Resisting methadone: criminal subculture and methadone implementation in Moldovan prisons

Maintenance treatment with methadone (MMT) is globally recommended as a key strategy for HIV prevention and addiction treatment in prisons, yet implementation remains limited. Moldova offers a rare exception, where MMT has been available in prisons for over two decades, though uptake remains low. This study aims to examine how criminal subcultures, widespread in many Eastern European prisons, shape access to and perceptions of MMT.

A total of 35 in-depth qualitative interviews were conducted in two men's prisons near Chišinău with participants of varied social standing and methadone treatment status. Thematic analysis was used to explore how carceral hierarchies and informal governance shape MMT.

Three major themes emerged: implementation efforts for prison-based MMT have largely failed to account for local contexts and the influence of criminal subcultures; MMT disrupts the hierarchical boundaries that structure prison subculture, resulting in the loss of material and social capital for those who initiate treatment; and MMT has become entangled in a power struggle between formal and informal prison authorities, functioning as a tool of influence for the prison administration and reinforcing its undesirable status among people in prison.

This study is among the first studies, to the best of the authors' knowledge, to capture how criminal subcultures reshape the implementation and meaning of MMT in Eastern European prisons. These findings underscore the need for future implementation efforts to engage with the social, economic and material logics of criminal subculture, enabling MMT programs to emerge that are independent of custodial control.