prisons because of its role in reducing drug injection and associated problems such as HIV

prisons because of its role in reducing drug injection and associated problems such as HIV transmission. The aim of this paper was to examine the extent to which opioid substitution treatment has been implemented in prisons internationally. As of January 2008, opioid substitution treatment had been implemented in prisons in at least 29 countries or territories. For 20 of those countries, the proportion of all prisoners in opioid substitution treatment could be calculated, with results ranging from less than 1% to over 14%. At least 37 countries offer opioid substitution treatment in community settings, but not prisons. This study has identified an increase in the international implementation of opioid substitution treatment in prisons. However, there remain large numbers of prisoners who are unable to access opioid substitution treatment, even in countries that provide such programs. This raises issues of equivalence of care for prisoners and HIV prevention in prisons.

Opioid substitution therapy, the most cost-effective treatment available for heroin dependence, is available in 66 countries and territories, including low- and middle-income countries such as China, Indonesia, and Iran. The largest prison programmes are in Ireland, Scotland, and Spain with 12 to 14% of inmates in these countries receiving opioid substitution treatment. Some countries unnecessarily restrict access to inmates serving sentences of a particular length, to those who were in treatment before incarceration, or to those who can confirm that they have a post-release treatment place. Furthermore, the 37 countries which offer opioid substitution therapy in the community but not in prisons are contravening the multiple international covenants and legal instruments that entitle incarcerated people access to health services equivalent to those available in the general community in their countries. Thus, despite prison access to opioid substitution treatment having increased from 5 countries in 1996 to 29 in 2008, much remains to be done to improve coverage worldwide both in prisons and in the community.