Continuity of opioid substitution treatment (OST) within reinsertion from prison to community in Southeast Asia: a scoping review

Abstract

Background: The ‘war against drugs’ in Southeast Asia (SEA) to eradicate illicit drug use including opioids, wages on. Criminalisation of drug use and compulsory detention has largely characterised the region’s response to people who use drugs (PWUD) for over a decade. Recent welcomed shifts towards voluntary-, community- and evidence-based drug dependence treatments have emerged. Provision of healthcare of people living in prison (PLP) are mandated by international standards of human rights. However, many in detention with opioid dependence continue to lack access to treatment. Those who do receive opioid substitution treatment (OST) during incarceration often face uncertainties of continuity of care beyond the prison gate.

Methods: This scoping review mapped what is currently known about the continuity of OST within reinsertion from prison to community in SEA, with a focus on three countries (Indonesia, Malaysia, Vietnam) which currently have OST available in at least one prison. A multi-lingual systematic search (English, Malay, Indonesian, Vietnamese) collected and reviewed all available and relevant published and grey literature between 2011 and 2021. Of 293 records found, 18 were eligible for inclusion following removal of duplicates and application of exclusion measures. These records were charted and thematically analysed.

Results: Three main themes were generated: facilitators of methadone maintenance treatment (MMT) in prison and continuity of care; barriers of MMT in prison and continuity of care; and MMT initiation, dosage and retention post-release. Themes demonstrated how individual and structural elements through partnership, training, guidelines and motivation are foundational to drive the provision of OST for opioid dependent PLP within detention settings and post-release. When gaps exist, disruptions to the delivery and continuity of OST ensued. Importantly, adequate dosage of >80mg/day was significantly associated with retention in post-release treatment.

Conclusion: This review highlights the urgent need to initiate and scale up voluntary, evidence- and human-rights based OST while incarcerated and during reinsertion, with a gender-sensitive approach for all PLP with opioid dependence. An accurate understanding of addictions and the will to engage in systemic reforms are key to dismantling the societal stigma towards PWUD in SEA, to ensure parity, quality and continuity of care for those often left invisible and forgotten in prison and community settings.