Treatment of opiate withdrawal on entry to prison

Forty-nine opiate-dependent persons entering remand prison were treated with methadone over 5-10 days in decreasing doses according to standard practice of the prison medical service. The prisoners were mainly young, unmarried men with an average of 5 years regular opiate use and an average of four previous imprisonments; 45% were known to be HIV infected, although routine testing was not carried out. Ten were on methadone maintenance prior to imprisonment. Urine analysis on entry detected an average of three psychoactive substances, principally opiates, benzodiazepines and cannabis. Prescribed starting doses of methadone were not correlated to independently assessed withdrawal severity. Starting doses were related to prisoners' requests and to their age. Withdrawal severity decreased after 4 days treatment but symptom relief was incomplete. Treating withdrawal symptoms on entry to prison poses unsolved ethical and practical problems.