Sustained-release morphine is seen as a valuable contribution to MAT in some countries (e.g. Australia, Austria, Bulgaria, Germany, The Netherlands, Slovenia, Switzerland and the United Kingdom). Some studies have reported that the use of oral sustained-release morphine leads to improved well-being of the people maintained on morphine compared to those receiving methadone maintenance due to a better side effect profile. In particular, sustained-release morphine is easy to use (once daily), and the users report better concentration, no major mood disturbances, no weight gain and a better drive.
Providing individualized patient care in the prison treatment setting can be a significant challenge. The high numbers of users requiring treatment in a setting where the supply of illicit drugs is markedly reduced can mean that protocols and practices of MAT are oriented more to the institution’s governance requirements rather than each patient’s needs and wishes. For instance, it takes approximately 5 minutes for the supervision administration of sublingual buprenorphine. This practice is both time-consuming and allows for a potential for diversion of the medication. Therefore, and also because it is cheaper, methadone is often prescribed in the prison as first line. However, some users can perceive such a practice as not equivalent to that offered in the community. Therefore, replacing one MAT drug with another obviously needs to be clearly communicated to prisoners.