The New South Wales Prison Methadone Program provides prison-based methadone maintenance treatment (MMT) for incarcerated injecting drug users (IDUs) dependent on opioids. The goals of the prison-based MMT program are to reduce recidivism, prevent the spread of HIV and hepatitis in prison, and encourage the continuation of treatment in the community following an inmate’s release from prison.
Methadone is a synthetic opioid agonist used in maintenance therapy or as a withdrawal agent for drug users dependent on opioids, such as heroin and oxycodone. It is taken orally on a daily basis and reduces the use of opioids through cross tolerance, which can result in a reduction of withdrawal symptoms, less desire to use opioids, and reduced euphoric effect when opioids are ingested. MMT programs are generally community based, but Australia is one of a few countries that operate and offer a prison-based program.
The prison methadone program began as a prerelease program that targeted IDUs with extensive drug careers and histories of incarceration (although inmates with less extensive drug careers and fewer prior incarcerations are now admitted). The program has been modified over the years to reflect a maintenance treatment philosophy. This includes shifting the concentration of MMT to not only reduce heroin injection and use but also to minimize the spread of blood-borne viral infections, such as HIV and hepatitis C.
Australia’s National Methadone Guidelines provide four basic categories where MMT might be appropriate for prisoners: 1) withdrawal; 2) continuation of treatment for those on methadone before imprisonment; 3) commencement of treatment for those who are heroin dependent on prison entry or who have used heroin in prison in a harmful way, including those who are HIV positive; and 4) the reduction of intravenous opioid use upon release (Dolan et al. 2002, 14).
The program is targeted toward incarcerated IDUs who are addicted to opioids. To determine eligibility for MMT, inmates are assessed by trained nurses who have experience conducting a standardized Corrections Health Methadone Assessment. The assessment is followed by a medical review by a corrections health career medical officer. The medical officer makes appropriate medical observations and confirms drug use history and any treatment history. Inmates found suitable for the methadone program are placed on a waitlist, which can last 6 months. If inmates are assessed as requiring priority placement (they are HIV positive), then they immediately begin the methadone program.
When inmates begin the prison methadone program, they start on a 30-milligram (mg) dose. This dosage increases by 5 mg every 3 days until a 60-mg dose is achieved. Inmates in MMT are subject to the usual security arrangements, which means they are subject to ‘lockdowns’ and not allowed unscheduled movements that may interrupt treatment or stabilization periods.
Drug and alcohol counseling is also available to all inmates in prison. Inmates treated through the prison methadone program are offered the opportunity to transfer to community-based methadone programs, to continue treatment following release.
The prison methadone program is available at five prison facilities in the Sydney, Australia, metropolitan area (John Morony, Long Bay Complex, Metropolitan Remand Centre, Parramatta, and Silverwater) and seven prisons outside the metropolitan area (Bathurst, Cessnock, Goulburn, Grafton, Junee, Lithgow, and Tamworth). If inmates are located in a prison that does not offer the methadone program, they may be moved to one that does.
The Department of Corrective Services (DCS) is in charge of running the prison system in New South Wales. However, the health needs and services of prisoners are the responsibility of the Corrections Health Service (CHS), which is part of the Department of Health and is separate from the DCS. The National Methadone Guidelines stipulate that the medical staff prescribing methadone to prisoners should be independent of the DCS, to minimize conflicts of interest. Therefore, trained medical staff from the CHS administers the methadone doses.