BACKGROUND & AIMS: :This study reports on a representative sample of prisoners in Michigan correctional facilities to determine the prevalence of psychiatric illness and the delivery of mental health (MH) services. Mental health assessments were conducted with 618 incarcerated subjects using the interRAI Correctional Facilities (interRAI CF). Subjects were randomly sampled based on four strata: males in the general population, males in administrative segregation, males in special units, and females. The interRAI CF assessments were merged with secondary data provided by the Michigan Department of Corrections (MDOC) containing information on MH diagnoses or services that the subjects were receiving within the facilities, demographics, and sentencing. Study results show that 20.1% of men and 24.8% of women in Michigan prisons have a substantial level of MH symptoms and that 16.5% and 28.9%, respectively, are receiving MH services. However, when compared with Michigan Department of Corrections MH care records, 65.0% of prisoners who are experiencing symptoms of mental illness are not currently receiving any psychiatric services. The mis-match between symptoms and service delivery suggests the need for improved procedures for identifying and measuring psychiatric symptoms within Michigan correctional facilities to ensure that appropriate individuals receive needed care. It is recommended that a standardized assessment process be implemented and conducted at regular intervals for targeting and improving psychiatric care in the prison system.

背景与目标： : 这项研究报告了密歇根州惩教所中囚犯的代表性样本，以确定精神疾病的患病率和提供精神卫生 (MH) 服务。使用interRAI教养所 (interRAI CF) 对618名被监禁的受试者进行了精神卫生评估。根据四个层次对受试者进行随机抽样: 普通人群中的男性，行政隔离中的男性，特殊单位中的男性和女性。interRAI CF评估与密歇根州惩教署 (MDOC) 提供的次要数据合并，其中包含有关受试者在设施，人口统计学和量刑范围内接受的MH诊断或服务的信息。研究结果表明，密歇根州监狱中20.1% 的男性和24.8% 的女性都有相当程度的MH症状，16.5% 和28.9% 分别接受MH服务。然而，与密歇根州惩教署MH护理记录相比，65.0% 患有精神疾病症状的囚犯目前没有接受任何精神病服务。症状与服务提供之间的不匹配表明，需要改进在密歇根州惩教所内识别和测量精神症状的程序，以确保适当的人得到所需的护理。建议定期实施和进行标准化评估程序，以针对和改善监狱系统中的精神病护理。

BACKGROUND & AIMS: :The aim of this study was to evaluate the prevalence and abuse potential of antiepileptic drugs (AEDs) among prison populations in Scotland, UK. Participants consisted of all admitted and released prisoners over a 1 month period who consented to provide samples. Urine samples were collected and analyzed by liquid chromatography coupled with triple quadrupole tandem mass spectrometry using a method validated for the simultaneous quantification of 21 AEDs in urine. A total of 904 samples were collected. The samples were also screened for drugs of abuse by using point-of-care testing kits. A total of 18% of the samples were positive for AEDs. Gabapentin (GBP) was identified in 118 samples (13%) and pregabalin (PRG) in 32 samples (3.5%). Interestingly, 12 samples contained both drugs (1.3%). The concentrations ranged from 0.5 to 1,100 mg/L (median, 15 mg/L) for GBP and from 0.5 to 440 mg/L (median, 7.3 mg/L) for PRG. Four samples were found to have concentrations >400 mg/L, two samples for GBP and two samples for PRG. These concentrations are at least 20 times above the median concentrations. Other AEDs detected were levetiracetam (four samples), vigabatrin (four samples), lamotrigine (three samples), valproic acid (three samples), carbamazepine (two samples) and topiramate (one sample). Illicit or non-prescribed drugs were detected in 81% of urine samples of which 80% were from admitted prisoners and 20% from released prisoners. Benzodiazepines, opiates and cannabis were the most frequently detected drugs. Other drugs found in positive AED samples were methadone (26%), cocaine (18%), buprenorphine (17%), amphetamines (4%), methamphetamines (4%) and barbiturates (4%). This study shows a high prevalence of AEDs within the Scottish prison system, primarily due to GBP and PRG; however, due to the anonymity of the sample collection, it is unknown if these are prescribed or illicit drug ingestions.

