Drugs Misuse in custodial settings: a systematic review and meta-analysis
Drugs Misuse in prison: a systematic review
DOI:
https://doi.org/10.54103/2282-0930/29025Abstract
Background: Increasing evidence suggests that custodial settings are at risk for the misuse of psychoactive drugs (DM) outside their prescription. The purpose of this systematic review and meta-analysis was to determine the extent of this phenomenon of psychoactive drug misuse in prisons, exploring the classes of drugs commonly used, the characteristics of inmates who are affected, and focusing on studies that have identified the phenomenon in an evidence-based manner.
Methods: From January 1 2025 to June 1 2025, we reviewed the scientific literature following PRISMA guidelines. 8826 studies were analyzed, 6 met the inclusion criteria.
Results: The overall rate of DM was 24%. Prisoner characteristics associated with DM included mental disorders, psychoactive substance use, and individual characteristics of prisoners. Social factors associated with DM included significant problems with the law, drug dealing, and arrests.
Conclusions: The DM issue is a non-negligible public health problem in custodial settings. Related factors can be identified and preventive actions taken.
Downloads
References
1. Cremers S, Wright DFB. Nonmedical use of prescription drugs. Br J Clin Pharmacol. 2021 Apr;87(4):1635–6.
2. Barrett SP, Meisner JR, Stewart SH. What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations. Curr Drug Abuse Rev. 2008 Nov;1(3):255–62.
3. Hockenhull J, Black JC, Haynes CM, Rockhill K, Dargan PI, Dart RC, et al. Nonmedical use of benzodiazepines and Z-drugs in the UK. Br J Clin Pharmacol. 2021 Apr;87(4):1676–83.
4. Wood DM, Dargan PI. Regional, national and international datasets: How they improve our understanding of the acute harms associated with prescription medicine misuse. Br J Clin Pharmacol. 2021 Apr;87(4):1654–9.
5. Marsden J, White M, Annand F, Burkinshaw P, Carville S, Eastwood B, et al. Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England. Lancet Psychiatry. 2019 Nov;6(11):935–50.
6. United Nations Office on Drugs and Crime. Non-medical use of benzodiazepines: a growing threat to public health? [Internet]. Available from: https://www.unodc.org/documents/scientific/Global_SMART_Update_2017_Vol_18.pdf
7. Baldwin DS, Aitchison K, Bateson A, Curran HV, Davies S, Leonard B, et al. Benzodiazepines: risks and benefits. A reconsideration. J Psychopharmacol. 2013 Nov;27(11):967–71.
8. UNITED NATIONS OFFICE ON DRUGS AND CRIME. World Drug Report 2023 [Internet]. Available from: https://www.unodc.org/res/WDR-2023/WDR23_Exsum_fin_DP.pdf
9. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019 Oct;18(3):337–52.
10. Schifano F, Chiappini S, Corkery JM, Guirguis A. An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. Int J Neuropsychopharmacol. 2019 Apr 1;22(4):270–7.
11. Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs. 2021 Jan;81(1):125–56.
12. Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016 Jul;111(7):1160–74.
13. Lyndon A, Audrey S, Wells C, Burnell ES, Ingle S, Hill R, et al. Risk to heroin users of polydrug use of pregabalin or gabapentin. Addiction. 2017 Sep;112(9):1580–9.
14. Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction. 2017 Oct;112(10):1725–39.
15. Gulati G, Keating N, O’Neill A, Delaunois I, Meagher D, Dunne CP. The prevalence of major mental illness, substance misuse and homelessness in Irish prisoners: systematic review and meta-analyses. Ir J Psychol Med. 2019 Mar;36(1):35–45.
16. Tay E, Makeham M, Laba TL, Baysari M. Prescription drug monitoring programs evaluation: A systematic review of reviews. Drug and Alcohol Dependence. 2023 Jun;247:109887.
17. Pirani F, Chiappini S, Schifano F, Giorgetti A. Editorial: Misuse and abuse of prescription drugs in custodial settings. Front Psychiatry. 2023 Nov 30;14:1339542.
18. HM Inspectorate of Prisons. HM Chief Inspector of Prisons for England and Wales Annual Report 2016–17 [Internet]. Available from: https://assets.publishing.service.gov.uk/media/5a82da01ed915d74e6237f3d/hmip-annual-report-2016-17.pdf
19. Prisons and Probation Ombudsman. Prisons & Probation Ombudsman Annual Report 2014–15 [Internet]. Available from: https://assets.publishing.service.gov.uk/media/5a7f2e23e5274a2e87db4486/ppo-annual-report-2014-15.pdf
20. Schifano F, Chiappini S, Corkery JM, Guirguis A. Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review. Brain Sci. 2018 Apr 22;8(4):73.
21. Bi-Mohammed Z, Wright NM, Hearty P, King N, Gavin H. Prescription opioid abuse in prison settings: A systematic review of prevalence, practice and treatment responses. Drug Alcohol Depend. 2017 Feb 1;171:122–31.
22. Chiappini S, Schifano F. A Decade of Gabapentinoid Misuse: An Analysis of the European Medicines Agency’s “Suspected Adverse Drug Reactions” Database. CNS Drugs. 2016 Jul;30(7):647–54.
23. Chiappini S, Schifano F. Is There a Potential of Misuse for Quetiapine?: Literature Review and Analysis of the European Medicines Agency/European Medicines Agency Adverse Drug Reactions’ Database. J Clin Psychopharmacol. 2018 Feb;38(1):72–9.
24. Milano G, Chiappini S, Mattioli F, Martelli A, Schifano F. β‐2 Agonists as Misusing Drugs? Assessment of both Clenbuterol‐ and Salbutamol‐related European Medicines Agency Pharmacovigilance Database Reports. Basic Clin Pharma Tox. 2018 Aug;123(2):182–7.
