HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2007, 09, 4 (pages: 21 - 30)

Agonist Opioid Treatment in Prisons

Kastelic A., Kostnapfel-Rihtar T.

Summary: It is estimated that approximately one third of prison inmates can be considered opiate-dependent, and that many more are experienced drug users. In several prisons, this includes up to three quarters of the inmate population. Prisons are extremely high-risk environments for HIV transmission because of overcrowding, poor nutrition, limited access, continued illicit drug use (“unhygienic relapses”) and unprotected sex. As to recidivism among substance abusing prisoners, between 70 and 98 % of those who have been imprisoned for drug-related crimes, but did not receive treatment during their imprisonment, undergo a relapse during the twelve months following their release. The recently published position paper WHO, UNODC and UNAIDS (2004) on agonist opioid maintenance therapy concludes that providing agonist opioid maintenance therapy in treating opioid dependence is an effective strategy for preventing HIV/AIDS, and that it should be considered for implementation as soon as possible in communities at risk from HIV infection. IDUs who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment. The death rate of people with opioid dependence in methadone maintenance treatment is between one third and one quarter the rate for those not in treatment. The health services for individuals in prisons or correction houses should have standards as high as those provided outside the correctional system.