背景与目标： : 这项研究的目的是评估英国苏格兰监狱人群中抗癫痫药 (aed) 的患病率和滥用潜力。参与者包括在1个月内同意提供样本的所有接纳和释放的囚犯。收集尿液样品，并通过液相色谱结合三重四极杆串联质谱法进行分析，该方法可同时定量尿液中的21种aed。总共收集了904个样品。还使用现场检测试剂盒对样本进行了滥用药物筛查。总共18% 个样品aed呈阳性。在118样品 (13%) 中鉴定出加巴喷丁 (GBP)，在32样品 (3.5%) 中鉴定出普瑞巴林 (PRG)。有趣的是，12个样品含有两种药物 (1.3%)。GBP的浓度范围为0.5至1,100 mg/L (中位数，15 mg/L)，PRG的浓度范围为0.5至440 mg/L (中位数，7.3 mg/L)。发现四个样品的浓度> 400 mg/L，两个样品的GBP和两个样品的PRG。这些浓度至少比中位数浓度高20倍。其他检测到的aed分别为左乙拉西坦 (4个样品) 、维加巴特林 (4个样品) 、拉莫三嗪 (3个样品) 、丙戊酸 (3个样品) 、卡马西平 (2个样品) 和托吡酯 (1个样品)。在81% 尿液样本中检测到非法或非处方药，其中80% 来自被接纳的囚犯，20% 来自被释放的囚犯。苯二氮卓类，鸦片和大麻是最常发现的药物。在阳性AED样品中发现的其他药物是美沙酮 (26%) 、可卡因 (18%) 、丁丙诺啡 (17%) 、安非他明 (4%) 、甲基苯丙胺 (4%) 和巴比妥类药物 (4%)。这项研究表明，苏格兰监狱系统中aed的流行率很高，主要是由于GBP和PRG; 但是，由于样本收集的匿名性，尚不清楚这些是处方药还是非法药物。

BACKGROUND & AIMS: :The purpose of the present study was to determine the vulnerability of women in prison to HIV infection. The study was carried out from August to October 2000 in a São Paulo State Penitentiary, where 299 female prisoners were serving time. We interviewed and obtained a blood sample from 290 females who agreed to enter the study. Sera were tested for the presence of antibodies to HIV, hepatitis C virus (HCV) and syphilis and the odds ratio (OR) was calculated for variables related to HIV positivity on the basis of a questionnaire. The overall prevalence data were: 13.9% for HIV (37 of 267), 22.8% for syphilis (66 of 290), and 16.2% for HCV (47 of 290). Sexual partnership variables were significantly related to HIV infection. These included HIV-positive partners (OR = 7.36, P = 0.0001), casual partners (OR = 8.96, P = 0.009), injectable drug user partners (OR = 4.7, P = 0.0001), and history of sexually transmitted disease (OR = 2.07, P = 0.05). In addition, a relationship was detected between HIV infection and drug use (OR = 2.48, P = 0.04) and injectable drug use (OR = 4.2, P = 0.002). Even women with only one partner presented a significant OR for HIV infection (OR = 2.57, P = 0.009), reflecting their vulnerability due to their trust in their partner, who did not use a condom. Although the use of injectable substances is associated with HIV infection, our results point to sexual behavior as the most important component of HIV transmission in the female prisoner population.

背景与目标： : 本研究的目的是确定监狱中妇女感染艾滋病毒的脆弱性。这项研究是从8月到2000年10月在圣保罗州监狱进行的，那里有299名女囚犯在服刑。我们采访并获得了290名同意进入研究的女性的血液样本。测试血清中是否存在针对HIV，丙型肝炎病毒 (HCV) 和梅毒的抗体，并根据问卷调查计算与HIV阳性相关的变量的比值比 (OR)。总体患病率数据为: HIV 13.9% (267 37例)，梅毒22.8% 例 (290例66例) 和HCV 16.2% 例 (290例47例)。性伴侣关系变量与HIV感染显着相关。其中包括艾滋病毒阳性伴侣 (OR = 7.36，P = 0.0001)，临时伴侣 (OR = 8.96，P = 0.009)，可注射吸毒者伴侣 (OR = 4.7，P = 0.0001) 和性传播疾病史 (OR = 2.07，P = 0.05)。此外，检测到HIV感染与药物使用 (OR = 2.48，P = 0.04) 和可注射药物使用 (OR = 4.2，P = 0.002) 之间的关系。即使只有一个伴侣的妇女也表现出严重的或感染艾滋病毒 (OR = 2.57，P = 0.009)，这反映出由于对不使用避孕套的伴侣的信任而使她们脆弱。尽管使用可注射物质与HIV感染有关，但我们的结果表明，性行为是女性囚犯人群中HIV传播的最重要组成部分。

