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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.

Background/Aims: Opioid substitution treatment (OST) is an effective treatment for heroin dependence. The World Health Organization has recommended that OST be implemented in prisons because of its role in reducing drug injection and associated problems such as HIV transmission. The aim of this paper was to examine the extent to which OST has been implemented in prisons internationally. 

Methods: Literature review. Results: As of January 2008, OST had been implemented in prisons in at least 29 countries or territories. For 20 of those countries, the proportion of all prisoners in OST could be calculated, with results ranging from less than 1% to over 14%. At least 37 countries offer OST in community settings, but not prisons. 

Conclusion: This study has identified an increase in the international implementation of OST in prisons. However, there remain large numbers of prisoners who are unable to access OST, even in countries that provide such programs. This raises issues of equivalence of care for prisoners and HIV prevention in prisons.


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Larney S, Dolan K. Eur Addict Res. 2009;15(2):107-12