Prescription Opioid Abuse in Prison Settings: A Systematic Review of Prevalence, Practice and Treatment Responses

Background
To systematically review the quantitative and qualitative evidence base pertaining to
the prevalence, practice of, and treatment response to the diversion of prescribed
opiates in the prison setting.
Methods
Medline, Embase, CINAHL, PsycINFO, Google Scholar, ASSIA and Science Direct
databases were searched for papers from 1995 to the present relevant to the abuse
of prescribed opiate medication. Identified journals and their reference lists were
hand searched for other relevant articles. Of the abstracts identified as relevant, full
text papers were retrieved and critiqued against the inclusion criteria for the review.
Results
Three hundred and fifty-five abstracts were identified, leading to 42 full-text articles
being retrieved. Of those, 10 papers were included in the review. Significant
differences in abuse behaviours between different countries were reported.
However, a key theme emerged from the data regarding a culture of nasal
administration of prescribed sublingual buprenorphine within some prisons due to
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both reduced prevalence of injection within prison and reduced supplies of illicit
drugs within prison. The buprenorphine/naloxone preparation appears to be less
amenable to abuse. The review highlighted a paucity of empirical research pertaining
to both prevalence of the phenomenon and treatment responses.
Clinical and research implications
Healthcare providers within prisons need to prescribe opioids in the least abuseable
preparation since the risk of abuse is significant, despite widespread processes of
supervised dispensing. Prescription medication abuse is not limited to opioids and
the predominant drug of abuse in an individual prison can rapidly change according
to availability.