BACKGROUND & AIMS: :This article examines international and European regulations on research involving prisoners for consensus, differences, and their consequences, and offers a critical evaluation of the various approaches. Agreement exists that prisoners are at risk of coercion, which might interfere with their ability to provide voluntary informed consent to research. Controversy exists about the magnitude of this risk and the consequences that should follow from this risk. Two strategies are proposed for a method of protecting prisoners that does not lead to discrimination: first, more caution to assure non-coerced consent and second, restrictions on the type of research. Most regulations stress the importance of the principle of equivalence of healthcare in places of detention as part of an efficient protection against research risks and discrimination. All the presented approaches have shortcomings. While 'over-use' of prisoners for research as compared to the general population is ethically unjustified, not granting prisoners access to studies beneficial to their own health because of over-strict regulations is equally unjustified. A middle solution should be preferred, one that grants a minimum of protection together with the lowest possible barriers. Research that does not entail a direct benefit for the individual detainee should be restricted to types of research that have a benefit for detainees as a group and that are of low risk. What will ultimately protect prisoners best, while producing the greatest benefit for them, is access to the same healthcare available to members of the community including research as a true option.

背景与目标： : 本文研究了国际和欧洲有关囚犯研究的法规，以达成共识，差异及其后果，并对各种方法进行了严格的评估。存在一致意见，即囚犯有遭受胁迫的风险，这可能会干扰他们提供自愿知情同意进行研究的能力。关于这种风险的大小以及这种风险应产生的后果存在争议。提出了两种保护囚犯的方法，这种方法不会导致歧视: 第一，更加谨慎，以确保非强制同意; 第二，限制研究类型。大多数法规都强调了拘留场所医疗保健等同原则的重要性，这是有效保护免受研究风险和歧视的一部分。所有提出的方法都有缺点。虽然与普通人群相比，“过度使用” 囚犯进行研究在道德上是不合理的，但由于过度严格的规定，不允许囚犯获得有益于自身健康的研究同样是不合理的。应该首选中间解决方案，即提供最低限度的保护和尽可能低的障碍。对被拘留者个人没有直接好处的研究应仅限于对被拘留者整体有益且风险较低的研究类型。最终将最好地保护囚犯，同时为他们带来最大的利益，是获得社区成员可获得的相同医疗保健，包括将研究作为真正的选择。

BACKGROUND & AIMS: :This study assessed both prevalence rates of substance dependence and level of treatment need among recently-incarcerated prisoners in a southeastern state. Participants were 752 consecutive admissions to the state prison system in 2002. They were administered the 93-item Substance Abuse Subtle Screening Inventory (SASSI). The results indicated that approximately 72% of participants met criteria for substance dependence and 46% of participants met criteria for prison-based residential treatment. The results of this study can be used to inform allocation of prison-based treatment resources.

背景与目标： : 这项研究评估了东南部州最近被监禁的囚犯的物质依赖患病率和治疗需求水平。参与者连续752次进入州监狱系统2002年。他们接受了93项药物滥用微妙筛查清单 (SASSI) 的管理。结果表明，大约72% 的参与者符合药物依赖标准，46% 的参与者符合监狱居住待遇标准。这项研究的结果可用于为基于监狱的治疗资源的分配提供信息。

