Extended-release pharmacotherapies for substance use disorders in incarcerated populations: A systematic review

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-01-30 DOI:10.1111/add.16766

Amelia Woods, Catherine Foley, Katherine M. Conigrave, Winifred Asare-Doku, Anthony Shakeshaft, Stella Settumba-Stolk, Michael Farrell, Michael Doyle

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Abstract

Background and aims

Substance use (SU) is prevalent among individuals in the criminal justice system (CJS). However, there is often poor access to treatment. We aimed to assess the effectiveness of two medications, extended-release naltrexone (XR-NTX) and extended-release buprenorphine (XR-BUP) for the prison population.

Methods

We searched Scopus, OVID/Embase, PubMed/Medline, ProQuest, EBSCO, Cochrane Library and Australian Criminology Database for original articles published from 1 January 2002 to 31 December 2022. Inclusion criteria: 18+, substance use disorder; XR treatment; recent incarceration. We extracted study, participants, treatment characteristics and outcome variables. We conducted risk of bias assessments using the RoB-2, ROBINS-I, JBI tools and Evers et al.

Results

We identified 25 papers (16 studies) examining 3403 participants. Sixteen papers (9 studies) focused on XR-NTX, eight (7 studies) on XR-BUP and one on both. Eighteen papers (11 studies) were from the US, with the remainder from Norway, Australia, UK, Canada and Germany. There were eight RCTs (10 papers), four secondary observational analyses, four cohort studies, four economic analyses, two case series and one qualitative paper. Most studies had small–moderate samples, with varying retention and follow-up periods. Among RCTs, two XR-NTX studies for opioid use found no difference in retention vs treatment as usual and placebo, while one reported improved retention for XR-NTX implant vs methadone. One RCT showed mixed retention results for XR-NTX vs placebo in alcohol use. One XR-BUP study showed improved or equivalent treatment retention (depending on measures) vs sublingual buprenorphine. There was no difference in overdoses. SU for XR-NTX was challenging to assess due to differing definitions, measures and comparators. XR-BUP yielded mixed SU results, with one indicating a greater effect and another no difference from comparators.

Conclusions

There is no clear evidence for the effectiveness of extended release naltrexone and buprenorphine among individuals in the criminal justice system compared with shorter acting formulations. But there is growing evidence for the effectiveness of extended release buprenorphine in reducing opioid use and improving treatment retention in that population, with potential cost offsets from initial medication expenses.

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.