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

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

“…Parts of our data regarding the criminal subculture in prisons in Ukraine are consistent with the literature from other EECA countries like Moldova and the Kyrgyz Republic, which illustrates how criminal subcultures can inhibit the uptake of prison-based methadone treatment programs ( 18 , 21 , 44 ). Ukraine, however, differs from these countries, where methadone had been introduced in prisons nearly two decades ago.…”

“…Additionally, the criminal subculture provides necessary resources to PDL like personal goods that are not provided by the formal prison authorities ( 25 ). Though the social order that evolves among PDL is not entirely unique to post-Soviet nations, its presence in Ukraine ( 26 , 27 ), Moldova ( 21 ), and Kyrgyzstan ( 28 ) is a particular phenomenon ( 29 ). In Moldova and Kyrgyzstan, where methadone treatment provided in prison has been present for nearly two decades, criminal subculture is described as especially powerful, and it has greatly inhibited OAT uptake ( 19 , 28 ).…”

“…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.…”

Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years

“…Despite maintenance on opioid agonists like methadone being part of the WHO’s list of essential medications and evidence-based treatment for opioid use disorder ( Degenhardt et al, 2019 ), coverage in Kyrgyzstan remains low (4.4%) with approximately 850 of 25,000 estimated PWID being on treatment ( Joint United Nations Programme on HIV/AIDS (UNAIDS), 2019 ; Vickerman et al, 2014 ); buprenorphine is not available. Despite Kyrgyzstan introducing methadone as pilot projects in 2004 to address HIV prevention in PWID, the legacy of Russian influence looms large throughout countries in the former Soviet Union and its continued ban on methadone continues to influence its scale-up among both patients ( Bojko et al, 2015 ; O’Hara et al, 2022 ; Rozanova et al, 2017 ) and providers ( LaMonaca et al, 2019 ). Scale-up challenges persist despite methadone maintenance treatment (MMT) not only improving a number of health and social outcomes ( Degenhardt et al, 2019 ; Wakeman, 2020 ), but it is especially crucial for the prevention of HIV and HCV in both community ( Alistar et al, 2011 ; Hodder et al, 2021 ; MacArthur et al, 2012 ; Platt et al, 2017 ) and carceral settings ( Altice et al, 2016 ; Stone et al, 2021 ).…”