Abstract
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. 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. 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. 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.
Highlights
Detainees are a vulnerable population with high morbidity [1, 2]
Human immunodeficiency virus (HIV) prevalence among prisoners is reported to be below 5% in most European countries, and the US
95.4% were male with a mean age of 29.6 years, and 74.7% had a previous incarceration
Summary
Detainees are a vulnerable population with high morbidity [1, 2]. The prevalence of drug use is high among detainees: in Europe, lifetime prevalence of drug use in this group ranges from 29% to 86% [5]. In Switzerland, 20% to 50% of detainees have a history of substance use, with up to 60% of them reporting having used drugs during incarceration [10, 11]. Prevalence of hepatitis C infection ranges between 12% and 31% in the prison setting, and is two- to six-fold higher than in the general population [12]. The postrelease period is a vulnerable transition time for prisoners – it carries a mortality rate that is 20 times higher than that of the general population [16, 17]. OST decreases IV use in jail and lowers the
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