Substance Use and The Necessity for Harm Reduction Programs in Prisons: A Qualitative Study in Central Prison of Sanandaj, Iran

Background: For decades, harm reduction programs for addiction have been started in Iranian prisons. The programs comprise methadone maintenance treatment, antiretroviral treatment, and other harm reduction programs implemented as a triangular clinic. Despite the lack of funding to provide mental health services, particularly for substance use and harm reduction in prisons of low- and middle-income countries, Iran provides well-developed services. Objectives: The study investigated the implementation and achievements of harm reduction programs in Sanandaj prison located in the center of Kurdistan Province, west of Iran. Methods: This was a qualitative cross-sectional study. We used various information sources such as a checklist and group discussions. The participants were chosen by the purposive sample method and included prison authorities and harm reduction service providers and recipients. The data were analyzed by content analysis. Results: The harm reduction programs included opioid substitution therapy, providing information and education, voluntary counseling and testing for blood-borne diseases, providing condoms, hepatitis C virus screening, and antiretroviral treatment. Following the implementation of the program, a significant decrease in violence, self-injury, illegal drug use and shared syringes, HIV-positive new comers, and no necessity for the needle and syringe program when starting methadone treatment was reported. Conclusions: Commitment to a strict ban on the entering of drugs to the prison is a reason for the use of high-risk methods of drug use and behaviors such as injection, self-injury, or violence. Sharing syringes and needles is a major cause of the transmission of HIV and hepatitis viruses among drug users. Harm reduction programs, especially methadone maintenance treatment and antiretroviral treatment, have reduced a large proportion of drug-related harms in prisons. Scaling up the programs and their extension to post-release treatment will greatly reduce the country's health costs.