Decisional considerations for methadone uptake in Kyrgyz prisons: The importance of understanding context and providing accurate information

Multi-level implementation factors that influence scale-up of methadone maintenance treatment in Moldovan prisons: A qualitative study

“…Similar to studies in Kyrgyzstan (Liberman et al, 2021;Rhodes et al, 2019), this study found that the prison subculture in Moldova creates a barrier to MMT uptake. Prisons in Moldova, which appear to vary depending on the specific colony, exist under two governance systems-a formal system that prison administrators run, and an informal system that incarcerated people create as a form of self-governance.…”

“…For example, study participants reported that the informal prison governance system controls drug distribution within the prison. This experience differs from the Kyrgyzstani experience, where illicit opioids are banned yet opioids are distributed regularly to loyal workers within the informal prison hierarchy every 10 days as a reward for their contributions to work efforts (Liberman et al, 2021;Rhodes et al, 2019). These participants also reported a deep distrust of the formal prison administration.…”

“…Findings here provide insights into some important barriers to MMT uptake that likely contribute to the low MMT coverage in EECA prisons. Aside from two qualitative studies from Kyrgyzstan (Liberman et al, 2021;Rhodes et al, 2019), this is the first study in Eastern Europe to examine how informal prisoner self-governance, formal prison governance, and individually held beliefs about MMT concurrently affect the decision to either accept or reject MMT while incarcerated.…”

“…Previous studies have found low uptake of MMT in EECA prisons (Altice et al, 2016), and they have suggested that this may be due to stigmatization of MMT by both staff and incarcerated people (Polonsky et al, 2015;. Studies of Moldovan and other EECA prisons have indicated that prisoner hierarchies enact social stigma against MMT and suppress MMT uptake (Azbel et al, 2021;Cotorobai et al, 2019;Liberman et al, 2021;Otiashvili, 2016). The results of this study show that according to rules by the informal governance (the ponyatiya), methadone is something that only lower-caste individuals access, thus limiting wider uptake.…”

“…The anticipated social consequences of engaging in MMT are also believed to shape MMT acceptance , yet the social context of access to MMT in prisons in Moldova, EECA, and elsewhere is poorly understood. In Moldova and other EECA countries, informal governance by prisoner hierarchies exerts control over the social order of prison communities by monopolizing and pooling resources, including access to drugs (Azbel, 2020;Azbel et al, 2021;Butler et al, 2018;Gasparyan et al, 2018;Kupatadze, 2014;Liberman et al, 2021). This informal governance operated by a caste system (i.e., hierarchies) of prisoners can compensate for the limited resources (e.g., food, personal hygiene, etc.)…”