Opioid misuse and dependence carries major implications on patients’ physical and mental health and also on the healthcare system. Individuals often have unsafe injecting practices, increasing the risk of transmission of blood borne viruses and life-threatening infections. Opioid replacement therapy was first initiated in the 1960s with the introduction of methadone, a full mu-receptor agonist. Later, buprenorphine was introduced due to its favourable properties as a partial agonist with many studies supporting its effectiveness in treating opioid dependence. Over time, there have been increasing cases of buprenorphine misuse. This discussion focuses on opioid misuse in prisons and the ongoing efforts to address this issue. In our hospitals, there has been an increasing number of incarcerated people presenting with hand abscesses after injecting buprenorphine. They often report that the tablet had been dissolved with another inmate’s saliva and that the needle had been shared. Most require a formal washout in theatre and infectious diseases involvement due to the multitude of organisms involved. Many individuals seek a referral to the alcohol and drug addiction unit early in their admission. Whilst there are those who struggle with their opioid addiction whilst in custody and are seeking help, it is essential to acknowledge the possibility of secondary gain behind these admissions as it is said that opioids hold greater monetary value in prison than in the community. Recently, there has been an introduction of buvidal, a subcutaneous formulation of buprenorphine. This aims to reduce the supply and unsafe handling of buprenorphine tablets in correctional centres whilst helping treat those with opioid use disorder.