnaire.

The most difficult and relatively important challenges identified were finding a job or a stable source of income and staying out of prison following release. Risk‐specific challenges pertinent to drug users and HIV‐infected individuals were assessed as difficult, but generally less important. Similarly, challenges associated with reducing drug relapse were ranked as less important, with only 0.6 percent identifying opioid substitution therapy as a helpful measure. In the multivariate analysis, having a greater number of challenges is associated with previous incarcerations, drug use immediately before incarceration and lower levels of social support.

To facilitate community re‐integration, it is vital to design interventions aimed at reducing recidivism and improvement of social support through comprehensive case management as well as to improve understanding about and address drug dependence issues among inmates by implementing evidence‐based treatment both within prisons and after release.

This is the first comprehensive assessment of community reentry challenges by prisoners in the former Soviet Union.

The prevalence of substance use disorders among incarcerated individuals in Canada is substantially higher than in the general population. Many incarcerated individuals with opioid use disorder remain untreated due to inadequate access to opioid agonist therapy (OAT). A considerable proportion of overdose-related deaths in the province of Ontario are individuals who have recently been released from prison. The purpose of this paper is to highlight that discontinuation of OAT as a disciplinary measure remains an active concern within prisons in Canada and places individuals with opioid use disorder at increased risk of relapse and resultant overdose death.

This case report describes an incarcerated client with opioid use disorder who was initially stable on OAT, but was forcibly tapered off OAT as a disciplinary measure and subsequently relapsed to illicit opioid use while in custody.

This case calls attention to concerns regarding treatment of opioid use disorder during incarceration, as forcible detoxification from OAT as a disciplinary measure is a highly dangerous practice. The authors discuss concerns regarding diversion and ways in which prison-based OAT programs can be improved to increase their safety and acceptability among correctional staff. Ongoing advocacy is required on the part of health-care workers and policymakers to ensure that individuals are able to appropriately access this life-saving therapy while incarcerated.

To the best of the authors’ knowledge, this is the first case report to describe forcible tapering of OAT as a disciplinary measure during incarceration. Despite existing evidence emphasizing the significant risk of overdose associated with detoxification from opioids, this case highlights the need for further research into the causes and prevalence of this practice.

A Rapid Evidence Assessment (REA) determined the effectiveness of correctional programmes for women offenders and examined features of programmes providing the strongest outcomes. The paper aims to discuss these issues.

Electronic databases and web sites were reviewed to identify literature focused on interventions with female offenders published since 2006, the end point of the last REA conducted in the area. The following retention criteria were applied: participants were over age 18; sample included women and results are reported separately for women; study included an appropriate comparison group; study included recidivism as an outcome measure. Studies’ methodological design quality was assessed using the Maryland Scientific Methods Scale.

In total, one meta-analysis and 22 studies reflecting 17 unique samples, published from 2006 to December 2014, were identified. Overall, the best evidence suggests that the following programmes and approaches have an evidence base: first, substance abuse treatment, in particular in-custody or hierarchical therapeutic community programmes; second, gender-responsive programmes that emphasize existing strengths and competencies, as well as skills acquisition; and third, following in-custody programme treatment with participation in community follow-up sessions. There is also promising evidence for the use of community opioid maintenance among heroin addicted women.

This review demonstrated that since 2006 the number of high-quality research studies assessing women’s correctional outcomes has grown considerably. The results provide guidance to programme designers and administrators on programmes for women offenders likely to be effective in promoting public safety goals and offender reintegration.