title: Opioid substitution treatment in pretrial prison detention: a case study from Geneva, Switzerland.
abstract: BACKGROUND
  Opioid substitution treatment (OST) is not uniformly provided in all prisons as recommended by international guidelines. The Swiss prison of Champ-Dollon in Geneva is an exception, where OST has been available for the last 20 years. The aims of this study were to describe the OST programme in this pretrial prison setting, and the patients involved.
  
  
  METHODS
  We reviewed health records of 2566 detainees entering Switzerland's largest pretrial prison in 2007. Sociodemographic characteristics, substance use diagnosis and history, OST history and prison course, medical complications, and evidence of OST side effects were assessed by questionnaire.
  
  
  RESULTS
  The mean age was 29.6 years (SD 7.1) and 95.4% of prisoners were male. Among 233 opioid users (9.1%) at baseline, 221 (94.8%) used other substances, and 39.9% had used drugs intravenously. Opioid dependence was confirmed in 71.2% of opioid users. OST was offered to all dependent users, and all patients accepted treatment. Methadone was the treatment of preference, with a prescribed mean dose of 41.7 mg (standard deviation 29.1) upon departure. No serious side effects or death by overdose occurred. There was postrelease OST continuity-of-care for 49.7% of OST patients.
  
  
  CONCLUSIONS
  Prescription of OST for opioid dependent detainees by trained physicians is feasible and safe in a pretrial setting. The methadone dose was lower when compared with general OST treatment recommendations. Nevertheless, treatment was available in accordance with national and international guidelines. In-prison OST offers access to a much needed and safe healthcare service for this vulnerable population.
authors.affiliation: Geneva University Hospitals, Penitentiary Medicine Service, Department of community medicine, primary care and emergency medicine, University of Geneva, Switzerland; Thierry.Favrod-Coune@hcuge.ch.
authors.forename: Thierry
authors.initials: T
authors.lastname: Favrod-Coune
authors.forename: Mariem
authors.initials: M
authors.lastname: Baroudi
authors.forename: Alejandra
authors.initials: A
authors.lastname: Casillas
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Rieder
authors.forename: Laurent
authors.initials: L
authors.lastname: Gétaz
authors.forename: Javier
authors.initials: J
authors.lastname: Barro
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: Barbara
authors.initials: B
authors.lastname: Broers
authors.forename: Hans
authors.initials: H
authors.lastname: Wolff
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011329:Prisoners; D011330:Prisons; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D013557:Switzerland; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone