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Heroin Addiction and Related Clinical Problems: 2025, 27, 4

The Innovation of Long-Acting Injectable Buprenorphine in the Management of Opioid Use Disorder in Prisons: A Manifesto Shared by Experts with Delphi Panel Survey

Sarah Vecchio, Carmelo Cantone, Felice Alfonso Nava, Francesca Sassano, Biagio Sciortino, Gennaro Sosto, Giulio Di Mizio, and Marco Riglietta

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-4

Summary: Treatment of Opioid Use Disorder (OUD) in prisons is challenging, mainly because of the risks of abuse, diversion and suboptimal treatment adherence. New weekly/monthly long-acting injectable formulations of buprenorphine could represent a paradigm shift in OUD treatment, limiting the risks of daily-dose therapies and ensuring a better quality of life for inmates with OUD. In light of this new pharmacological technology, actions and areas for improvement in the management and recovery of detained people with OUD were highlighted. Methods. During four workshops, improvement areas for treating patients with OUD were identified. Based on the outputs, two modified group consensus techniques (Nominal Group and Delphi) were used consecutively, involving a growing number of experts in the field. The overall results led to a manifesto focused on improving the management and recovery of inmates with OUD. Results. Significant needs of inmates with OUD are reduction of stigma and equity in access to treatment options. Regarding operators, dissemination of best practices, application of scientific evidence and adequate educational training are required. Concerning treatments, new long-acting buprenorphine formulations could reduce the risks of abuse and diversion linked to current daily therapies. These innovative treatments find one of their ideal contexts in prisons and therapeutic communities. Conclusions. Inmates with OUD have the right to access innovative treatments like other citizens. Long-acting buprenorphine formulations are of particular interest because of their efficacy and tolerability and their potential to improve the quality of life of detained people with OUD.

Keywords: Opioid Use Disorder; Prison; Health; Long-acting Buprenorphine; Expert Consensus; Clinical Risk Management