This publication sheds light on the situation of drug users among criminal justice populations and corresponding health care responses in nine countries in Eastern and South-East Europe and Kosovo.
Heroin dependence is associated with severe negative outcomes such as HIV and hepatitis C transmission, criminal activity, imprisonment and death from opioid overdose. Opioid substitution treatment (OST) is the most effective treatment available for heroin dependence, resulting in reduced heroin use, HIV transmission, criminal activity and mortality. It is cost-effective and has higher retention rates than other forms of treatment for drug dependence. OST is available in at least 66 countries and territories, including low- and middle-income nations such as China, Indonesia and Iran. The World Health Organization, the Joint United Nations Programme on HIV/AIDS and the United Nations Office on Drugs and Crime have recommended the implementation of OST in prisons as an essential part of HIV prevention programming. It is argued that, as in the community, heroin-using inmates treated with opioid substitution will inject drugs less often, thus reducing the risk of HIV transmission between prisoners sharing needles and syringes. Other grounds for implementing OST in prisons include improvements in inmate manageability and prison safety and reductions in postrelease criminal activity and re-incarceration.
Objectives: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. Methods: All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. Results: Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. Conclusions: Consideration should be given to the introduction of prison methadone programs particular where community based programs exist.
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