Methadone maintenance reduces injecting in prison
BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7039.1162b (Published 04 May 1996) Cite this as: BMJ 1996;312:1162
- Kate Dolan,
- Wayne Hall,
- Alex Wodak
- Research officer Director National Drug and Alcohol Research Centre, Sydney, Australia
- Director Alcohol and Drug Service, St Vincent's Hospital, Sydney
EDITOR,—HIV can spread rapidly among injecting drug users in prison, even when HIV prevalence is low.1 Despite this, few countries have implemented HIV prevention measures for inmates and no evidence exists on the effectiveness of such measures in correctional environments. Condoms are provided to inmates in 19 countries and bleach in 13. Methadone is provided to inmates on a maintenance treatment basis in only five countries and for detoxification in a further six countries including England, Ireland, and Scotland.2 Calls for policy reform in the United Kingdom have supported the provision of methadone on a reduction regimen for prisoners.3 Methadone maintenance treatment is well known to be effective in community settings,4 but its effectiveness in prisons is not known. Therefore we evaluated the effectiveness of methadone maintenance treatment in reducing risk behaviour among prisoners.
In 1993 we interviewed 185 ex-prisoners with a history of injecting drug use in New South Wales, of whom 64 reported receiving methadone maintenance treatment before, during, and after their period in prison; 80 reported receiving no treatment. injecting drug users who reported receiving methadone maintenance treatment in the three months before prison were significantly less likely to report daily injecting (42% v 60%, odds ratio=0.4 (95% confidence interval 0.2 to 0.9); P=0.03) and syringe sharing (13% v 26%, 0.4 (0.2 to 0.9); P=0.04) than those not receiving the treatment.
Injecting drug users who received methadone maintenance treatment during imprisonment reported significantly fewer injections per week (mean 0.16 v 0.35; P=0.03 Mann-Whitney test) than those not receiving the treatment but only when the maximum methadone dose exceeded 60 mg and if methadone maintenance treatment had been provided for the entire duration of imprisonment.
These results suggest that the reduction of injecting and syringe sharing that occur with methadone maintenance treatment in community settings also occur in prisons. However, inmates need a daily dose of at least 60 mg of methadone and treatment is required for the duration of incarceration for these benefits to be realised in prison. Methadone maintenance treatment has an important role to reduce the spread of HIV and hepatitis in prison.