Drug substitution programs effective in jails and prisons

The Department of Forensic Psychology in Erlangen researches substitution treatment in offenders dependent on opioids

Providing offenders dependent on heroin with substitution treatment has a positive effect on their life behind bars and after release from prison. People who receive medical opioid substitutes during their time in prison suffer opioid relapses less frequently than those who do not participate in an opioid substitution program. This is the conclusion reached in a unique long-term study conducted by a team of researchers from the Department of Forensic Psychology at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), a worldwide first of its kind.

The project for treating opioid dependent offenders in Bavarian prisons (title: “Imprisonment and opioid addiction – an evaluation study”, or HOpE study for short) has received almost 540,000 euros in funding from the Bavarian Ministry of Justice. As the backdrop to the study, an inmate lodged a complaint with the European Court of Human Rights (ECHR) claiming that refusal to provide substitution treatment was a breach of the European Convention on Human Rights. The judges ruled in his favor. In its judgment, the ECHR declared that categorically denying substitution treatment after refusing to have the necessity of such treatment examined by an external medical expert constituted a breach of the prohibition of inhuman treatment (Article 3 of the European Convention of Human Rights)(judgment dated September 1, 2016, case no. 62303/13).

The increasing number of cases of substitution treatment based on this jurisdiction led the Free State of Bavaria to commission a scientific study investigating the effects of opioid substitution, for example by using methadon. The team of researchers led by Prof. Dr. Mark Stemmler from the Chair of Psychological Assessment, Quantitative Methods and Forensic Psychology investigated a sample of 247 inmates in Bavarian prisons and interviewed law enforcement staff as well. In a longitudinal study, prisoners dependent on opioids were questioned on their use of drugs and substitution medication shortly before release, one month after release, between three and six months after release, and twelve months after release. Saliva samples were examined and law enforcement staff interviewed.

According to the researchers, treatment based on substitution medication during imprisonment can be considered effective. It did not only lead to a reduction in the consumption of opioids, it also led to a reduction in the use of illegally obtained substitutes. Participation in the substitution program reduced boredom during imprisonment, which is considered a risk factor for drug misuse.

It was revealed that compared to those who did not partake in a drug substitution program, those who received substitution treatment used fewer illegal opioids and substitution medication that had not been prescribed even after release from prison (between three and six months after release), experienced fewer cravings and also committed fewer narcotics offenses than those who did not participate in the program.

The effects of the substitution were still noticeable twelve months after release, but to a much lesser extent. The researchers believe a need for action still remains: “Substitution is not a universal remedy. Purely medication-based substitution treatment of offenders dependent on heroin must be continued, but that in itself is not enough. These people require support during their time in prison and after release with additional psychosocial measures such as drug therapy,” explains Prof. Mark Stemmler. His team of researchers are currently preparing a fourth follow-up investigation (two years after release from prison).

Further information:
Prof. Dr. Mark Stemmler
Chair of Psychological Assessment, Quantitative Methods and Forensic Psychology
mark.stemmler@fau.de