¿Es necesario disponer de tratamientos con buprenorfina/naloxona para los presos dependientes de opiáceos?

Abstract

Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective way to prevent relapse in opioid-dependent patients. These programs reduce morbidity and risk behaviours for HIV transmission and other infections, improve quality of life and retention in treatment, and have a positive impact on antisocial behaviour. They are therefore very useful for prisoners with a history of opiate use. OATs based on buprenorphine/naloxone (B/N), along with others using methadone, are currently available in Spain. Diversified treatment offers an alternative treatment for opioid dependence that is more personalized and tailored to the patient's characteristics. As regards effectiveness, both drugs are very similar, but B/N shows a better safety profile and fewer drug-drug interactions and can be dispensed in pharmacies once the patient is released, which can assist with the patient' social reintegration. B/N treatment is more expensive than methadone. It is advisable to have different modes of OAT. These should be prescribed according to the characteristics and needs of each case, without incarceration impeding the right to drug treatment, which should be similar to that performed outside prison.

http://www.sanipe.es/OJS/index.php/RESP/article/view/661/1286

“… Is it necessary to have Buprenorphine/Naloxone treatments for opioid-dependent prisoners? Marco A 19 2013 Spain Literature Review Evaluate the advantages and disadvantages of the substances used in agonist substitution treatments, as well as review the aspects related to equality of treatment in prison and in the community. Both the methadone option and the buprenorphine option have sufficient evidence, but the buprenorphine option has a greater safety profile and fewer drug interactions.…”

“…Marco et al 19 and Fuentes et al . 25 compared the effectiveness of MMPs with other rehabilitation treatments used in the prison setting, and indicate that both methods have obtained similarly favourable results, although they mention some important differences.…”

“… 18 and Marco et al . 19 , agree that this program has been very effective in reducing illegal opioid consumption and HIV transmission, since it has brought about a change in high risk behaviours of consumption and has reduced the incidence of IDU and syringe exchanges.…”

“…Diversos autores, como Gowing et al 17 , Clark et al 18 y Marco et al 19 , están de acuerdo con el hecho de que este programa ha sido muy efectivo a la hora de reducir el consumo de opiáceos de manera ilegal y la transmisión del VIH, debido a que ha supuesto un cambio en las conductas de riesgo de consumo y ha disminuido la incidencia del uso de la vía parenteral y el intercambio de jeringuillas.…”

The discourses of risk of drug users in prison

“…In view of the wide range of meanings given to this programme, it is considered worthwhile adapting the MMPs so that they respond to the perspectives and needs of the users themselves 24 , 25 . One alternative to methadone is to give wider diffusion to treatments with buprenorphine/naloxone, which is a safe drug, with fes medical interactions and less stigmatising, as proposed in other studies 26 , 27 . In the case of the “prudent” users, it may be considered that the posture regarding MMP detoxification could be related to family pressures or the difficulties associated with going to drug dependency centres in the community, which involves a risk of overdose in the event of a relapse, and they comment on the need to attract and retain patients in an MMP, as indicated in other studies 22 , 28 , 29 .…”