Prisons are not the right place for treating drug dependent men and women, and countries should develop policies for alternatives to imprisonment. As long as these alternatives have not been developed and implemented, prison authorities are faced with this specific population, in need of treatment, care and support. Research has shown that substitution therapy is the most effective way to treat opioid dependence, to reduce the risk of HIV and hepatitis C transmission, and to reduce the risk of overdose.
The course is based on the expertise of scientists and medical doctors/psychiatrists/healthcare professionals working in the field of substitution treatment in prisons. This course is to support prison doctors, contracted doctors, prison health care workers, prison administration, NGOs and others in delivering or supporting substitution treatment to opioid dependent prisoners.
See "Introduction" for more information about the course.
In the first part, we present a summary of the basic issues discussed in the course. This course is designed as a self-study online. We recommend taking a few minutes to read a short manual to the course in the introductory section.
15 key takeaway points
In this part you'll find out the main goals of substitution treatment, you'll see how differ agonists from antagonists and you'll read about the benefits of substitution treatment
Many drug users spend years of their lives going in and out of prison. Generally, prisoners are often from the poorest sectors of society and consequently already have worse health than other social groups. Being in prison commonly exacerbates existing health problems, especially with vulnerable groups such as drug users.
The most common form of substitution treatment is methadone maintenance treatment. Methadone has been used to treat heroin and other opiate dependence for decades. The more recently developed buprenorphine is also quite commonly used in some countries. Both have been proven to greatly reduce the risk of HIV infection by reducing drug injection and improving the health and quality of life of opiate-dependent people.
In this part you'll find out to use methadone in substitution therapy, you'll see how differ substitution treatment regimens, you'll read how to use buprenorphine and sustained-release morphine in substitution therapy. At the end you'll find out how to use naltrexone as a prevent to addiction.
Substitution treatment programmes vary in duration, dosage and scheme. Although much evidence indicates that substitution treatment, especially methadone treatment, is more effective when higher dosages are prescribed on a maintenance basis, many programmes focus on short-term detoxification with decreasing dosages.
Methadone is a cheap, safe medication with no lasting deleterious physical or physiological effects. Methadone should be provided pursuant to the same professional and ethical standards that apply to all other health services. Findings have consistently demonstrated significant benefits associated with both methadone and buprenorphine maintenance treatment.
In this part you'll read how to use buprenorphine in substitution therapy. Buprenorphine is a prescribed medication with weaker opioid agonist activity than methadone. It is acceptable to heroin users, has few side effects and is associated with a relatively mild withdrawal syndrome.
In this part you'll read how to use sustained-release morphine in substitution therapy
Naltrexone is a pure opiate antagonist and, as such, is not considered a substitution medication agonist. It has received attention when used for ultrarapid detoxification under general anaesthesia - a practice that is not without risk to the patient. In addition to its use as a rapid detoxification agent, Naltrexone has also been used for decades as a longer-term blocking agent (full opiate antagonist) in maintenance treatment.
Summary table and description of substitution agents. One-page, A4 PDF sheet convenient to print & pin.
In this part you'll find out how to implement substitution treatment in a prison and you'll read about the role of psychological and social care in prison.
In this part we showing how to implement substitution treatment in a prison
Example substitution guidelines for penal institutions in Austria
This video presents the model of opiate substitution treatment (OST) in managing opioid dependence of inmates in the Republic of Moldova. It was produced by the Council of Europe's Pompidou Group in collaboration with the Moldovan Department of Penitentiary Institutions for the training of prison staff.
In this part you'll find out the basic information for the patient on substitution treatment, you'll read about how a patient can continue treatment after commencement or termination of prison sentence. At the end we describing the links between substitution therapy and treatment of blood-borne infections (eg HIV / AIDS, HBV, HCV) and others (eg tuberculosis or sexually transmitted diseases).
Basic information for the patient on substitution treatment
The information how a patient can continue treatment after commencement or termination of prison sentence
Substitution treatment may also play an important role in police detention and pre-trial detention institutions. Existing substitution treatments should be continued in police detention and pre-trial detention centres and remand prisons.
In this part we presentation of the ethical basis of substitution
Drug addiction is subject to strong ideological and cultural conceptions, which influence treatment approaches and treatment goals of drug addiction. Access to treatments and the choice of treatments are often decided on ideological rather than medical considerations.