Maintenance therapy and 3-year outcome of opioid-dependent prisoners: a prospective study in France (2003-06).

AIMS: To describe the profile of imprisoned opioid-dependent patients, prescriptions of maintenance therapy at imprisonment and 3-year outcome in terms of re-incarceration and mortality. DESIGN: Prospective, observational study (France, 2003-06). SETTING: Health units of 47 remand prisons. PARTICIPANTS: A total of 507 opioid-dependent patients included within the first week of imprisonment between June 2003 and September 2004, inclusive. MEASUREMENTS: Physicians collected socio-demographic data, penal history, history of addiction, maintenance therapy and psychoactive agent use, general health status and comorbidities. Prescriptions at imprisonment were recorded by the prison pharmacist. Re-incarceration data were retrieved from the National Register of Inmates, survival data and causes of death from the National Registers of vital status and death causes. FINDINGS: Prison maintenance therapy was delivered at imprisonment to 394/507 (77.7%) patients. These patients had poorer health status, heavier opioid use and prison history and were less socially integrated than the remaining 113 patients. Over 3 years, 238/478 patients were re-incarcerated [51.3 re-incarcerations per 100 patient-years, 95% confidence interval (CI) 46.4-56.2]. Factors associated independently with re-incarceration were prior imprisonment and benzodiazepine use. After adjustment for confounders, maintenance therapy was not associated with a reduced rate of re-incarceration (adjusted relative risk 1.28, 95% CI 0.89-1.85). The all-cause mortality rate was eight per 1000 patient-years (n = 10, 95% CI 4-13). CONCLUSIONS: Prescription of maintenance therapy has increased sharply in French prisons since its introduction in the mid-1990s. However, the risk of re-imprisonment or death remains high among opioid-dependent prisoners. Substantial efforts are needed to implement more effective preventive policies.

[High-dose buprenorphine substitution during incarceration. Management of opiate addicts]. / Substitution par buprénorphine haut dosage lors d'une incarcération. Prise en charge de détenus pharmacodépendants aux opiacés.

OBJECTIVE: To describe the social and medical profiles of incarcerated (in detention or after sentencing) opiate addicts, whether or not they had already begun substitution treatment at arrival, and assess the impact of high-dose buprenorphine substitution therapy on the health of prisoners and the course of their incarceration. METHODS: A prospective survey was conducted on opiate addicts on admission to prison and after 2 months of incarceration, from December 2001 to February 2003, in 6 prison centres in the South East of France. RESULTS: During incarceration, no significant difference (other than in medical follow-up) appeared between the prisoners receiving substitution treatment and those who went through withdrawal on arrival. The first group differed from the second in several respects: their occupational history before incarceration was less stable, their history of drug addiction and incarceration was more serious (injection, psychotropic use, number of prior incarcerations, early age at first incarceration). The buprenorphine patients also differed in their more intense use of medical follow-up before incarceration. CONCLUSION: The impact of buprenorphine substitution therapy during incarceration could not be demonstrated, but prisoners receiving this treatment had a substantially different profile than those who were not receiving treatment when they arrived in prison.

[High-dose buprenorphine substitution during incarceration.] / Substitution par buprénorphine haut dosage lors d'une incarcération.

MANAGEMENT OF OPIATE ADDICTS: OBJECTIVE: To describe the social and medical profiles of incarcerated (in detention or after sentencing) opiate addicts, whether or not they had already begun substitution treatment at arrival, and assess the impact of high-dose buprenorphine substitution therapy on the health of prisoners and the course of their incarceration. METHODS: A prospective survey was conducted on opiate addicts on admission to prison and after 2 months of incarceration, from December 2001 to February 2003, in 6 prison centres in the South East of France. RESULTS: During incarceration, no significant difference (other than in medical follow-up) appeared between the prisoners receiving substitution treatment and those who went through withdrawal on arrival. The first group differed from the second in several respects: their occupational history before incarceration was less stable, their history of drug addiction and incarceration was more serious (injection, psychotropic use, number of prior incarcerations, early age at first incarceration). The buprenorphine patients also differed in their more intense use of medical follow-up before incarceration. CONCLUSION: The impact of buprenorphine substitution therapy during incarceration could not be demonstrated, but prisoners receiving this treatment had a substantially different profile than those who were not receiving treatment when they arrived in prison.

[Frequency of re-incarcerations in the same detention center: role of substitution therapy. A preliminary retrospective analysis]. / Fréquence des réincarcérations dans une même maison d'arrêt: rôle des traitements de substitution.

A retrospective study was carried out using 3 606 medical files of nine detention centers in France, over a three-month period (May to July 1997). The files were analyzed to determine, age, type of addiction and subsequent type of therapy proposed: methadone, high-dose buprenorphine or abstinence. A comparison was then made to determine whether or not there exists a statistical relationship between the type of therapy given in prison for drug abuse and subsequent recurrent use during the following three and a half years, until December 2000.