Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

Autoři: Monica Malta aff001;  Thepikaa Varatharajan aff001;  Cayley Russell aff001;  Michelle Pang aff001;  Sarah Bonato aff004;  Benedikt Fischer aff005
Působiště autorů: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada aff001;  Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada aff002;  Social Science Department, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil aff003;  Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada aff004;  Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada aff005;  Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil aff006;  Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand aff007
Vyšlo v časopise: Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review. PLoS Med 16(12): e32767. doi:10.1371/journal.pmed.1003002
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003002



Worldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration.

Methods and findings

We systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273–131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27–960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15–1,557) and 44 (range 27–382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36–55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research.


In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.

Klíčová slova:

Addiction – Death rates – Drug therapy – Heroin – Hispanic people – Opioids – Prisons – Systematic reviews


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