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Background: The COVID-19 pandemic has led to an increase in drug use among inmates in prisons worldwide, including Kosovo, due to restrictions on visitation and addiction recovery programs. Objectives: This study analyzed drug use among 33,144 inmates in Kosovo prisons over nine years and aimed to identify potential solutions, foster collaboration between relevant institutions, and develop better programs and treatments. Methods and Results: The study is based on data from the medical files of inmates examined over nine years (2014-2022) in 10 Kosovo prison health units. From the total number of inmates, 8.22% were identified as drug users, and the percentage of drug use among inmates steadily increased from 5.8% in 2014 to 15.48% in 2019. In 2020, the first year of the pandemic, there was a decrease of 1.16% (from 15.48% to 14.28%), which was the first decrease in six years. The study also found a disproportional decrease in the number of inmates admitted during the same period. The Medico Psycho Therapeutic Center “Labyrinth” showed a similar trend. Suicide attempts, death under custody, and tobacco use increased linearly, with alcohol use remaining stable. Conclusion: The study highlights the need for effective prevention, treatment, and management strategies for drug use among inmates and the general population in Kosovo. Continuous collaboration between relevant institutions and stakeholders is essential to improve the health and well-being of those affected by drug use and create a brighter future for Kosovo.