Addiction treatment and harm reduction programs in prisons: lessons from Iran

AbstractBackground. Substance use disorder is one of the most prevalent health issues among prison populations. In this regard, the Department of Health and Treatment of the Iranian Prisons has implemented treatment and harm reduction programs in prisons since 2002. The purpose of the present study was to describe the practical experience of implementation of addiction treatment and harm reduction programs in Iran's prisons.Methods. A qualitative cross-sectional study was designed in the present study. Further to library sources, we used face-to-face semi-structure interviews with 11 key informants with question about the evolution of treatment and harm reduction programs in Iranian prisons. We analyzed the data using content analysis method by MAXQDA-10 software.Results. The HIV outbreaks was a challenge in Iranian prisons in the late 18th-century (1999). Policy makers had different responses ranging from denying the issue to solving it according to the abstinence paradigm that was prevailed among the majority of drug experts and politicians, and finally to issuing a legal amendment based on evidence-based health literature. Although, at first, financial problems and lack of human resources hindered the implementation of large scale harm reduction measures, the extent and quality of these programs rapidly improved. Recently, these programs in Iranian prisons are a unique model of health in the Persian Gulf region. The main treatment and harm reduction programs in Iranian prisons were methadone maintenance treatment and setting up triangular clinics. Also, the national program for diagnosing HIV/AIDS and tuberculosis in prison were provided by the collaboration of medical sciences universities.Conclusion. One of the main measures to provide evidence-based health interventions in prisons is the advocating for policy reform to implementation and expand harm reduction-based approaches. Providing evidence-based treatment and harm reduction programs in prisons and after inmates’ release into the community can significantly reduce health costs.