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

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.