25. Lasoff DR, Koh CH, Corbett B, Minns AB, Cantrell FL. Loperamide Trends in Abuse and Misuse Over 13 Years: 2002–2015. Pharmacotherapy. 2017 Feb;37(2):249–53.
26. European Medicines Agency (EMA). European Medicines Agency (EMA) Pharmacovigilance [Internet]. Available from: https://www.ema.europa.eu/en/human-regulatory-overview/pharmacovigilance-overview
27. Rutherford M, Duggan S. Meeting complex health needs in prisons. Public Health. 2009 Jun;123(6):415–8.
28. Hassan L, Senior J, Webb RT, Frisher M, Tully MP, While D, et al. Prevalence and appropriateness of psychotropic medication prescribing in a nationally representative cross-sectional survey of male and female prisoners in England. BMC Psychiatry. 2016 Oct 10;16(1):346.
29. Abuzour AS, Magola-Makina E, Dunlop J, O’Brien A, Khawagi WY, Ashcroft DM, et al. Implementing prescribing safety indicators in prisons: A mixed methods study. Br J Clin Pharmacol. 2022 Feb;88(4):1866–84.
30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71.
31. Current version of ROBINS-I [Internet]. [cited 2023 Jul 11]. Available from: https://www.riskofbias.info/welcome/home/current-version-of-robins-i
32. DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemporary Clinical Trials. 2015 Nov;45:139–45.
33. Barker TH, Migliavaca CB, Stein C, Colpani V, Falavigna M, Aromataris E, et al. Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence. BMC Med Res Methodol. 2021 Sep 20;21(1):189.
34. Higgins JPT. Measuring inconsistency in meta-analyses. BMJ. 2003 Sep 6;327(7414):557–60.
35. R Core Team. The R Project for Statistical Computing [Internet]. Available from: https://www.r-project.org/
36. Franchetti G, Thierauf-Emberger A, Franz A, Thoma V, Auwärter V, Huppertz LM. Detection of methadone and buprenorphine in urine samples from inmates of German prisons. Front Psychiatry. 2023;14:1139370.
37. Sec I, Questel F, Rey C, Pourriat JL. [Misuse of psychotropic medications in a population of subjects held for custody in the city of Paris]. Therapie. 2009;64(2):129–34.
38. Plojovic S, Dimitrijevic S, Maksimovic A, Zejnelagic S, Hurem A, Muraspahic M. Misuse of Psychologically Active Substances of Convicts being in Prisons and their Treatment. Open Access Maced J Med Sci. 2016 Mar 15;4(1):172–80.
39. Soni A, Walters P. A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants. Int J Prison Health. 2019 Aug 27;16(1):67–77.
40. Durand L, Keenan E, O’Reilly D, Bennett K, O’Hara A, Cousins G. Prescription drugs with potential for misuse in Irish prisons: analysis of national prison prescribing trends, by gender and history of opioid use disorder, 2012 to 2020. BMC Psychiatry. 2023 Oct 6;23(1):725.
41. Morrison M, Hai AH, Bandaru YS, Salas-Wright CP, Vaughn MG. Opioid Misuse and Associated Health Risks among Adults on Probation and Parole: Prevalence and Correlates 2015-2020. Subst Use Misuse. 2024;59(1):20–8.
42. Siu BWM, Lai ESK, Lam JPY, Chan C, Chan AWL, Chu KY, et al. Profiling mentally ill offenders in Hong Kong: A 10-year retrospective review study. Asia Pac Psychiatry. 2022 Sep;14(3):e12505.
43. Rao R, Mandal P, Gupta R, Ramshankar P, Mishra A, Ambekar A, et al. Factors Affecting Drug Use During Incarceration: A Cross-Sectional Study of Opioid-Dependent Persons from India. J Subst Abuse Treat. 2016 Feb;61:13–7.
44. Pedrola-Pons A, Sanchez-Carro Y, Pemau A, Garcia-Ramos A, De la Torre-Luque A. Efficiency of psychological interventions in the prevention of suicidal behavior and self-injury in penitentiary population: A systematic review. Int J Law Psychiatry. 2024;92:101948.
45. Shewan D, Dalgarno P. Evidence for controlled heroin use? Low levels of negative health and social outcomes among non-treatment heroin users in Glasgow (Scotland). Br J Health Psychol. 2005 Feb;10(Pt 1):33–48.
46. Schjerning O, Rosenzweig M, Pottegård A, Damkier P, Nielsen J. Abuse Potential of Pregabalin: A Systematic Review. CNS Drugs. 2016 Jan;30(1):9–25.
47. Schjerning O, Pottegård A, Damkier P, Rosenzweig M, Nielsen J. Use of Pregabalin – A Nationwide Pharmacoepidemiological Drug Utilization Study with Focus on Abuse Potential. Pharmacopsychiatry. 2016 Mar 7;49(04):155–61.
48. Schifano F. Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern? CNS Drugs. 2014 Jun;28(6):491–6.
49. Schifano F, Orsolini L, Duccio Papanti G, Corkery JM. Novel psychoactive substances of interest for psychiatry. World Psychiatry. 2015 Feb;14(1):15–26.
50. Chiappini S, Vaccaro G, Mosca A, Miuli A, Stigliano G, Stefanelli G, et al. New trends of drug abuse in custodial settings: A systematic review on the misuse of over-the-counter drugs, prescription-only-medications, and new psychoactive substances. Neurosci Biobehav Rev. 2024 Jul;162:105691.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Silvia Martinelli, Mario C. Nurchis, Emanuele Caroppo, Kıvanç Kok, Gianfranco Damiani
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
