A pilot implementation study to scale-up methadone in incarcerated persons with opioid use disorder and retain them on treatment after release in Moldova

Dorgay, Coriann E.; Bromberg, Daniel J.; Doltu, Svetlana; Litz, Taylor; Galvez, Samy; Polonsky, Maxim; Dvoryak, Sergey; Altice, Frederick L.

doi:10.1016/j.drugpo.2022.103683

Cited by 5 publications

(5 citation statements)

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“…Drug‐dependent inmates are also exploited by ‘upper‐class’ prisoners. Researchers found that informal prison leaders disseminate negative myths and misinformation to discourage prisoners from enrolling in drug‐treatment programmes (Dorgay et al., 2022). Moreover, this criminal ‘view of the world’ (‘ poniatiia’ in Russian) used to permeate mainstream culture outside prison walls ‘through a variety of cultural and linguistic practices, such as jargon, tattoos, gestural language, gang signs, underworld songs, literature, and other mass media productions’ and is often romanticised by youngsters and outside‐of‐prison gangs throughout the post‐Soviet context (Yusupova, 2015).…”

Section: Literature Review: Path Dependence and Policy Transfermentioning

confidence: 99%

Europeanisation of post‐Soviet prisons: A comparative case study of prison policy transfer from Norway to Latvia and Lithuania

Burciu¹

2023

Howard J Crime Justice

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Despite shared history and a common ambition to comply with European standards, post‐Soviet countries differ in the way in which they reform prisons. By investigating two most‐similar cases of policy transfer from Norway – the establishment of the Olaine Drug Centre in Latvia and the Pravieniškės Drug Unit in Lithuania – this article explains why outcomes diverge and how Western‐European carceral individualism clashes with path‐dependent carceral collectivism. Where leadership is unstable, with limited powers, the informal legacies are strong, and policy‐transfer strategy is fragmented, as in Lithuania, the outcome is likely to be non‐transformative. Where, on the contrary, leadership is stable, enjoying larger discretionary powers and the intervention strategy is holistic, as in Latvia, the import of foreign institutional models is likely to be successful.

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Section: Literature Review: Path Dependence and Policy Transfermentioning

confidence: 99%

Europeanisation of post‐Soviet prisons: A comparative case study of prison policy transfer from Norway to Latvia and Lithuania

Burciu¹

2023

Howard J Crime Justice

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“…Maintenance with opioid agonist therapy (OAT), using methadone (MMT) or buprenorphine, is the most effective treatment for opioid use disorder ( 13 ) among PWID, substantially reducing mortality and transmission of blood-borne infections ( 13 , 14 ). Introducing and scaling up OAT within the prison, when combined with an effective linkage program to community treatment, contributes to country-wide scale-up of OAT as most PDL return to their communities ( 15 , 16 ). Despite the increasing availability of OAT programs, they are substantially more limited within prisons and primarily use MMT as it is the least expensive ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…Suboptimal implementation of OAT within prisons, alongside the disabling HIV risk environment, the legal framework, criminal subculture, and the perception that OAT is ineffective, has undermined OAT scale-up within prisons (17). Moreover, misinformation and negative attitudes toward OAT by prison administration personnel (18) and people deprived of liberty (PDL) (15,(19)(20)(21) continue to impede scale-up.…”

Section: Introductionmentioning

confidence: 99%

Introducing methadone maintenance therapy into Ukrainian prisons: a qualitative study of criminal subculture, Russia’s full-scale invasion, and contested methadone objects

