As jails and prisons across the United States continue to provide limited and fragmented medication-based treatment for opioid use disorder, it is worth looking beyond these borders to see what treatments for people in correctional settings are available around the world.
In 2019, WHO Regional Office for Europe Health in Prisons Programme, established in 1995, produced a report that outlines the health prison health systems in 38 European countries. Healthcare systems in European jails and prisons are overseen either by the country’s Ministry of Justice (ex: Netherlands), by the Ministry of Health (ex: Norway), or by mutual cooperation between both Ministries (ex: Albania). The transfer of responsibility for the provision of care in jails and prisons to the Ministry of Health and outside healthcare providers is generally made to increase the quality of care and facilitate continuity of care following release.
Medication-based treatments for opioid use disorder are provided in most European countries however not all prisoners necessarily have access to these treatments. The majority of countries – including, but not limited to France, Latvia, Poland, and Serbia – provide medication based treatment to both individuals who have been sentenced, as well as those in pre-trial detention, while Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Monaco, and Romania only provide medication based treatment to people who have been sentenced. There remain other limitations to the use of medication-based treatment within the prisons and jails. For example, incarcerated individuals in Netherlands, Latvia, and Czech Republic only have access to medication based treatment if they began treatment prior to arrival (with initiation of opioid use disorder treatment medications only in exceptional circumstance in the Czech Republic).
With the exception of Armenia, Bulgaria, Luxembourg, Moldova, Romania, Spain, and Switzerland, most European countries do not provide needle or syringe exchange programs for prisoners who inject drugs. Of those countries that provide syringe exchanges, only Armenia, Spain, and Luxembourg provide this program in all prisons. Germany introduced a syringe-dispensing machine in a women’s prison in Berlin and the Portuguese Ministry of Health approved a legal framework for establishing a syringe exchanges in prisons, but as of 2019 it had yet to be implemented. Naloxone kits are provided to prisoners in the Netherlands, Estonia (with prisoners receiving naloxone kits upon release) and the United Kingdom (take-home naloxone widely available in Scotland and Wales).
North of the United States, medication based treatment in Canada has been available in certain prisons across the country since 1999, with initiation and continuation of medication based treatment available in all 43 federal prisons. Provincial and territorial prisons do not consistently provide medication-based treatment. In response to a (settled) lawsuit against BC Corrections, British Columbia provided access to medication-based treatment, typically methadone or buprenorphine, to prisoners. BC Corrections also expanded its overdose prevention efforts by providing naloxone kits through a “take home naloxone” program that also includes training sessions. In Ontario, despite a 2016 provincial report recommending that patients residing in correctional facilities be able to continue treatment or access new opioid agonist therapy where clinically indicated, it was revealed that another provincial policy dictates that, except in special circumstances, such treatment should not be provided to incarcerated individuals who have not previously accessed this treatment. In 2018, Correctional Service of Canada (CSC) rolled out a Prison Needle Exchange Program (PNEP) in federal institutions across Canada (with the program implemented in six to date); there is no equivalent program across the provinces and territories.
While no country has yet developed a comprehensive system that ensures access to medication-based treatments in jails and prisons, jurisdictions in the United States can learn from other countries to ensure that incarcerated individuals receive needed treatment and harm reduction services.