Buprenorphine and Therapy for Treating Opioid Dependence in Prison

Background: Opioid dependence is a chronic relapsing disease resulting from a complex interaction of drug effects, individual genetics, and environmental factors. According to recent estimates, nearly 1 in 4 inmates in U.S. prisons are opioid dependent. Approximately 45% of inmates with a history of substance abuse continue to use drugs in prison. Relapse to drug use often leads to high-risk behaviors, death from overdose, and reincarceration. Treatment of opioid dependence in prisoners represents an important public health opportunity, yet most inmates are not offered treatment. Buprenorphine is an evidence-based medication used to treat opioid-dependence, but little is known about its efficacy and cost-effectiveness for opioid-dependent inmates.  

Methods: Prior studies on buprenorphine treatment and substance abuse treatment in prison were synthesized. Data from published trials was then used to estimate the costs and benefits of buprenorphine therapy for prison inmates in the United States.

Results: Few studies have examined the efficacy of buprenorphine for prison inmates. Preliminary results show that buprenorphine may effectively decrease opioid relapse rates and is well-tolerated and feasible for implementation in prisons. Although the initial cost of adopting buprenorphine may be relatively high, reductions in criminal justice related costs and criminal activity could save money in the long term.

Conclusions: Based on preliminary efficacy and cost-effectiveness research, prison administration should consider the implementation of buprenorphine for opioid-dependent prison inmates.