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Methadone within prison and linkage to and retention in treatment upon community release for people with opioid use disorder in Kyrgyzstan: Evaluation of a national program.
- Source :
-
The International journal on drug policy [Int J Drug Policy] 2022 Mar; Vol. 101, pp. 103558. Date of Electronic Publication: 2021 Dec 13. - Publication Year :
- 2022
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Abstract
- Background: HIV incidence in Eastern Europe and Central Asia (EECA) continues to increase, primarily among people who inject drugs (PWID) and people in prisons. In Kyrgyzstan, an estimated 35% of people in prison are PWID, and 10% have been diagnosed with HIV. In 2008, Kyrgyzstan became the first country in EECA to provide free and voluntary methadone in prisons. We examine the impact of this national program on methadone within prison as well as linkage to and retention in treatment upon release to the community.<br />Methods: Administrative data from a national methadone registry with de-identified information were assessed retrospectively. We examined the delivery of methadone services, including the duration of treatment both within prison and after release, for all prisoners who were prescribed methadone in Kyrgyz prisons from 2008 to 2018. Reasons for discontinuing methadone, HIV status and methadone dose are also analyzed.<br />Results: Between 2008 and 2018, nine of Kyrgyzstan's 16 prisons offered methadone, and 982 incarcerated people initiated methadone within prison. Prisoners prescribed methadone were mostly male (96.2%), in their mid-30s (mean=34.9 years), and had been incarcerated for a relatively long time (mean = 44.1 months); their mean treatment duration in prison was 12.5 months, and 31.6% had HIV. A subsample (N = 645; 65.7%) of these were released to the community. Of these 645 people, 356 (55.2%) were not taking methadone at the time of release, 128 (19.8%) were on methadone and continued it after release, and the remainder (N=161, 25.0%) were on methadone at the time of release, but subsequently discontinued it, most within the first 7 days after release. Among those continuing methadone, 14.8% (N=19) remained on treatment ≥ 12 months. Independent correlates of linkage to methadone after release included positive HIV status (adjusted hazard ratio (aHR)=1.55; p = 0.033), receipt of methadone before their incarceration (aHR=2.01; p = 0.039), and receipt of methadone at the time of release (aHR = 20.81; p<0.001).<br />Conclusion: This is the first evaluation of within-prison methadone treatment in EECA. Uptake of methadone within prison and retention in treatment after release were both low. Continuous maintenance of treatment throughout incarceration is an opportunity to optimize HIV prevention and link patients to methadone post-release.<br />Competing Interests: Declarations of Interest The authors of this study have no conflicts of interest to declare.<br /> (Copyright © 2021. Published by Elsevier B.V.)
- Subjects :
- Female
Humans
Kyrgyzstan epidemiology
Male
Methadone therapeutic use
Prisons
Retrospective Studies
HIV Infections drug therapy
HIV Infections epidemiology
HIV Infections prevention & control
Opioid-Related Disorders drug therapy
Opioid-Related Disorders epidemiology
Opioid-Related Disorders rehabilitation
Prisoners
Substance Abuse, Intravenous drug therapy
Substance Abuse, Intravenous epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1873-4758
- Volume :
- 101
- Database :
- MEDLINE
- Journal :
- The International journal on drug policy
- Publication Type :
- Academic Journal
- Accession number :
- 34915426
- Full Text :
- https://doi.org/10.1016/j.drugpo.2021.103558