People who are incarcerated—both in Canada and globally—experience disproportionately high rates of substance use, including opioid use disorder (OUD). This population faces an elevated risk of relapse, overdose, and mortality, particularly during the transition from incarceration to the community. Opioid agonist treatment (OAT) is the gold-standard treatment for OUD and has been associated with numerous positive outcomes, including reduced illicit opioid use, lower overdose and mortality rates, decreased recidivism and re-incarceration, and improved engagement with healthcare and addiction treatment services. Despite these benefits and the increasing availability of OAT in correctional settings, research on OAT engagement—including barriers and facilitators to access during and after incarceration—remains limited.
The Ontario CRISM Node Team (OCRINT) is actively engaged in research to better understand OAT access, effectiveness, and the experiences of individuals receiving treatment before, during, and after incarceration. As part of our Implementation Science Program, OCRINT coordinated four correctional projects. Additionally, OCRINT continues to lead additional research in this area through the following projects:
Commentary on Correctional Service Canada (CSC)’s Decision to Delist Suboxone from their Formulary
In October 2025, Correctional Service Canada (CSC) updated its opioid agonist treatment (OAT) policy by removing buprenorphine/naloxone (Suboxone) from its formulary and designating extended-release buprenorphine (Sublocade) as the preferred first-line treatment for opioid use disorder (OUD). This decision was partly based on research suggesting that Sublocade is effective and feasible in correctional settings, as well as concerns about the diversion (misuse or sharing) of Suboxone. However, this shift has raised concerns about patient choice and access to a range of treatment options.
Members of the OCRINT team who conducted a systematic review that was used as a key source of evidence informing this decision recently published a follow-up commentary highlighting limitations in the existing evidence base, including gaps in generalizability and the need for caution when translating findings into system-wide policy. The article argues that restricting access to evidence-based OAT options among correctional populations risks undermining patient-centered care, continuity of treatment, and alignment with general clinical guidelines, and suggests that XR-BUP should be offered as a valuable addition, while preserving access to the full range of evidence-based OAT options. Please see the link to the commentary here.
Longitudinal Study on OAT Among Federally Incarcerated Individuals
OCRINT conducted a multi-phase longitudinal study examining OAT experiences among federally incarcerated individuals in Ontario. This study explored treatment continuity, barriers to care, and key outcomes related to opioid use and community reintegration. Data collection took place between January 2019 and March 2020 in federal correctional institutions and confidential community field settings. Participants completed a brief quantitative survey (integrated with select administrative correctional data) and an in-depth qualitative interview.
Baseline and follow-up reports submitted to Correctional Service Canada
Examining Experiences of Federal Offenders on Opioid Agonist Treatment (OAT) During Release from Incarceration in Ontario, Canada: A Post-Release Report
Examining Experiences of Federal Offenders on Opioid Agonist Treatment (OAT) During Incarceration in Ontario, Canada: A Pre-Release Report
Academic publications
Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada. Russell, C., Pang, M., Nafeh, F., Farrell Macdonald, S., Derkzen, D., Rehm, J., & Fischer, B. (2022).
Opioid agonist treatment (OAT) experiences and release plans among federally incarcerated individuals with opioid use disorder (OUD) in Ontario, Canada: a mixed-methods study. Russell, C., Nafeh, F., Pang, M., MacDonald, S. F., Derkzen, D., Rehm, J., & Fischer, B.
Applying the socio-ecological model to understand community reintegration experiences among individuals on opioid agonist treatment (OAT) released from federal incarceration in Ontario, Canada. Russell, C., Pang, M., Nafeh, F., MacDonald, S. F., Derkzen, D., Rehm, J., & Fischer, B.
Systematic Review on Extended-Release Buprenorphine (Sublocade) in Corrections
OCRINT led a systematic review evaluating the feasibility and effectiveness of extended-release buprenorphine (Sublocade) among correctional populations. This review synthesizes existing research on treatment retention, opioid use outcomes, and implementation challenges to inform future policies and best practices.
View the press release HERE
Academic publications
Feasibility and effectiveness of extended-release buprenorphine (XR-BUP) among correctional populations: a systematic review. Russell, C., George, T. P., Chopra, N., Le Foll, B., Matheson, F. I., Rehm, J., Lange, S.
Community-Based Study on Post-Release Experiences with Sublocade
OCRINT is conducting an ongoing community-based study examining the experiences of individuals recently released from incarceration who have received Sublocade. This qualitative study explores the benefits, challenges, and overall acceptability of extended-release buprenorphine during the critical transition from custody to community.
Through these projects, OCRINT aims to inform evidence-based policy and practice, ensuring that opioid agonist treatments are accessible, effective, and tailored to meet the needs of individuals involved in the correctional system.
Data collection is currently underway and results will be posted here
Retrospective Cohort Study: Examining how Correctional Populations in Ontario use Healthcare Services
OCRINT collaborated with researchers at ICES and St. Michael’s Hospital’s MAP Centre for Urban Health Solutions on a retrospective cohort study examining how correctional populations in Ontario use healthcare services both overall, and specifically for substance use-related issues using population-level administrative health data.
View the press release HERE
Academic Publications
Overall and substance use-specific healthcare utilization among individuals with and without criminal justice involvement in Ontario, Canada
Russell, C., Yakubovich, A., O'Campo, P., Qu, K., Pluptre, L., Kouyoumdjian, F., Matheson, F. I.
Knowledge Translation (KT) Products
Correctional Populations in Ontario Have Twenty Times the Rate of Substance-Use Related Healthcare Visits