A qualitative inquiry into methadone maintenance treatment for opioid-dependent prisoners in Tehran, Iran

Abstract

Background: This study aimed to investigate the context in which methadone maintenance treatment (MMT) is provided for opioid-dependent prisoners, and to identify barriers against further scale-up of MMT in Ghezel Hesar prison in Tehran.

Methods: This was a cross-sectional qualitative study using field observations, focus group discussions, and individual interviews. In total, 30 prisoners and 15 prison staff and health policymakers participated in this study in November 2006.

Results: The rate of drug injecting in the prison unit was unanimously reported to have decreased drastically since introducing the MMT program. In addition to the health benefits to MMT recipients, interview data indicates that MMT has had positive effects on socio-economic status of prisoners' families. Nevertheless, several impediments to the provision of MMT services and to its further expansion were also identified, including staff shortages, some degree of methadone diversion, widespread concerns over the possible side effects of methadone, and the stigma attached to methadone treatment.

Conclusion: MMT constitutes one of the main components of the Iran Prison Organization's comprehensive HIV prevention package and is becoming increasingly accessible to opioid-dependent prisoners in Iran. Our findings indicate that the MMT program in Ghezel Hesar prison has been helpful for many opioid-dependent prisoners to reduce their risk of drug-related harm and to ease social and financial burden over their families. Meanwhile, existing barriers against provision of MMT should be properly addressed before further scale up of the program.