Making evidence about medication-assisted treatment in prisons: challenges across regions and ways forward to improve the health of incarcerated people who use drugs

The HIV epidemic is concentrated in prisons throughout Eastern and Southeast Europe and the Mediterranean region, particularly among people who inject opioids. Medication-assisted treatment (MAT), with methadone or buprenorphine, is the evidence-based gold standard for HIV prevention and addiction treatment in prisons. Yet, spotty implementation of MAT in the region’s prisons has been one of the major roadblocks to turning the tide of the HIV epidemic. Opting for a cookie-cutter approach, actors in global health have not sufficiently accounted for the influence of socio-structural environmental factors within prisons on MAT treatment outcomes.This structured session will provide an overview of the challenges and lessons from implementing MAT in prisons in three geographic areas (Eastern Europe & Central Asia, the Mediterranean, and Southeast Europe) with differing challenges. Despite more than a decade of availability of MAT in the Republic of Moldova, uptake remains low, with sociological studies detailing how methadone within post-Soviet prisoner subculture acts differently from evidence-based methadone. In Morocco the MAT program in prisons presents challenges to expansion due to the relational effects between the prison administration and people in prisons on treatment uptake. In Croatia, a high-quality program showcases the importance of methadone distribution practices on enrollment. These presentations challenge implementers to see evidence about MAT as locally made. They argue that accounting for who, where, when, and how treatment is administered makes the difference as to whether MAT emerges as a treatment for addiction or an addictive drug.