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Exploring Iatrogenic Opioid Use Disorder in Prison.

Duncan Stewart MacLennan¹, Dawson Hartman², Bricelle Kruger¹

¹Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Journal of Forensic Nursing

|July 3, 2026

Summary

Diversion of buprenorphine/naloxone in jail led to opioid dependence in a patient without prior opioid use disorder. This highlights iatrogenic opioid use disorder and risks upon release.

Keywords:

Buprenorphine correctional facilities medication diversion opioid agonist therapy opioid use disorder

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Area of Science:

Addiction Medicine
Forensic Psychiatry
Public Health

Background:

Buprenorphine/naloxone is crucial for treating opioid use disorder (OUD) in correctional facilities, aiming to reduce overdose deaths post-release.
Diversion and non-prescribed use of opioid agonist therapy (OAT) within correctional settings are recognized issues.
Incarceration is linked to increased mortality, particularly from overdose, upon community re-entry.

Purpose of the Study:

To report a case of iatrogenic opioid dependence developed from illicit buprenorphine/naloxone use during incarceration.
To emphasize the potential risks of newly acquired OUD in individuals re-entering the community.
To highlight the need for improved screening and harm-reduction strategies in correctional settings.

Main Methods:

Case report of a 29-year-old male patient with no prior history of OUD.
Detailed description of the patient's development of opioid dependence through illicit buprenorphine/naloxone use while incarcerated.
Review of literature concerning OAT diversion and post-release overdose risks.

Main Results:

The patient developed opioid dependence during incarceration due to repeated illicit use of diverted buprenorphine/naloxone.
This newly acquired dependence poses a significant vulnerability for overdose upon release.
The case illustrates an iatrogenic pathway to OUD originating within the correctional environment.

Conclusions:

Correctional facilities must implement robust screening and diagnostic measures upon admission for OUD.
Consideration of abuse-deterrent formulations of buprenorphine/naloxone may be necessary.
Addressing co-occurring mental health and trauma disorders is vital for preventing iatrogenic OUD and informing harm-reduction strategies.