Maintenance therapy and 3-year outcome of opioid-dependent prisoners: a prospective study in France (2003-06)

Addiction. 2009 Jul;104(7):1233-40. doi: 10.1111/j.1360-0443.2009.02558.x. Epub 2009 Apr 29.


Aims: To describe the profile of imprisoned opioid-dependent patients, prescriptions of maintenance therapy at imprisonment and 3-year outcome in terms of re-incarceration and mortality.

Design: Prospective, observational study (France, 2003-06).

Setting: Health units of 47 remand prisons.

Participants: A total of 507 opioid-dependent patients included within the first week of imprisonment between June 2003 and September 2004, inclusive.

Measurements: Physicians collected socio-demographic data, penal history, history of addiction, maintenance therapy and psychoactive agent use, general health status and comorbidities. Prescriptions at imprisonment were recorded by the prison pharmacist. Re-incarceration data were retrieved from the National Register of Inmates, survival data and causes of death from the National Registers of vital status and death causes.

Findings: Prison maintenance therapy was delivered at imprisonment to 394/507 (77.7%) patients. These patients had poorer health status, heavier opioid use and prison history and were less socially integrated than the remaining 113 patients. Over 3 years, 238/478 patients were re-incarcerated [51.3 re-incarcerations per 100 patient-years, 95% confidence interval (CI) 46.4-56.2]. Factors associated independently with re-incarceration were prior imprisonment and benzodiazepine use. After adjustment for confounders, maintenance therapy was not associated with a reduced rate of re-incarceration (adjusted relative risk 1.28, 95% CI 0.89-1.85). The all-cause mortality rate was eight per 1000 patient-years (n = 10, 95% CI 4-13).

Conclusions: Prescription of maintenance therapy has increased sharply in French prisons since its introduction in the mid-1990s. However, the risk of re-imprisonment or death remains high among opioid-dependent prisoners. Substantial efforts are needed to implement more effective preventive policies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Buprenorphine / therapeutic use*
  • Female
  • France / epidemiology
  • Humans
  • Male
  • Methadone / therapeutic use*
  • Middle Aged
  • Narcotic Antagonists / therapeutic use*
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / mortality
  • Opioid-Related Disorders / rehabilitation*
  • Prescription Drugs
  • Prisoners*
  • Prisons
  • Prospective Studies
  • Recurrence
  • Young Adult


  • Narcotic Antagonists
  • Prescription Drugs
  • Buprenorphine
  • Methadone