BACKGROUND & AIMS: OBJECTIVE:This study examined long-term outcomes (at 36 months) from Washington State's policy of expediting Medicaid enrollment for prison releasees with severe mental illness and compares them with previously reported short-term outcomes (at 12 months). METHODS:Linked administrative data on prison releasees (2006-2007) were analyzed by using a quasi-experimental design comparing those referred to expedited Medicaid (N=895) with a control group of those not referred (N=2,189). Aggregate outcomes were analyzed with inverse probability of treatment-weighted logit models. RESULTS:Expedited Medicaid had a sustained effect on both increased months of enrollment (p<.01) and increased use of community mental health and general medical services (p<.01) 36 months after prison release. However, expedited Medicaid did not reduce criminal recidivism, consistent with 12-month findings, Conclusions: Outcome results at 12 months were sustained at 36 months-namely, expedited Medicaid for released prisoners with severe mental illness improved enrollment and service use with no effects on criminal recidivism.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Prisoners have heightened health needs, and only recently has the importance of skin diseases in this group been recognized. The aim of this study was to estimate the prevalences of dermatological diseases among prisoners in the jails of southern Lazio and to investigate the determinants of these. METHODS:A cross-sectional study was carried out in three jails in southern Lazio. Retrospective data collection for sociodemographic characteristics, lifestyle habits, and health status was realized using patients' charts. RESULTS:The study sample consisted of 2653 male prisoners detained during 1995-2000. A total of 7.9% of the sample were found to have dermatological disease. The most common diseases were nonspecific dermatitis (3.1%), acne (1.5%), mycosis (1.4%), and scabies (0.7%). Multiple regression analyses were conducted to establish the associations of skin diseases with substance addiction status and age. In addition, a highly significant association emerged between length of detention and rate of dermatological disease. CONCLUSIONS:This study shows that habitual offenders, foreign inmates, prisoners serving long sentences, and prisoners who are illiterate are the most affected by dermatological disease. The conditions of detention may be the main reason; preventative strategies such as limiting overcrowding and the provision of electronic case sheets and a centralized database to collect and maintain patient clinical data might be effective in improving public health in jails.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To conduct a review of the literature on prescribing psychotropic drugs for prisoners. METHODS:Articles were retrieved from nine databases, reference lists, citations, governmental prison websites, and contact with authors. The articles included were written in English, focused on adults' time as prisoners, included at least one drug of interest, and discussed prescribing. Thirty-two articles met these inclusion criteria. RESULTS:Five main themes were identified from the reviewed studies: polypharmacy, high-dose therapy, duration of treatment, documentation and monitoring, and issues associated with the prisoners' environment. CONCLUSIONS:Consideration of these themes within the included studies identified areas for future research, particularly models of good practice, as numerous descriptions of poor practice exist. Policy-makers and prescribers should review current systems and practices, to ensure the care being offered to prisoners is optimal.

背景与目标：

BACKGROUND & AIMS: :During 2009, 730,000 prisoners were released from federal and state prisons--a 21 percent increase from the number of prisoners released in 2000. Poor health and poor health coverage have been major challenges for former prisoners trying to reintegrate into the community and find work. We discuss these challenges and the likely effect of recent federal legislation, including the Second Chance Act, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act. We estimated that with the implementation of health reform, up to 33.6 percent of inmates released annually--more than 245,000 people in 2009--could enroll in Medicaid. Similarly, we estimated that up to 23.5 percent of prisoners released annually-more than 172,000 people in 2009-could be eligible for federal tax credits to defray the cost of purchasing insurance from state health exchanges. This health insurance, combined with new substance abuse services and patient-centered medical home models, could dramatically improve the health and success of former inmates as they return to the community. States should consider several policy changes to ease prisoners' transitions, including suspending rather than terminating Medicaid benefits for offenders; incorporating corrections information into eligibility determination systems; aiming Medicaid outreach and enrollment efforts at prison inmates; and designing comprehensive approaches to meeting former prisoners' health care needs.

