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Heroin Addiction and Related Clinical Problems: 2026, 28: 119-130

Effectiveness of Extended-Release Buprenorphine in Custodial Settings and during the High-Risk Eight Weeks Post-Release: A Scoping Review

Nandakumar Ravichandran, Tishya Kumar, Marie Claire Van Hout, Walter Cullen, and Des Crowley

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-15

Summary: Background: Opioid dependence is highly prevalent among people in custody and is associated with substantial morbidity, mortality and incarceration-related challenges. The eight-week period following prison release is particularly high-risk, with elevated rates of fatal overdose. Opioid substitution treatment in both community and custodial settings is protective; however, global availability remains suboptimal. In 2017, U.S. Food and Drug Administration approved a long-acting formulation of buprenorphine (XR-BUP) for moderate to severe opioid disorder. This scoping review aimed to assess the effectiveness of XR-BUP in custodial settings and during the critical eight-week post-release period. Methods: This review was conducted following the Arksey and O’ Malley framework. Search was conducted across PubMed, EMBASE, Web of Science, and PsycINFO to identify relevant papers adhering to PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Themes were identified using narrative synthesis as informed by Popay et al. Results: Of the 618 records identified initially, 15 records are included in the final analysis. The review identified four key themes on XR-BUP in custodial settings: a) Clinical outcomes b) Implementation and delivery c) Patient satisfaction and experiences d) Economic and resource considerations and two themes on post-release at 8 weeks: a) continuity of care and retention and b) post-release acceptability and patient experiences. Studies consistently reported benefits of XR-BUP, including reduced opioid use and cravings, high retention in custodial settings, and safe transition to the community. Conclusions: XR-BUP offers multiple advantages in custodial settings, including reduced stigma, improved quality of life, high patient satisfaction, and potential cost-effectiveness. Evidence also suggests positive outcomes following release, supporting XR-BUP as a valuable intervention for OUD in custodial populations.

Keywords: People Who Use Opioids; Opioid Agonist Treatment; XR-Bup; Depot Buprenorphine; Incarceration; Post-Release