Implementing methadone maintenance treatment in prisons in Malaysia

Area of Science:

• Public Health
• Infectious Diseases
• Addiction Medicine

Background:

• Malaysia faces a concentrated human immunodeficiency virus (HIV) epidemic among people who inject opioids.
• A three-phase methadone maintenance treatment (MMT) program was implemented to address this public health challenge.
• Phase 3 focused on integrating MMT within the prison system to manage HIV among incarcerated individuals.

Purpose of the Study:

• To assess the implementation and retention in care of a methadone maintenance treatment (MMT) program within Malaysian prisons.
• To evaluate the effectiveness of prison-based MMT as part of a national harm reduction strategy.

Main Methods:

• Pilot MMT programs were established in two high-HIV prevalence prisons (Kelantan and Selangor) following the development of standard operating procedures.
• Community-based MMT programs were established concurrently to ensure continuity of care upon prisoner release.
• Standard operating procedures were modified to include slower dose escalation, enhanced education, extended treatment duration, reinforced community linkages, and co-treatment for tuberculosis.

Main Results:

• Modified standard operating procedures included slower methadone dose escalation and optimized daily oral doses (>80 mg) before release.
• Enhanced protocols involved ongoing education for staff and inmates, increased treatment duration, and reinforced linkages with community MMT programs.
• Screening and treatment for tuberculosis (TB) were integrated, with dose escalation for methadone during co-treatment for HIV and TB.

Conclusions:

• Prison-based MMT programs are feasible and can be effectively implemented within correctional facilities.
• Successful implementation necessitates adequate methadone dosing and improved inter-agency communication between prison and health authorities.
• Enhanced post-release support, including preventing police harassment and improving release date tracking, is crucial for sustained treatment engagement.