In prison pain assumes a disproportionate magnitude and it is not generally adequately treated. The reasons are often due to the fear to prescribe to detainees opioid analgesic agents for the risk of misuse and diversion. The purpose of this observational study, carried out on 598 detainees in the sentence prison of Padua, was to identify the obstacles and barriers to the use opioid analgesic drugs for pain management and to find recommendations for their implementation and rational use.The study showed an inappropriate prescription of analgesic drugs and misuse and diversion phenomena, especially in detained drug users. Recommendations, procedures and guidelines for the pain treatment should be adopted in all prisons.