Home > Effectiveness of pharmacotherapies in increasing treatment retention and reducing opioid overdose death in individuals recently released from prison: a systematic review.

Crowley, Des and Van Hout, Marie Claire (2017) Effectiveness of pharmacotherapies in increasing treatment retention and reducing opioid overdose death in individuals recently released from prison: a systematic review. Heroin Addiction and Related Clinical Problems , 19 , (2) .

URL: http://www.heroinaddictionrelatedclinicalproblems....


Background: Opioid dependence is common amongst the prison population, with increased risk of fatal overdose in the immediate post-release period.

Aim: The study aimed to review the effectiveness of pharmacotherapies (Methadone (METH), Buprenorphine (BUP), levo-alpha acetyl methadol (LAAM), Naltrexone (NLT) and Naloxone (NLX)) in reducing overdose deaths and increasing treatment retention in opioid dependent prisoners on release.

Methods: A systematic review of studies on recently discharged opioid dependent prisoners receiving METH, BUP, LAAM, NLT and/or NLX was conducted. Factors of interest regarded post-release treatment retention, non-fatal overdoses (NFODs), overdose mortality, and continued heroin and/or other illicit drug use. Searches were conducted using MESH terms; opioid related disorder, prisoner, NLT, NLX, METH, BUP, LAAM, overdose. Exclusion criteria were applied as per PRISMA guidelines. Quality, outcome and risk of bias assessments were applied across studies.

Results: Eight randomised control trials (RCT), one non-randomised trial and five observational studies formed the data set. Agonist Opioid Treatment (AOT) (METH, BUP, LAAM) initiated pre-release was associated with significant post-release treatment retention on dischargeinto the community, and post-release reduction in heroin use. Prisoners on BUP or METH on discharge had significantly reduced mortality risks in the immediate four weeks post-release. There was insufficient evidence supporting a reduction in NFODs and continued other illicit drug use.

Conclusions: The review underscores the need for prisoners on AOT to be supported with continued treatment on release into the community. Further research is warranted to investigate potential utility of long-acting NLT formulations and take-home NLX (THN) in pre –release opioid dependant prisoners.

Item Type:Article
Date:2017
Publisher:European Opiate Addiction Treatment Association
Volume:19
Number:2
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:B Substances > Opioids (opiates) > Opioid product > Naloxone
B Substances > Opioids (opiates) > Opioid product > Naltrexone
B Substances > Opioids (opiates) > Opioid product > Buprenorphine / Suboxone
G Health and disease > Substance use disorder > Drug use > Drug intoxication > Poisoning (overdose)
HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution) > Methadone maintenance
J Health care, prevention and rehabilitation > Health care programme or facility > Substance disorder treatment unit
MM-MO Crime and law > Justice system > Correctional system and facility > Prison
T Demographic characteristics > Prison Inmate (prisoner)
VA Geographic area > International aspects

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