背景与目标： : 2009年，有730,000名囚犯从联邦和州监狱获释，比2000年释放的囚犯人数增加了21%。对于试图重新融入社区并找到工作的前囚犯来说，健康状况不佳和健康状况不佳一直是主要挑战。我们讨论了这些挑战以及最近的联邦立法的可能影响，包括《第二次机会法》，《精神卫生均等和成瘾公平法》和《平价医疗法案》。我们估计，随着医疗改革的实施，每年释放的囚犯多达33.6%-2009超过245,000人-可以参加医疗补助。同样，我们估计，每年释放的囚犯中有多达23.5% 人 (2009超过172,000人) 有资格获得联邦税收抵免，以支付从州卫生交易所购买保险的费用。这种健康保险，加上新的药物滥用服务和以患者为中心的医疗之家模式，可以极大地改善前囚犯返回社区时的健康和成功。各国应考虑几项政策变化，以缓解囚犯的过渡，包括暂停而不是终止对罪犯的医疗补助福利; 将惩戒信息纳入资格确定系统; 针对监狱囚犯的医疗补助宣传和登记工作; 并设计综合方法来满足前囚犯的医疗保健需求。

BACKGROUND & AIMS: :Insomnia has been associated with suicidality. Prisoners have an increased risk of both insomnia and suicidal behaviour. Therefore, it was decided to examine for a relationship between insomnia and suicidal behaviour in a large group of 1420 prisoners. Prisoners had a semi-structured psychiatric interview, which included the Hamilton Depression Rating Scale (HDRS), and completed the Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Spielberg Anger Expression Inventory and Connor-Davidson Resilience Scale. It was found that 568 (61.2%) of the prisoners scored in the insomnia cluster of the HDRS and that 183 (12.8%) had attempted suicide. Regression analyses showed that insomnia was significantly and independently associated with a lifetime history of attempting suicide. Insomnia was also significantly related to actual suicidality. After controlling for confounders, axis 1 psychiatric disorder, childhood trauma, neuroticism, low resilience, and anger were significantly associated with insomnia in male prisoners. These data suggest the possibility of a relationship between insomnia and suicidality in prisoners. Assessing insomnia may be helpful when evaluating the risk of suicidality in prisoners.

背景与目标： : 失眠与自杀倾向有关。囚犯失眠和自杀行为的风险增加。因此，决定在一大群1420名囚犯中检查失眠与自杀行为之间的关系。囚犯进行了半结构化的精神病学访谈，其中包括汉密尔顿抑郁量表 (HDRS)，并完成了儿童创伤问卷，艾森克人格问卷，斯皮尔伯格愤怒表达量表和康纳-戴维森复原力量表。发现568 (61.2%) 的囚犯在hdr的失眠群中得分，而183 (12.8%) 曾试图自杀。回归分析表明，失眠与自杀的终生史显着且独立相关。失眠也与实际的自杀倾向显着相关。在控制了混杂因素之后，axis 1精神疾病，儿童创伤，神经质，低韧性和愤怒与男性囚犯的失眠显着相关。这些数据表明囚犯失眠和自杀之间存在关系的可能性。在评估囚犯自杀风险时，评估失眠可能会有所帮助。

BACKGROUND & AIMS: BACKGROUND:Older adults comprise an increasing proportion of the prison and homeless populations. While older age is associated with adverse post-release health events and incarceration is a risk factor for homelessness, the health status and homelessness risk of older pre-release prisoners are unknown. Moreover, most post-release services are geared towards veterans; it is unknown whether the needs of non-veterans differ from those of veterans. OBJECTIVE:To assess health status and risk of homelessness of older pre-release prisoners, and to compare veterans with non-veterans. DESIGN/PARTICIPANTS:Cross-sectional study of 360 prisoners (≥ 55 years of age) within 2 years of release from prison using data from the 2004 Survey of Inmates in State and Federal Correctional Facilities. MAIN MEASURES:Veteran status, health status (based on self-report), and risk of homelessness (homelessness before arrest). KEY RESULTS:Mean age was 61 years; 93.8% were men and 56.5% were white. Nearly 40% were veterans, of whom 77.2% reported likely VA service eligibility. Veterans were more likely to be white and to have obtained a high school diploma or GED. Overall, 79.1% reported a medical condition and 13.6% reported a serious mental illness. There was little difference in health status between veterans and non-veterans. Although 1 in 12 prisoners reported a risk factor for homelessness, the risk factors did not differ according to veteran status. CONCLUSIONS:Older pre-release prisoners had a high burden of medical and mental illness and were at risk for post-release homelessness regardless of veteran status. Reentry programs linking pre-release older prisoners to medical and psychiatric services and to homelessness prevention programs are needed for both veterans and non-veterans.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To describe the use of primary care services by a prisoner population so as to understand the great number of demands and therefore to plan services oriented to the specific needs of these patients. DESIGN:Retrospective cohort study of a sample of prisoners' medical records. SETTING:All Belgian prisons (n = 33). PATIENTS:513 patients over a total of 182 patient years, 3328 general practitioner (GP) contacts, 3655 reasons for encounter. MAIN RESULTS:Prisoners consulted the GP 17 times a year on average (95%CI 15 to 19.4). It is 3.8 times more than a demographically equivalent population in the community. The most common reasons for encounter were administrative procedures (22%) followed by psychological (13.1%), respiratory (12.9%), digestive (12.5%), musculoskeletal (12%), and skin problems (7.7%). Psychological reasons for consultations (n = 481) involved mainly (71%) feeling anxious, sleep disturbance, and prescription of psychoactive drugs. Many other visits concerned common problems that in other circumstances would not require any physician intervention. CONCLUSION:The most probable explanations for the substantial use of primary care in prison are the health status (many similarities noted between health problems at the admission and reasons for consultations during the prison term: mental health problems and health problems related to drug misuse), lack of access to informal health services (many contacts for common problems), prison rules (many consultations for administrative procedures), and mental health problems related to the difficulties of life in prison.

