Substitution or abstinence?
At least six percent of all prisoners in Germany are addicted to heroin or other opioids. Which form of treatment is best for them in the long term: substitution or abstinence? And what effects does the chosen type of treatment have later on, once they have been released from prison? These are the questions currently being investigated by the research project ‘Imprisonment and opioid addiction – an evaluatory study (HOPE)’ at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), commissioned by the Bavarian Ministry of Justice.
Numerous studies have proven that addicts benefit from substituting illegal opioids with methadone or buprenorphine. On average, people given this treatment consume fewer illegal opioids, are less likely to commit a crime, demonstrate less unhealthy behaviour – such as sharing needles – and have a higher survival rate. As a result, guidelines published by the German Medical Association in 2017 recommend substitution treatment for people addicted to opioids over abstinence-based treatment. Until now, however, it has been unclear whether this also applies to addicts in prison. Compared to addicts on the outside, addicts in prison benefit from special circumstances such as better healthcare and constant supervision.
Which treatment is better suited to prisoners: abstinence or substitution?
The aim of the research project is to evaluate various types of treatment for opioid addicts serving time in Bavarian prisons. The researchers led by Prof. Dr. Mark Stemmler from the Chair of Psychological Assessment, Quantitative Methods and Forensic Psychology at FAU are investigating to what extent findings gained to date on treating opioid addicts can be transferred to the special circumstances in imprisonment, which prisoners may benefit from substitution treatment and which dosage and which period of time would be recommended for substitution treatment. At the same time, they hope to be able to provide specific empirical recommendations on when primarily abstinence-based treatment would be likely to succeed.
Detailed questionnaire on state of health and personal circumstances after release
The researchers will question prisoners addicted to opioids in Bavarian prisons in detail on their current state of health and personal circumstances before release and again several times over the course of the first year after release. The researchers plan to start collecting data in early 2020, and the project will run until the end of 2022. The results of the study are hoped to provide a scientific basis for the discussion concerning substitution treatment for prisoners addicted to opioids in Bavarian prisons and to make it easier for prison doctors to take a decision.
The Bavarian Ministry of Justice has provided half a million euros in funding for the evaluatory study. The project is coordinated by Dr. Maren Weiss from the Chair of Psychological Assessment, Quantitative Methods and Forensic Psychology at FAU, in cooperation with Dr. Johannes Endres from the Criminological Service of the Bavarian law enforcement authorities. Other cooperation partners are the Department of Addiction Research at University Hospital Regensburg and the working group for drug and addiction issues in the Bavarian law enforcement authorities.
Prof. Dr. Mark Stemmler
Phone: + 49 9131 8564020