In South Africa, there is no provision of medication for opioid use disorder (MOUD) for people who are incarcerated or were recently incarcerated. This study aimed to describe MOUD uptake and barriers among people living with human immunodeficiency virus and using illicit opioids reentering the community from incarceration. A mixed-method exploratory study was conducted between September 2021 and September 2022 in South Africa, during which we offered low-barrier MOUD and harm reduction services. We followed 23 participants postrelease and observed a low uptake of MOUD after release (8 of 23, 35%). Reported barriers to MOUD included perceived ineffectiveness, a preference for residential withdrawal management, and delays in initiating MOUD. Innovation is needed in strategies to deliver MOUD and harm reduction in South Africa.
Get full access to this article
View all access options for this article.
References
1.
AickenC. R., NardoneA., & MercerC. H. (2011). Alcohol misuse, sexual risk behaviour and adverse sexual health outcomes: Evidence from Britain’s national probability sexual behaviour surveys. Journal of Public Health, 33(2), 262–271. 10.1093/pubmed/fdq056
2.
AlamF., WrightN., RobertsP., DhadleyS., TownleyJ., & WebsterR. (2019). Optimising opioid substitution therapy in the prison environment. International Journal of Prisoner Health, 15(4), 293–307. 10.1108/IJPH-12-2017-0061
3.
AllenB., NolanM. L., & PaoneD. (2019). Article commentary: Underutilization of medications to treat opioid use disorder: What role does stigma play? Substance Abuse, 40(4), 459–465. 10.1080/08897077.2019.1640833
4.
AlticeF. L., KamarulzamanA., SorianoV. V., SchechterM., & FriedlandG. H. (2010). Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. The Lancet, 376(9738), 367–387. 10.1016/S0140-6736(10)60829-X
5.
AnY., HoffmannC. J., BhooraU., NdiniP., MoyoD., SteinerL., TshumaS., MabutoT., HugoJ., OwczarzakJ., & MarcusT. S. (2023). Opioid use and HIV treatment services experiences among male criminal justice-involved persons in South Africa: A qualitative study. Harm Reduction Journal, 20(1), 90. 10.1186/s12954-023-00834-6
6.
AzbelL., WegmanM. P., PolonskyM., BachireddyC., MeyerJ., ShumskayaN., KurmanalievaA., DvoryakS., & AlticeF. L. (2018). Drug injection within prison in Kyrgyzstan: Elevated HIV risk and implications for scaling up opioid agonist treatments. International Journal of Prisoner Health, 14(3), 175–187. 10.1108/ijph-03-2017-0016
7.
BachireddyC., ShresthaR., BrombergD. J., AzbelL., KurmanalievaA., WegmanM., ShumskayaN., RozanovaJ., MeyerJ. P., & AlticeF. L. (2022). Methadone within prison and linkage to and retention in treatment upon community release for people with opioid use disorder in Kyrgyzstan: Evaluation of a national program. The International Journal on Drug Policy, 101, 103558. 10.1016/j.drugpo.2021.103558
8.
BinswangerI. A., BlatchfordP. J., MuellerS. R., & SternM. F. (2013). Mortality after prison release: Opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Annals of Internal Medicine, 159(9), 592–600. 10.7326/0003-4819-159-9-201311050-00005
9.
BradfordD., ParmanM., LevyS., TurnerW. H., LiL., LeischL., EatonE., & CrockettK. B. (2023). HIV and addiction services for people who inject drugs: Healthcare provider perceptions on integrated care in the U.S. South. Journal of Primary Care & Community Health, 14, 21501319231161208. 10.1177/21501319231161208
10.
CatesL., & BrownA. R. (2023). Medications for opioid use disorder during incarceration and post-release outcomes. Health & Justice, 11(1), 4. 10.1186/s40352-023-00209-w
11.
ChamberlainA., NyamuS., AminawungJ., WangE. A., ShavitS., & FoxA. D. (2019). Illicit substance use after release from prison among formerly incarcerated primary care patients: A cross-sectional study. Addiction Science & Clinical Practice, 14(1). 10.1186/s13722-019-0136-6
12.
CioeK., BiondiB. E., EaslyR., SimardA., ZhengX., & SpringerS. A. (2020). A systematic review of patients’ and providers’ perspectives of medications for treatment of opioid use disorder. Journal of Substance Abuse Treatment, 119, 108146. 10.1016/j.jsat.2020.108146
DomingoA. K., PascheS., JarvisL., & WeichL. (2022). Perceptions and experiences of patients attending an opioid substitution clinic in South Africa. South African Journal of Psychiatry, 28, 1936. 10.4102/sajpsychiatry.v28i0.1936
15.
