title: Prescription opioid abuse in prison settings: A systematic review of prevalence, practice and treatment responses.
abstract: To systematically review the quantitative and qualitative evidence base pertaining to the prevalence, practice of, and treatment response to the diversion of prescribed opiates in the prison setting.
  
  
  
  Medline, Embase, CINAHL, PsycINFO, Google Scholar, ASSIA and Science Direct databases were searched for papers from 1995 to the present relevant to the abuse of prescribed opiate medication. Identified journals and their reference lists were hand searched for other relevant articles. Of the abstracts identified as relevant, full text papers were retrieved and critiqued against the inclusion criteria for the review.
  
  
  
  Three hundred and fifty-five abstracts were identified, leading to 42 full-text articles being retrieved. Of those, 10 papers were included in the review. Significant differences in abuse behaviours between different countries were reported. However, a key theme emerged from the data regarding a culture of nasal administration of prescribed sublingual buprenorphine within some prisons due to both reduced prevalence of injection within prison and reduced supplies of illicit drugs within prison. The buprenorphine/naloxone preparation appears to be less amenable to abuse. The review highlighted a paucity of empirical research pertaining to both prevalence of the phenomenon and treatment responses.
  
  
  
  Healthcare providers within prisons need to prescribe opioids in the least abuseable preparation since the risk of abuse is significant, despite widespread processes of supervised dispensing. Prescription medication abuse is not limited to opioids and the predominant drug of abuse in an individual prison can rapidly change according to availability.
authors.affiliation: University of Leeds, School of Healthcare Baines Wing, LS2 9UT, United Kingdom. Electronic address: z.bimohammed@leeds.ac.uk.
authors.forename: Zanib
authors.initials: Z
authors.lastname: Bi-Mohammed
authors.affiliation: Spectrum Community Health CIC, Hebble Wharf, Wakefield, WF1 5RH, United Kingdom. Electronic address: Nat.wright@spectrum-cic.nhs.uk.
authors.forename: Nat M
authors.initials: NM
authors.lastname: Wright
authors.affiliation: Spectrum Community Health CIC, Hebble Wharf, Wakefield, WF1 5RH, United Kingdom. Electronic address: Pip.hearty@spectrum-cic.nhs.uk.
authors.forename: Philippa
authors.initials: P
authors.lastname: Hearty
authors.affiliation: University of Huddersfield, School of Human and Health Sciences, HD1 3DH, United Kingdom. Electronic address: n.king@hud.ac.uk.
authors.forename: Nigel
authors.initials: N
authors.lastname: King
authors.affiliation: University of Huddersfield, School of Human and Health Sciences, HD1 3DH, United Kingdom. Electronic address: h.gavin@hud.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Gavin
mesh_terms: D000286:Administration, Sublingual; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use; D011307:Drug Prescriptions; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000639:trends; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000517:prevention & control / Q000639:trends*; D015995:Prevalence; D011330:Prisons / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D013287:Illicit Drugs; D009294:Narcotics; D002047:Buprenorphine
keywords: Abuse; Abuse of prescribed medication; Buprenorphine; Buprenorphine/Naloxone; Diversion; Methadone; Misuse; Opioid; OxyContin; Oxycodone; Prison; Prisoner