[e-drug] Indonesia sets up prison methadone maintenance treatment

["Beverley Snell" <bev@burnet.edu.au>]

E-DRUG: Indonesia sets up prison methadone maintenance treatment
------------------------------------------------

Indonesia sets up prison methadone maintenance treatment
Addiction
Volume 101 Page 1525  - October 2006
doi:10.1111/j.1360-0443.2006.01657.x

News and Notes

[Copied as fair use]

<http://www.blackwell-synergy.com/doi/full/10.1111/j.1360-0443.2006.01657.x#h1>

By Ingrid Irawati; Fabio Mesquita; Inang Winarso; Hartawan and Putu Asih

Indonesia faces an alarming HIV/AIDS problem with injecting drug 
users accounting for the majority of prevalent and recent cases of 
HIV infection.  The Ministry of Health data indicates that more than 
50% of AIDS cases involve injecting drug users or their sexual 
partners. The situation in prison settings is even more serious than 
in the community. Like many other Asian countries, Indonesia has 
strict drug laws that criminalize all drug users with little regard 
to the quantity of illicit drugs intercepted or differentiation 
between drug dealers and users. Traffickers receive the death 
penalty. The increasing number of prisoners serving sentences for 
drug related offences prompted the Department of Justice to establish 
13 special narcotics prisons. In March 2006, there were 23 406 
prisoners serving sentences for drug related offences in Indonesia 
(75% of whom are considered to be active users) including over 8000 
active injectors. In common with many other countries, the use of 
drugs inside prisons in Indonesia is
very prevalent.

In August 2005, the Department of Justice and Human Rights supported 
by the Indonesia HIV/AIDS Prevention and Care Project/AUSAID 
commenced a prison methadone maintenance treatment (PMMT) programme 
in Kerkoban Prison, Bali. This was the first PMMT in Asia. Kerobokan 
Prison has 753 prisoners of whom 51% were imprisoned for narcotics 
related offences. This prison service is a satellite to a methadone 
maintenance treatment programme in Sanglah hospital which was one of 
the first methadone treatment services established in Indonesia. In 
July 2006, Kerobokan PMMT had 31 patients being treated with 
methadone. There have been no reports of serious adverse events to 
date.

Indonesia now has about 80 needle and syringe programs in the 
community (which are run by NGOs and government health centres); five 
methadone programs and some care support and treatment is focused on 
drug users with HIV/AIDS.  As injecting drug users are often sent to 
prison there has been some debate about whether or not to continue 
their treatment there. In order to strengthen support for anti-retro 
viral treatment in prison, the
Indonesia HIV/AIDS Prevention and Care Project supported visits of 
government officials to Australia and Iran to inspect PMMT schemes in 
other countries. In 2004, the Ministry of Health held discussions 
with prison
authorities to enable patients to continue with their anti-retroviral 
treatment when imprisoned. PMMT received high-level support when it 
was included in Indonesia's National HIV in Prison Strategy (launched 
in July 2005).

With this project, Indonesia has confirmed that it is feasible to 
provide methadone maintenance treatment to prisoners in developing 
countries. Current plans are to expand PMMT in Indonesia and to offer 
this experience to other developing countries.

Contact details: Fabio Mesquita. <fmesquita@ihpcp.or.id >

Information provided by

Dr. Alex Wodak,
Director, Alcohol and Drug Service,
St. Vincent's Hospital,
Darlinghurst, NSW, 2010,
AUSTRALIA
awodak@stvincents.com.au

-----------
Beverley Snell
Senior Fellow
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
GPO Box 2284, Melbourne 3001 Australia
http://www.burnet.internationalhealth.edu.au

Telephone 613 9282 2115 / 9282 2275
Fax 61 3 9282 2144  or  9282 2100
Time zone: 10 hours ahead of GMT.
email <bev@burnet.edu.au>