4. Impact, role, and prevalence of medication assisted treatment (MAT) for opioid users in European prisons

Medication-assisted treatment (MAT) is the main and most researched approach to the treatment of opioid dependence and one of the components of a wider range of treatment options available to people who use opioids. Evidence shows that MAT is associated with considerable reductions in all-cause and overdose mortality risk among people who use opioids. Although methadone, buprenorphine, and naltrexone are the most-commonly used medications to treat opioid dependence, other medications including buprenorphinenaloxone combined, slow-release morphine, codeine, dihydrocodeine and diacetylmorphine are available in different European countries and are being used as well. Apart from the pharmacological part of the treatment (which includes offering the whole variety of medications for choice), psycho-social assistance for patients is of utmost importance. In all but one prisons in Europe MAT is available, either as continuation of treatment started in the community or as initiation prior to release. However, coverage, quality of intervention, variety of medications for choice, integration of patient’s views is often hampering.

Methods: Desk review of existing data on coverage, impact and role of MAT in European prisons

Coverage of MAT in prisons is often lower than those for opioid users in the community (e.g. Germany 23 vs. 50%). Psycho-social support and assistance is often lacking, patients often do not have the choice between medication as security aspects are dominating the choice of medication and the quality of service is often insufficient (e.g. standard instead of individual dosage).

MAT standards for patients in prisons need to be discussed and implemented European wide. The survey indicates that in many countries there are double standards with regard to service quality, coverage, choice of medications and accompanying psycho-social care. A bottleneck remains the continuity of care after release from prison.