DorgayC. E., BrombergD. J., DoltuS., LitzT., GalvezS., PolonskyM., DvoryakS., & AlticeF. L. (2022). A pilot implementation study to scale-up methadone in incarcerated persons with opioid use disorder and retain them on treatment after release in Moldova. The International Journal on Drug Policy, 104, 103683. 10.1016/j.drugpo.2022.103683
16.
DuffyM., GhoshA., GeltmanA., MahaniahG. K., Higgins-BiddleM., & ClarkM. (2022). Coordinating Systems of care for HIV and opioid use disorder: A systematic review of enablers and barriers to integrated service access, and systems and tools required for implementation. Medical Care Research and Review, 79(5), 618–639. 10.1177/10775587211051182
17.
FanucchiL., SpringerS. A., & KorthuisP. T. (2019). Medications for treatment of opioid use disorder among persons living with HIV. Current HIV/AIDS Reports, 16(1), 1–6. 10.1007/s11904-019-00436-7
18.
FippsD. C., OesterleT. S., & KollaB. P. (2024). Opioid maintenance therapy: A review of methadone, buprenorphine, and naltrexone treatments for opioid use disorder. Seminars in Neurology, 44(4), 441–451. 10.1055/s-0044-1787571
19.
FuJ. J., ZallerN. D., YokellM. A., BazaziA. R., & RichJ. D. (2013). Forced withdrawal from methadone maintenance therapy in criminal justice settings: A critical treatment barrier in the United States. Journal of Substance Abuse Treatment, 44(5), 502–505. 10.1016/j.jsat.2012.10.005
20.
GordonM. S., KinlockT. W., & MillerP. M. (2011). Medication-assisted treatment research with criminal justice populations: Challenges of implementation. Behavioral Sciences & the Law, 29(6), 829–845. 10.1002/bsl.1015
21.
HaleyD. F., GolinC. E., FarelC. E., WohlD. A., ScheyettA. M., GarrettJ. J., RosenD. L., & ParkerS. D. (2014). Multilevel challenges to engagement in HIV care after prison release: A theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry. BMC Public Health, 14(1), 1253. 10.1186/1471-2458-14-1253
22.
HarkerN., LucasW. C., LaubscherR., DadaS., MyersB., & ParryC. D. (2020). Is South Africa being spared the global opioid crisis? A review of trends in drug treatment demand for heroin, nyaope and codeine-related medicines in South Africa (2012-2017). International Journal of Drug Policy, 83, 102839. 10.1016/j.drugpo.2020.102839
23.
JoudreyP. J., AdamsZ. M., BachP., Van BurenS., ChaitonJ. A., EhrenfeldL., GuerraM. E., GleesonB., KimmelS. D., MedleyA., MekidecheW., PaquetM., SungM., WangM., You KheangR. O., ZhangJ., WangE. A., & EdelmanE. J. (2021). Methadone access for opioid use disorder during the COVID-19 pandemic within the United States and Canada. JAMA Network Open, 4(7), e2118223. 10.1001/jamanetworkopen.2021.18223
24.
JoudreyP. J., ChadiN., RoyP., MorfordK. L., BachP., KimmelS., WangE. A., & CalcaterraS. L. (2020). Pharmacy-based methadone dispensing and drive time to methadone treatment in five states within the United States: A cross-sectional study. Drug and Alcohol Dependence, 211, 107968. 10.1016/j.drugalcdep.2020.107968
25.
Khazaee-PoolM., MoeeniM., PonnetK., FallahiA., JahangiriL., & PashaeiT. (2018). Perceived barriers to methadone maintenance treatment among Iranian opioid users. International Journal for Equity in Health, 17(1), 75. 10.1186/s12939-018-0787-z
26.
KinlockT. W., BattjesR. J., SchwartzR. P., & TeamM. T. C. P. (2005). A novel opioid maintenance program for prisoners: Report of post-release outcomes. American Journal of Drug and Alcohol Abuse, 31(3), 433–454. 10.1081/ada-200056804
27.
KrawczykN., PicherC. E., FederK. A., & SalonerB. (2017). Only one in twenty justice-referred adults in specialty treatment for opioid use receive methadone or buprenorphine. Health Affairs, 36(12), 2046–2053. 10.1377/hlthaff.2017.0890
28.
