Exploring Iatrogenic Opioid Use Disorder in Prison

Buprenorphine/naloxone is widely used in correctional settings to treat opioid use disorder and reduce post-release overdose risk. However, diversion and nonprescribed use of opioid agonist therapy within custody have been documented. This case report describes a 29-year-old man without a prior history of opioid use disorder who developed opioid dependence during incarceration through repeated illicit use of diverted buprenorphine/naloxone. Given the link between incarceration and elevated post-release overdose mortality, newly acquired opioid dependence may increase vulnerability during community re-entry. This case highlights an iatrogenic opioid use disorder pathway arising within correctional environments and underscores the importance of screening upon admission, diagnostic measures, and consideration of abuse-resistant formulations when implementing opioid agonist therapy. Addressing co-occurring trauma, substance use, and mental health disorders may be integral to prevention. Further research is needed to better characterize potential iatrogenic pathways to opioid dependence and inform harm-reduction strategies across correctional and community settings.