Abstract
BackgroundThe above-average proportion of people with opioid use disorder living in prisons is a worldwide reality, and the need to treat these people was recognized internationally more than 20 years ago. Studies have shown that substitution therapies are best suited to treat opioid use disorder and reduce the risk of HIV and hepatitis C transmission and overdose. However, huge health inequalities exist in and outside of prison due to the different implementation of opioid substitution therapy (OST). People living in prisons are entitled to the best possible health care. This is established by the Universal Declaration of Human Rights and by the International Convention on Economic, Social and Cultural Rights. Solely the imprisonment, and not the loss of fundamental human rights, constitutes the punishment.MethodsA qualitative literature search using PubMed and Google Scholar was performed in order to identify relevant publications.ResultsThis review shows the inequality in availability of opioid substitution therapy for people living in prison compared with people outside of prison in Germany. It also gives possible reasons and evidence for this inequality, showing that continuing or initiating OST in prison is more beneficial for the health of people living in prison than abstinence-oriented treatment only.ConclusionIt is important that drug use disorder is treated as a serious illness also in prison. Joint efforts are needed to provide people living in prison with the best possible treatment and to minimize the adverse effects of drug use. Therefore, with laws, policies, and programs that conform to international human rights standards, each state must ensure that people living in prison receive the same health care as people outside of prison.
Highlights
The above-average proportion of people with opioid use disorder living in prisons is a worldwide reality, and the need to treat these people was recognized internationally more than 20 years ago
Opioid use disorder is often associated with fatal consequences, especially for people living in prison
The need for OST to treat people with opioid use disorder living in prisons was internationally endorsed in 1993 and confirmed by UN agencies including the United Nations Office on Drugs and Crime (UNODC), the World Health Organization (WHO), and others in 2013: “Considering that opioid substitution therapy is the most effective drug dependence treatment for people dependent on opiates, where it is available in the community, it should be accessible in prisons.” [9]
Summary
The above-average proportion of people with opioid use disorder living in prisons is a worldwide reality, and the need to treat these people was recognized internationally more than 20 years ago. Huge health inequalities exist in and outside of prison due to the different implementation of opioid substitution therapy (OST). Opioid use disorder is often associated with fatal consequences, especially for people living in prison These consequences include an increased risk of hepatitis B and C, and HIV due to the use of contaminated syringes, and an above-average mortality rate shortly after release from prison, mostly as a result of fatal overdose [2]. The need for OST to treat people with opioid use disorder living in prisons was internationally endorsed in 1993 and confirmed by UN agencies including the United Nations Office on Drugs and Crime (UNODC), the World Health Organization (WHO), and others in 2013: “Considering that opioid substitution therapy is the most effective drug dependence treatment for people dependent on opiates, where it is available in the community, it should be accessible in prisons.” [9]. There is hardly any psychosocial care in prisons, and if there is, only in a reduced form and with months of waiting time [12]
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