LibermanA. R., BrombergD. J., LitzT., KurmanalievaA., GalvezS., RozanovaJ., AzbelL., MeyerJ. P., & AlticeF. L. (2022). Interest without uptake: A mixed-methods analysis of methadone utilization in Kyrgyz prisons. PLOS One, 17(10), e0276723. 10.1371/journal.pone.0276723
29.
LierA. J., TarfaA., ShenoiS. V., KuoI., & SpringerS. A. (2024). HIV and substance use disorders. Infectious Disease Clinics of North America, 38(3), 599–611. 10.1016/j.idc.2024.06.003
30.
LoeligerK. B., MeyerJ. P., DesaiM. M., CiarleglioM. M., GallagherC., & AlticeF. L. (2018). Retention in HIV care during the 3 years following release from incarceration: A cohort study. PLOS Medicine, 15(10), e1002667. 10.1371/journal.pmed.1002667
31.
MabutoT., WoznicaD. M., LekubuG., SeatlholoN., Mshweshwe-PakelaN., CharalambousS., & HoffmannC. J. (2020). Observational study of continuity of HIV care following release from correctional facilities in South Africa. BMC Public Health, 20(1), 324. 10.1186/s12889-020-8417-2
32.
MabutoT., WoznicaD. M., NdiniP., MoyoD., AbrahamM., HanrahanC., CharalambousS., ZackB., BaralS., OwczarzakJ., & HoffmannC. J. (2024). Transitional community adherence support for people leaving incarceration in South Africa: A pragmatic, open-label, randomised controlled trial. The Lancet. HIV, 11(1), e11–e19. 10.1016/s2352-3018(23)00235-7
33.
MartinR. A., Alexander-ScottN., BerkJ., CarpenterR. W., KangA., HoadleyA., KaplowitzE., HurleyL., RichJ. D., & ClarkeJ. G. (2023). Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: A retrospective cohort study. The Lancet Regional Health. Americas, 18, 100419. 10.1016/j.lana.2022.100419
34.
MassonC. L., SorensenJ. L., PhibbsC. S., & OkinR. L. (2004). Predictors of medical service utilization among individuals with co-occurring HIV infection and substance abuse disorders. AIDS Care, 16(6), 744–755. 10.1080/09540120412331269585
35.
McKenzieM., ZallerN., DickmanS. L., GreenT. C., ParihkA., FriedmannP. D., & RichJ. D. (2012). A randomized trial of methadone initiation prior to release from incarceration. Substance Abuse, 33(1), 19–29. 10.1080/08897077.2011.609446
36.
McNamaraK. F., BiondiB. E., Hernández-RamírezR. U., TawehN., GrimshawA. A., & SpringerS. A. (2021). A systematic review and meta-analysis of studies evaluating the effect of medication treatment for opioid use disorder on infectious disease outcomes. Open Forum Infectious Diseases, 8(8), ofab289. 10.1093/ofid/ofab289
37.
MeyerJ. P., AlthoffA. L., & AlticeF. L. (2013). Optimizing care for HIV-infected people who use drugs: Evidence-based approaches to overcoming healthcare disparities. Clinical Infectious Diseases, 57(9), 1309–1317. 10.1093/cid/cit427
38.
MooreK. E., RobertsW., ReidH. H., SmithK. M. Z., OberleitnerL. M. S., & McKeeS. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32–43. 10.1016/j.jsat.2018.12.003
39.
NaidooS., & MkizeD. L. (2012). Prevalence of mental disorders in a prison population in Durban, South Africa. African Journal of Psychiatry, 15(1), 30–35. 10.4314/ajpsy.v15i1.4
40.
NaidooS., SubramaneyU., ParukS., & FerreiraL. (2022). Mental illness and HIV amongst female inmates in Durban, South Africa. South African Journal of Psychiatry, 28, 1628. 10.4102/sajpsychiatry.v28i0.1628
41.
NyashanuT., ScheibeA., & VisserM. (2024). ‘I went for rehab many times and it never worked, but the harm reduction process has given me renewed hope’. Perceptions on the effectiveness of harm reduction and community-based opioid substitution therapy. Health Promotion Journal of Australia, 35(3), 653–661. 10.1002/hpja.789
42.
ParchinskiK., Di PaolaA., WilsonA. P., & SpringerS. A. (2023). The relationship between reincarceration and treatment of opioid use disorder with extended-release naltrexone among persons with HIV. Drug and Alcohol Dependence Reports, 7(2), 100159. 10.1016/j.dadr.2023.100159
43.
RabinovichR., OwczarzakJ., MabutoT., NtombelaN., WoznicaD., & HoffmannC. J. (2022). Social support needs of HIV-positive individuals reentering community settings from correctional facilities in Johannesburg, South Africa. AIDS Care, 34(10), 1347–1354. 10.1080/09540121.2021.1990200
44.
