Opioid substitution therapy for people living in German prisons—inequality compared with civic sector

Stöver, Heino; Jamin, Daniela; Michels, Ingo Ilja; Knorr, Bärbel; Keppler, Karlheinz; Deimel, Daniel

doi:10.1186/s12954-019-0340-4

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…Some interventions—the effectiveness of which are supported by evidence and are largely implemented in the community—are still scarcely introduced. It must be noted that implementation of such services can still be set back by various prison setting-specific obstacles, such as security, overall ban on illicit drug use inside prisons, lack of capacity, adequate resources, technical expertise, infrastructure and trained staff, attitude towards harm reduction in the prisons such as the peculiar prison context as place of punishment and the moral considerations around it [ 79 , 87 – 91 ]. Moralistic attitude to health in prison should be replaced by pragmatic and scientific evidence-based approach to have a public health impact.…”

Section: Discussionmentioning

confidence: 99%

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

Stöver

Tarján²,

Horváth³

et al. 2021

Harm Reduct J

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Background People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe. Methods Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions. Results Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12. Conclusions Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and ‘on-paper’ availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.

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Section: Discussionmentioning

confidence: 99%

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

Stöver

Tarján²,

Horváth³

et al. 2021

Harm Reduct J

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some interventionsthe effectiveness of which are supported by evidence and are largely implemented in the community -are still scarcely introduced. It must be noted that implementation of such services can still be set back by various prison setting speci c obstacles, such as: security, overall ban on illicit drug use inside prisons, lack of capacity, adequate resources, technical expertise, infrastructure and trained staff, attitude towards harm reduction in the prisons such as the peculiar prison context as place of punishment and the moral considerations around it (83,(91)(92)(93)(94)(95). Moralistic attitude to health in prison should be replaced by pragmatic and scienti c evidence-based approach to have a public health impact.…”

Section: Discussionmentioning

confidence: 99%

The State of Harm Reduction in Prisons in 30 European Countries with a Focus on People Who Inject Drugs and Infectious Diseases

Stöver

Tarján²,

Horvath³

et al. 2020

Preprint

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Background: People who inject drugs are often imprisoned which is associated with increased levels of health risks including overdose and infectious diseases affecting the prison population and the community where they return to. Information about responses to this in prisons is limited and heterogeneous in Europe. The paper aims to give a comprehensive, up-to-date overview of the availability, coverage and policy framework of prison-based harm reduction interventions. Methods: Systematic review of international agencies’ data sources and data collection were conducted in 2018 followed by a questionnaire survey in 30 European countries through the Reitox National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction.Results: Opioid substitution treatment (OST) is available in 29 countries, but coverage remains below 30% of people in need (low) in half of the countries. Needle and syringe programmes, bleach and lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available (in 3/8/9/9/10 countries respectively), and often with low coverage. Testing of drug related infectious diseases (DRID) are provided however typically only upon entry, with a last year population coverage remaining low in about half of the countries. While DRID treatment is available, its coverage is mostly reported high for Human Immunodeficiency Virus (HIV) and Tuberculosis, but lower for Hepatitis B and C (HCV). Health education on DRID, HIV health promotion programmes, and condom distribution are usually provided but at low levels in nearly half of the countries. Post-release linkages to addiction, HIV and HCV care is available in 22/25/17 countries, but implementation is often partial. Other upon-release interventions as OST initiation, take-home naloxone, health education, DRID testing are rarely provided. Harm reduction in prison is addressed in national strategic documents in 21 countries while interventions upon release in only 12. Conclusions: Availability and coverage of harm reduction interventions in prisons is limited and delayed compared to community implementation in European countries. There is a critical gap between international recommendations, on-paper availability and the actual implementation of these interventions. Most people will return to the community, therefore interventions in prison and throughcare should be scaled up for individual and public health benefits.

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“…However, in Germany opiate substitution treatment is variable between people in prison and those living outside of prison. According to a report by Stöver et al, the application of OST in German prisons depends on the federal state, the prison and prison doctors (Stöver et al, 2019 ). Existing barriers to accessing OST in both high and LMICs include criminalization and financial barrier, for example, OST is forbidden in Russia and Uzbekistan.…”

Section: Population Disparity In the Use Of Cyp2b6 Substrates And Consequent Exposure To Substrate-specific Adverse Drug Reaction (Adr)mentioning

confidence: 99%

CYP2B6 Functional Variability in Drug Metabolism and Exposure Across Populations—Implication for Drug Safety, Dosing, and Individualized Therapy

et al. 2021

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Adverse drug reactions (ADRs) are one of the major causes of morbidity and mortality worldwide. It is well-known that individual genetic make-up is one of the causative factors of ADRs. Approximately 14 million single nucleotide polymorphisms (SNPs) are distributed throughout the entire human genome and every patient has a distinct genetic make-up which influences their response to drug therapy. Cytochrome P450 2B6 (CYP2B6) is involved in the metabolism of antiretroviral, antimalarial, anticancer, and antidepressant drugs. These drug classes are commonly in use worldwide and face specific population variability in side effects and dosing. Parts of this variability may be caused by single nucleotide polymorphisms (SNPs) in the CYP2B6 gene that are associated with altered protein expression and catalytic function. Population variability in the CYP2B6 gene leads to changes in drug metabolism which may result in adverse drug reactions or therapeutic failure. So far more than 30 non-synonymous variants in CYP2B6 gene have been reported. The occurrence of these variants show intra and interpopulation variability, thus affecting drug efficacy at individual and population level. Differences in disease conditions and affordability of drug therapy further explain why some individuals or populations are more exposed to CYP2B6 pharmacogenomics associated ADRs than others. Variabilities in drug efficacy associated with the pharmacogenomics of CYP2B6 have been reported in various populations. The aim of this review is to highlight reports from various ethnicities that emphasize on the relationship between CYP2B6 pharmacogenomics variability and the occurrence of adverse drug reactions. In vitro and in vivo studies evaluating the catalytic activity of CYP2B6 variants using various substrates will also be discussed. While implementation of pharmacogenomic testing for personalized drug therapy has made big progress, less data on pharmacogenetics of drug safety has been gained in terms of CYP2B6 substrates. Therefore, reviewing the existing evidence on population variability in CYP2B6 and ADR risk profiles suggests that, in addition to other factors, the knowledge on pharmacogenomics of CYP2B6 in patient treatment may be useful for the development of personalized medicine with regards to genotype-based prescription.

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Opioid substitution therapy for people living in German prisons—inequality compared with civic sector

Cited by 17 publications

References 25 publications

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

The State of Harm Reduction in Prisons in 30 European Countries with a Focus on People Who Inject Drugs and Infectious Diseases

CYP2B6 Functional Variability in Drug Metabolism and Exposure Across Populations—Implication for Drug Safety, Dosing, and Individualized Therapy

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