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The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.

Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).

Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.

Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.

Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.

Neuroscientific technologies have begun to change the ways in which we understand, respond to, and treat drug addiction. According to addiction researchers, neuroscience marks a new era because of its potential to locate the causes of addiction within the brain and to treat addiction through altering neurochemistry. However, little is known about how addiction neuroscience and new neurochemical treatments shape individuals' experience of addiction and constitute new arrangements of knowledge and power that shape subjectivity and governance. This chapter addresses these domains by drawing on an analysis of scientific literature about addiction neuroscience and qualitative interviews with people being treated for addiction with buprenorphine, a pharmaceutical treatment for opioid dependence. The chapter charts four major themes in the addiction neuroscience literature (pleasure and the limbic system, rationality and the role of the prefrontal cortex, theories of plasticity, and the role of volition) and explores how each of these is incorporated, adapted, or rejected by individuals being treated for addiction with a pharmaceutical. This analysis demonstrates how neuroscientific ideas are mediated by the lived experiences of those being treated under a neuroscientific model. It also suggests that while neuroscientific interventions, like pharmaceuticals, shape the experience of those being treated for addiction, so too do many other forces, including social circumstances, moral frameworks, the drive for autonomy, and the quest to be “normal.”

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.

The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples taken from an unsuccessful randomised controlled trial. The first sample comprised 68 participants who were randomly allocated to naltrexone treatment. The second sample comprised 47 participants who commenced opioid pharmacotherapy during the study period. Thirteen per cent of subjects started naltrexone, with only 7% retained in treatment at six months. Six‐month retention was significantly lower in naltrexone compared to methadone (p = 0.0007). Poor patient acceptability and retention did not support oral naltrexone maintenance in this treatment group.

Recent political commentary in the USA has suggested that there is great potential for current criminal justice practices designed for drug-involved offenders to be significantly overhauled in the near future. It is imperative to plan for these changes by assessing how well current programs serve drug-involved criminal justice populations. The paper aims to discuss these issues.

This critical assessment begins with an overview of the most recent research on the prevalence and impact that substance use disorders have within the criminal justice system. Although the evidence demonstrates that relying on incarceration as a crime control method for drug-involved offenders has many shortcomings, there are innovative new programs being adopted across the country. Two of these promising programs are discussed, as well as the potential results that could be realized from integrating medication assisted treatment into appropriate criminal justice programs designed for drug-involved offenders.

Incarceration is a failed practice for attending to the underlying reasons why many drug-involved offenders become involved in criminal activities. There are encouraging new programs emerging in different parts of the USA, but the inclusion of supplemental treatment options could further promote positive outcomes.

The impending expansion of criminal justice programs for drug-involved offenders must consider how innovative new programs can be fused with supplemental treatment options to achieve the best results.

The objective of this study was to examine practices and policies in place for the provision of substitution treatment in prison in 18 European countries. Methodology. Across the 15 European member states (prior to 1 May 2004) and Czech Republic, Poland and Slovenia, interviews with ministerial representatives, professionals (i.e. service providers and security officials) working in prisons, and a total of 33 focus groups with a total of 132 male and 52 female prisoners were conducted. Results. Although constraints of access to substitution treatment for specific target groups only (e.g. HIV‐positive opiate users) have largely vanished, substitution treatment is now offered to a broad cross‐section of prisoners. The provision of this treatment still lags behind the standards of substitution treatment in the community (regarding access and continuity). In most countries, this form of therapy is most likely to be discontinued when entering prison. A treatment gap persists between prisoners requiring substitution maintenance treatment and those receiving it. Heterogeneous and inconsistent regulations and treatment modalities appear throughout Europe, sometimes within the same country or region. The concrete provision practice of substitution treatment in prison varies from one country to the other, from one prison to the other, within a medical team, and even from one doctor to another. Although psychosocial care was seen as a valuable additional and necessary part of the treatment to support the medical part of the substitution treatment in prison, it was found that such support was rarely provided. Compared to previous research, this study illustrates that the scope of substitution treatment has extended considerably across Europe. Across the board, a consensus surrounding the need to continue substitution treatment that had already been started in the community was apparent.

Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue.

The authors reviewed the literature on compulsory drug treatment in seven Asian countries.

The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantly male. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour, military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were; no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates.

The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease.

Many countries are spending vast amounts of funding on ineffective treatments for drug users.

Funding should be directed to community-based drug treatments that have been shown to work.

This is the largest review of compulsory treatment of drug users to date.

To underscore the significance of international health care management, we focus on three themes: the problem of global blindness; global health care challenges and opportunities; and learning from international health care management. The problem of global blindness highlights how health care managers’ inattentional blindness to competitors’ operational performance and market strategies lead to avoidable and expensive failures. To address global challenges and opportunities, health care organizations are employing two different strategies: (1) building and marketing a world-class health care facility internationally, and (2) organizing and integrating multinational health care operations. The first strategy exploits the medical-tourism market. The second strategy requires either multinational health care networks or transnational health care organizations. One of the lessons to be learned from international health care management is that an organization can create a meta-national competitive advantage. Another lesson is that by examining best practices from around the world, health care organizations can obtain new insights and become more innovative within their home markets. A corollary and third lesson is that while health care organizations can learn a great deal from examining international best clinical practices, sometimes the most important management lessons are lost in clinical translations. The fourth and last lesson is that worst cases – serious international management failures – offer perhaps the most valuable insights into the role of culture, complexity, and leadership for health care organizations.

Purpose – This chapter provides an overview of the importance of seeing personal troubles as public issues when examining the mass incarceration of people of color, specifically Black Americans in the United States. A response to the mass incarceration of Black Americans unrooted in a sociological understanding may lead to victim-blaming. This chapter demonstrates how personal problems are often intertwined with public issues. The chapter concludes with a discussion on the importance of shifting blame away from the victim and appropriately addressing systemic challenges.

Methodology/approach – This chapter applies sociological theories to examine high rates of incarceration of people of color that get attributed to personal problems. The authors based the analysis on previous research and governmental reports.

Findings – Sociological theory can offer new solutions to transforming the criminal justice system to alleviate injustices in communities of color. The criminal justice system has negative consequences, but resistance to accepting new ideas perpetuates inequality and limits opportunity for social change. The authors recognize that policy changes must occur at the institutional and structural levels to expose social injustice.

Originality/value – A dearth of research examines the approach of framing personal troubles as public issues to reduce mass incarceration. The authors intend to expand the discourse on how personal troubles intersect with public issues and how the authors must examine mass incarceration as the typical response.

Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States – methadone and buprenorphine – in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use.

Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine.

Findings – Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation, while the association of buprenorphine with white, middle class prescription opioid users enabled its use in deregulated private physicians’ offices.

Originality/value of paper – Advocates of biomedicalization of behaviors and conditions thought of as social or moral, such as addiction, argue that biomedicalization reduces the stigma of the condition and imply that, in turn, it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified, rather than reduced, the stigma of addiction for black and Latino low-income patients.