背景与目标：

BACKGROUND & AIMS: :Most incarcerated women suffer from adverse childhood experiences (ACEs), such as abuse (e.g., physical, sexual, emotional), neglect, (e.g., physical, emotional), and chaotic home environments (e.g., witnessing domestic violence), and adult intimate partner violence (IPV). Yet the majority of research on the relationship between ACEs and IPV has been limited to non-incarcerated populations. Using data from a stratified random sample of all incarcerated women in Oklahoma (n = 355), we explore the relationships between individual, cumulative, and clusters of ACEs as they relate to multiple forms of IPV in adulthood utilizing a feminist life course theory approach. Our findings indicate that individual ACEs, high accumulation of ACEs (five or more), and clusters of ACEs are linked to simple assault, aggravated assault, sexual abuse, and psychological abuse in adult intimate relationships in the pre-prison lives of women prisoners suggesting strong support for the use of a feminist life course theory approach in understanding these relationships.

背景与目标： : 大多数被监禁的妇女遭受不良的童年经历 (ace)，例如虐待 (例如身体，性，情感)，忽视 (例如身体，情感) 和混乱的家庭环境 (例如目睹家庭暴力)，和成人亲密伴侣暴力 (IPV)。然而，有关ace和IPV之间关系的大多数研究仅限于非监禁人群。使用来自俄克拉荷马州所有被监禁妇女的分层随机样本的数据 (n   =   355)，我们利用女权主义生命历程理论方法探索了个体，累积和ace簇之间的关系，因为它们与成年后IPV的多种形式有关。我们的发现表明，单个ace、高积累的ace (五个或更多) 和ace集群与简单攻击、严重攻击、性虐待、在女性囚犯的监狱前生活中，成年人亲密关系中的心理虐待表明，强烈支持使用女权主义生命历程理论方法来理解这些关系。

BACKGROUND & AIMS: AIM:Prisoners exhibit high rates of substance use and mental health problems. In the present study, we sought to gain a detailed understanding of substance use amongst young prisoners to inform early detection and early intervention strategies in a prison setting. METHODS:This is a cross-sectional study of 2102 prisoners who were screened by the London Early Detection and Prevention in Prison Team (LEAP). Data on the use of substances were collected including age of first use, recent use, duration of use and poly-drug use. The Prodromal Questionnaire - Brief Version was used to screen for the at-risk mental state. RESULTS:We found high rates of lifetime and recent use and low age of first use of a number of substances. We also found strong associations between substance use and screening positive for an at-risk mental state. Logistic regression analysis confirmed that use of any drug in the last year, poly-drug and early use, as well as heavy alcohol use, were related to an increased risk of screening positive. CONCLUSIONS:Substance use in the prison population is not only widespread and heavy but is also strongly linked with a higher risk of developing mental health problems. The need for early detection and early intervention in prison is discussed.

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BACKGROUND & AIMS: 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.

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