Table 1 Research evidence on buprenorphine/naloxone initiation for people in correctional facilities with OUD who were not opioid dependent or tolerant

Garcia et al., 2007

Intervention with no control group: daily bup/nal in prison and post-release

42 males in total, most were opioid tolerant, with ~ 6 months prior to release

Treatment was initiated pre-release. Opioid nontolerant participants were initiated at 2 mg, and increased by 2 mg increments prn. They were assessed 1x/week in first month, then every 2 weeks until release. Goals were to reach a therapeutic dose and eliminate cravings.

Results were not stratified by opioid tolerance. Comparing drug use in the 30 days before incarceration and the 30 days after release, those who remained on treatment (n = 33) reported a median reduction in days of drug use of 22 for heroin use and 25 for cocaine use, whereas those who did not remain in treatment (n = 9) reported no reduction in days of heroin or cocaine use after release.

Springer et al., 2010

Intervention with no control group (nested in an RCT) comparing outcomes pre- and post-bup/nal treatment

People with HIV and OUD: 23 received bup/nal: 18 males and 5 females

Treatment was initiated around the day of release. Initial dose was 2 mg and dose was increased by 2 mg prn. Participants were assessed daily during induction and monthly thereafter.

91% of participants completed induction and 74% completed 12-week treatment. Likert scale rating of opioid craving reduced from mean 6.0/10 to 2.2/10 and satisfaction level was 9.5/10 throughout the 12 weeks. For those who completed induction: no change in undetectable viral load for those in treatment at 12 weeks compared to baseline: 61% vs. 63% log₁₀ copies/mL, or negative urine drug screen: 83% vs. 71%.

Zaller et al., 2013

Intervention with two non-randomized groups: pre- and post-release initiation of treatment

44 people: 37 males and 7 females

12 subjects started treatment within 2 weeks pre-release and 32 subjects started treatment 3 days post-release. Dose was adjusted based on symptom review.

For those who initiated treatment in prison vs. post-release, mean time to first post-release prescriber appointment was 3.9 vs. 8.8 days. At the study conclusion 6 months after release, 91% of those who initiated treatment in prison remained in treatment vs. 34% of those who initiated treatmented post-release, and median post-release treatment duration was 24 vs. 9 weeks.

Vocci et al., 2015

Gordon et al., 2014

RCTof in-prison buprenorphine treatment vs. counselling only (series of 12 weekly sessions)

211 people with heroin dependence prior to imprisonment: 148 males and 63 females

Treatment was initiated 3–9 months pre-release. The standard protocol was induction at 1 mg, then dose increased 1 mg/week to 4 mg, then 2 mg/week to 8 mg, then to 16 mg after 2 weeks and administered every other day. If tolerated, dosing was changed to 3x/week. Dosing was changed based on side effects and patient requests.

Results were not stratified for those who were not opioid tolerant. Compared with those randomized to counseling only, those randomized to the buprenorphine treatment group were more likely to initiate treatment in prison: 99.0% started buprenorphine vs. 80.4% started counselling, and to continue treatment in the community after release: 47.5% vs. 33.7%. There was no difference in completing treatment in prison: 61.5% of the buprenorphine group remained in treatment at release vs. 63.6% of those randomized to counselling only.