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<p>Correctional Service Canada (CSC) recently revised its opioid agonist treatment (OAT) policy, designating extended-release injectable buprenorphine (XR-BUP; Sublocade) as the first-line treatment for opioid use disorder (OUD) in Canadian federal corrections. Methadone is now a second-line option, and buprenorphine/naloxone is no longer available, raising concerns regarding access, clinical autonomy, and equivalence of care. CSC cited clinical evidence suggesting advantages of XR-BUP, including reduced diversion, simplified dosing, and superior efficacy. One of the primary sources referenced for the policy revisions was a systematic review examining the feasibility and effectiveness of XR-BUP among correctional populations. Here, we clarify the findings and limitations of this&#xa0;review, and examine key implications of CSC’s policy revision. While available evidence suggests that XR-BUP is a beneficial OAT option for incarcerated individuals, the literature remains preliminary, heterogeneous, and methodologically limited. It currently does not robustly support the use of XR-BUP as an exclusive replacement for established first-line OAT options. Restricting access to evidence-based OAT options among correctional populations risks undermining patient-centered care, continuity of treatment, and alignment with general clinical guidelines. Ideally, XR-BUP should be offered as a valuable addition, while preserving access to the full range of evidence-based OAT options. </p>

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Clarifying the evidence and implications of prioritizing extended-release buprenorphine for opioid agonist treatment in Canada’s federal correctional system

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月9日

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  • Cayley Russell,
  • Tony P. George,
  • Nitin Chopra,
  • Bernard Le Foll,
  • Flora I. Matheson,
  • Gillian Kolla,
  • Jennifer Wyman,
  • Benedikt Fischer,
  • Nikki Bozinoff,
  • Jürgen Rehm,
  • Shannon Lange

摘要

Correctional Service Canada (CSC) recently revised its opioid agonist treatment (OAT) policy, designating extended-release injectable buprenorphine (XR-BUP; Sublocade) as the first-line treatment for opioid use disorder (OUD) in Canadian federal corrections. Methadone is now a second-line option, and buprenorphine/naloxone is no longer available, raising concerns regarding access, clinical autonomy, and equivalence of care. CSC cited clinical evidence suggesting advantages of XR-BUP, including reduced diversion, simplified dosing, and superior efficacy. One of the primary sources referenced for the policy revisions was a systematic review examining the feasibility and effectiveness of XR-BUP among correctional populations. Here, we clarify the findings and limitations of this review, and examine key implications of CSC’s policy revision. While available evidence suggests that XR-BUP is a beneficial OAT option for incarcerated individuals, the literature remains preliminary, heterogeneous, and methodologically limited. It currently does not robustly support the use of XR-BUP as an exclusive replacement for established first-line OAT options. Restricting access to evidence-based OAT options among correctional populations risks undermining patient-centered care, continuity of treatment, and alignment with general clinical guidelines. Ideally, XR-BUP should be offered as a valuable addition, while preserving access to the full range of evidence-based OAT options.