Opioid substitution treatment in pretrial prison detention: a case study from Geneva, Switzerland
BACKGROUND: Opioid substitution treatment (OST) is not uniformly provided in all prisons as recommended by international guidelines. The Swiss prison of Champ-Dollon in Geneva is an exception, where OST has been available for the last 20 years. The aims of this study were to describe the OST programme in this pretrial prison setting, and the patients involved.
METHODS: We reviewed health records of 2566 detainees entering Switzerland’s largest pretrial prison in 2007. Sociodemographic characteristics, substance use diagnosis and history, OST history and prison course, medical complications, and evidence of OST side effects were assessed by questionnaire.
RESULTS: The mean age was 29.6 years (SD 7.1) and 95.4% of prisoners were male. Among 233 opioid users (9.1%) at baseline, 221 (94.8%) used other substances, and 39.9% had used drugs intravenously. Opioid dependence was confirmed in 71.2% of opioid users. OST was offered to all dependent users, and all patients accepted treatment. Methadone was the treatment of preference, with a prescribed mean dose of 41.7 mg (standard deviation 29.1) upon departure. No serious side effects or death by overdose occurred. There was postrelease OST continuity-of-care for 49.7% of OST patients.
CONCLUSIONS: Prescription of OST for opioid dependent detainees by trained physicians is feasible and safe in a pretrial setting. The methadone dose was lower when compared with general OST treatment recommendations. Nevertheless, treatment was available in accordance with national and international guidelines. In-prison OST offers access to a much needed and safe healthcare service for this vulnerable population.
- Binswanger IA, Krueger PM, Steiner JF. Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. J Epidemiol Community Health. 2009;63(11):912–9.
- Fazel S, Baillargeon J. The health of prisoners. Lancet. 2011;377(9769):956–65.
- Watson R, Stimpson A, Hostick T. Prison health care: a review of the literature. Int J Nurs Stud. 2004;41(2):119–28.
- Council of Europe. Recommandation R (98) 6. 1998. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6CjZdvEkj
- EMCDDA. Annual report on the state of the drugs problem in Europe. 2010 – 102 pp. 2010. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6CjZt2Esa
- Bird SM, Rotily M. Les usagers de drogue dans le système judiciaire: les détenus. 2003. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6Cja4ZYzp
- Greifinger R. Public health behind bars: from prisons to communities. New York: Springer; 2007. 576p.
- Mumola CJ, Karberg JC. Drug Use and Dependence, State and Federal Prisoners, 2004. Washington, DC: Office of Justice Programs, Bureau of Justice Statistics. Dept of Justice publication NCJ 213530. 2006.
- Rich JD, McKenzie M, Shield DC, Wolff FA, Key RG, et al. J. Linkage with methadone treatment upon release from incarceration: a promising opportunity. J Addict Dis. 2005,24(3):49–59.
- Hausser D. PREVENTION DE LA TRANSMISSION DU VIH DANS LES PRISONS SUISSES. Analyse secondaire sur la base de la littérature disponible. Raisons de santé. 1999; (40). Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6Cja9WN2T
- Wolff H, Sebo P, Haller DM, Eytan A, Niveau G, Bertrand B et al. Health problems among detainees in Switzerland: a study using the ICPC-2 classification. BMC Public Health. 2011;11:245.
- Tan JA, Joseph TA, Saab S. Treating hepatitis C in the prison population is cost-saving. Hepatology. 2008;48(5):1387–95.
- Jürgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infect Dis. 2009;9(1):57–66.
- Huang YF, Kuo HS, Lew-Ting CY, Tian F, Yang CH, Tsai TI, et al. Mortality among a cohort of drug users after their release from prison: an evaluation of the effectiveness of a harm reduction program in Taiwan. Addiction. 2011;106(8):1437–45.
- Brugal MT, Domingo-Salvany A, Puig R, Barrio G, García de Olalla P, de la Fuente L, et al. Evaluating the impact of methadone maintenance programmes on mortality due to overdose and AIDS in a cohort of heroin users in Spain. Addiction. 2005;100(7):981–9.
- Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, et al. Release from prison – a high risk of death for former inmates. N Engl J Med. 2007;356(2):157–65.
- Seaman SR, Brettle RP, Gore SM. Mortality from overdose among injecting drug users recently released from prison: database linkage study. BMJ. 1998;316(7129):426–8.
- Larney S, Toson B, Burns L, Dolan K. Effect of prison-based opioid substitution treatment, and post-release retention in treatment, on risk of re-incarceration. Addiction. 2012;107(2):372–80.
- Teesson M, Ross J, Darke S, Lynskey M, Ali R, et al. One year outcomes for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Depend. 2006;83(2):174–80.
- Bruce RD, Schleifer RA. Ethical and Human Rights Imperatives to Ensure Medication-Assisted Treatment for Opioid Dependence in Prisons and Pre-trial Detention. Int J Drug Policy. 2008;19(1):17–23.
- Kastelic A, Jörg P, Stöver H. Opioid Substitution Treatment in Custodial Settings A Practical Guide. WHO Europe, United Nations Office on Drugs and Crime. 2008. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6CjaR26JG http://www.webcitation.org/6CjZdvEkj
- Harm Reduction International. The Global State of Harm Reduction 2012. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6Cjad49BY
- Swiss Society of Addiction Medicine. Recommandations médicales pour les traitements basés sur la substitution des patients dépendants aux opioïdes. 2010.
- Kastelic A, Pont J, Stover H. Opioid Substitution Treatment in Custodial Settings. A Practical Guide. WHO, Europe and United Nations Office on Drugs and Crimes. BIS-Verlag der Carl Ossietzky Universitat Oldenburg. 2007, 2008.
- Office cantonal de la statistique de la République et Canton de Genève. Population résidante genevoise : + 2 278 personnes en 2007. January 2008. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6CjakRjsq
- Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.
- Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res. 2005;29(5):844–54.
- Larney S, Dolan K. A literature review of international implementation of opioid substitution treatment in prisons: equivalence of care? Eur Addict Res. 2009;15(2):107–12.
- Kinlock TW, Gordon MS, Schwartz RP, Fitzgerald TT, O’Grady KE, et al. A randomized clinical trial of methadone maintenance for prisoners: results at 12 months postrelease. J Subst Abuse Treat. 2009;37(3):277–85.
- Michels II, Stöver H, Gerlach R. Substitution treatment for opioid addicts in Germany. Harm Reduct J. 2007;4:5.
- Maruschak LM. Medical problems of jail inmates. 2006. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6Cjaoq3mq
- Der Forschungsverbund stationäre Suchttherapie act-info-FOS im Jahr 2005. Cited and archived Dec 7 2012. Available from: http://www.webcitation.org/6Cjb2FxYu
- Magura S, Lee JD, Hershberger J, Joseph H, Marsch L, et al. Buprenorphine and methadone maintenance in jail and post-release: a randomized clinical trial. Drug Alcohol Depend. 2009;99(1-3):222–30.
- Liebrenz M, Boesch L, Stohler R, Caflisch C. Agonist substitution – a treatment alternative for high-dose benzodiazepine-dependent patients? Addiction. 2010;105(11):1870–4.
- Fazel S, Danesh J. Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys. Lancet. 2002;359(9306):545–50.
- Elger BS. Prison medicine, public health policy and ethics: the Geneva experience. Swiss Med Wkly. 2011;141:w13273