Ponticiello,

Azbel,

Tate

et al. 2023

Front. Psychiatry

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BackgroundAfter pilot testing, methadone was newly being introduced into Ukrainian prisons in 2021 as part of a national scale-up strategy to treat opioid use disorder and prevent transmission of HIV and HCV infections. Opioid agonist therapy (OAT) scale-up in Eastern Europe and Central Asia prisons has been hampered by varying levels of influence of criminal subculture, an extralegal informal governance by a social hierarchy that operates in parallel to formal prison authorities. This study examined the socio-environmental factors influencing the uptake of methadone treatment in Ukrainian prisons, including changes that evolved during Russia’s full-scale invasion of Ukraine and the displacement of people deprived of liberty (PDL) from conflict to non-conflict regions.MethodsIn-depth qualitative interviews (N = 37) were conducted from January 2021 to October 2022 in the only two Ukrainian prisons where methadone was being introduced with PDL (N = 18). These two prisons continued to provide methadone after the full-scale invasion. Former PDL (N = 4) were also interviewed and prison staff (N = 15). Interviews were audio-recorded, transcribed, and translated into English. Four authors independently reviewed, coded, and applied a phenomenological framework for data analysis, delineating themes related to criminal subculture, drug use, methadone uptake, and evolving changes during the Russian invasion.FindingsCriminal subculture perceptions varied, with some seeing it as strongly discouraging drug use among certain groups, while others described it as a residual and weak influence from a more distant past. The influence of the subculture on methadone treatment uptake, however, was less clear. PDL and prison staff struggled to identify and articulate differences between illicit street-bought methadone, used recreationally, and medically prescribed methadone. Thus, the meaning of “methadone” varies in interpretation as it is being introduced, making it potentially conflicting for patients to opt into this evidence-based treatment. As Russia invaded Ukraine in 2022, PDL from conflict zones were transferred to non-conflict regions where methadone was being introduced. The prison environment became more enabling for PDL to start methadone as they were segregated and not subject to the existing criminal subculture’s rules and lacked the social ties necessary to procure drugs illegally.ConclusionIt appears that the criminal subculture is variable and evolving in Ukrainian prisons and appears to be impacted differently by the invasion of Russia. As methadone scale-up in prisons expands, it will be important to distinguish the meaning of methadone perpetuated negatively by the prison subculture versus that in which it is intended as a medical treatment by the formal prison authorities. The current invasion of Ukraine by Russia provides a potential disruption to alter this course.

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“…SBIRT is an evidence-based strategy to identify people with substance use disorders and engage them in care [18]. It has been deployed in multiple community settings in the US with modest effectiveness [19][20][21][22][23][24], although to our knowledge, only one other study (from this lab) has examined its effectiveness in another EECA country [25], and it has not previously been implemented in the Kyrgyz Republic. In this study, we recruited 125 soon-to-be released incarcerated people with OUD in the Kyrgyz Republic who participated in the SBIRT intervention.…”

Section: Introductionmentioning

confidence: 99%

Interest without uptake: A mixed-methods analysis of methadone utilization in Kyrgyz prisons

Liberman

Bromberg²,

Litz³

et al. 2022

PLoS ONE

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HIV incidence continues to increase in Eastern Europe and Central Asia (EECA), in large part due to non-sterile injection drug use, especially within prisons. Therefore, medication-assisted therapy with opioid agonists is an evidence-based HIV-prevention strategy. The Kyrgyz Republic offers methadone within its prison system, but uptake remains low. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a framework for identifying people who would potentially benefit from methadone, intervening to identify OUD as a problem and methadone as a potential solution, and providing referral to methadone treatment. Using an SBIRT framework, we screened for OUD in Kyrgyz prisons among people who were within six months of returning to the community (n = 1118). We enrolled 125 people with OUD in this study, 102 of whom were not already engaged in methadone treatment. We conducted a pre-release survey followed by a brief intervention (BI) to address barriers to methadone engagement. Follow-up surveys immediately after the intervention and at 1 month, 3 months, and 6 months after prison release assessed methadone attitudes and uptake. In-depth qualitative interviews with 12 participants explored factors influencing methadone utilization during and after incarceration. Nearly all participants indicated favorable attitudes toward methadone both before and after intervention in surveys; however, interest in initiating methadone treatment remained very low both before and after the BI. Qualitative findings identified five factors that negatively influence methadone uptake, despite expressed positive attitudes toward methadone: (1) interpersonal relationships, (2) interactions with the criminal justice system, (3) logistical concerns, (4) criminal subculture, and (5) health-related concerns.

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A pilot implementation study to scale-up methadone in incarcerated persons with opioid use disorder and retain them on treatment after release in Moldova

Cited by 5 publications

References 43 publications

Europeanisation of post‐Soviet prisons: A comparative case study of prison policy transfer from Norway to Latvia and Lithuania

Europeanisation of post‐Soviet prisons: A comparative case study of prison policy transfer from Norway to Latvia and Lithuania

Introducing methadone maintenance therapy into Ukrainian prisons: a qualitative study of criminal subculture, Russia’s full-scale invasion, and contested methadone objects

Interest without uptake: A mixed-methods analysis of methadone utilization in Kyrgyz prisons

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