RichJ. D., McKenzieM., LarneyS., WongJ. B., TranL., ClarkeJ., NoskaA., ReddyM., & ZallerN. (2015). Methadone continuation versus forced withdrawal on incarceration in a combined U.S. prison and jail: A randomised, open-label trial. The Lancet, 386(9991), 350–359. 10.1016/s0140-6736(14)62338-2
45.
RodgerL., NaderM., TurnerS., & LurieE. (2023). Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: A case series. European Journal of Medical Research, 28(1), 573. 10.1186/s40001-023-01538-0
46.
Rowell-CunsoloT. L., & BelleroseM. (2021). Utilization of substance use treatment among criminal justice-involved individuals in the United States. Journal of Substance Abuse Treatment, 125, 108423. https://doi.org10.1016/j.jsat.2021.108423
47.
SharmaA., O’GradyK. E., KellyS. M., GryczynskiJ., MitchellS. G., & SchwartzR. P. (2016). Pharmacotherapy for opioid dependence in jails and prisons: Research review update and future directions. Substance Abuse and Rehabilitation, 7, 27–40. 10.2147/SAR.S81602
48.
ShellyS. H., J., ScheibeA., & MarcusT. (2019). The community oriented substance use programme: A public well-being response to the use of drugs in Tshwane, South Africa, HR19-281 [paper presentation]. Harm Reduction International Conference, Porto, Portugal.
49.
SmithH. J., HerceM. E., MwilaC., ChisengaP., YengaC., ChibweB., MaiV., KashelaL., NanyagweM., HatwiindaS., MoongaC. N., MushekeM., LunguY., SikazweI., & ToppS. M. (2023). Experiences of justice-involved people transitioning to HIV care in the community after prison release in Lusaka, Zambia: A qualitative study. Global Health: Science and Practice, 11(2), e2200444. 10.9745/ghsp-d-22-00444
50.
SociasM. E., & MilloyM.-J. (2018). Substance use and adherence to antiretroviral therapy: What is known and what is unknown. Current Infectious Disease Reports, 20(9), 36. 10.1007/s11908-018-0636-7
51.
SpringerS. A., Di PaolaA., AzarM. M., BarbourR., BiondiB. E., DesabraisM., LincolnT., SkiestD. J., & AlticeF. L. (2018). Extended-release naltrexone improves viral suppression among incarcerated persons living with HIV with opioid use disorders transitioning to the community: Results of a double-blind, placebo-controlled randomized trial. Journal of Acquired Immune Deficiency Syndromes (1999), 78(1), 43–53. 10.1097/qai.0000000000001634
52.
StoverH., TarjanA., HorvathG., & MontanariL. (2021). The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases. Harm Reduction Journal, 18(1). 10.1186/s12954-021-00506-3
53.
TelisingheL., FieldingK. L., MaldenJ. L., HanifaY., ChurchyardG. J., GrantA. D., & CharalambousS. (2014). High tuberculosis prevalence in a South African prison: The need for routine tuberculosis screening. PLOS One, 9(1), e87262. 10.1371/journal.pone.0087262
54.
TlaliM., ScheibeA., RuffieuxY., CornellM., WettsteinA. E., EggerM., DaviesM.-A., MaartensG., JohnsonL. F., & HaasA. D. (2022). Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study. The International Journal on Drug Policy, 109, 103853. 10.1016/j.drugpo.2022.103853
55.
WHO ASSIST Working Group. (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility. Addiction, 97(9), 1183–1194. 10.1046/j.1360-0443.2002.00185.x
56.
XuH., GuJ., LauJ. T. F., ZhongY., FanL., ZhaoY., HaoC., HeW., & LingW. (2012). Misconceptions toward methadone maintenance treatment (MMT) and associated factors among new MMT users in Guangzhou, China. Addictive Behaviors, 37(5), 657–662. 10.1016/j.addbeh.2012.01.020
57.
ZanoniB. C., MilfordC., SitholeK., MoseryN., WilsonM., BosmanS., & SmitJ. (2023). High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa. PLOS One, 18(5), e0281030. 10.1371/journal.pone.0281030
58.
ZumaK., SimbayiL., ZunguN., MoyoS., MarindaE., JoosteS., NorthA., NadolP., AynalemG., IgumborE., DietrichC., SigidaS., ChibiB., MakolaL., KondloL., PorterS., & RamlaganS. (2022). The HIV epidemic in South Africa: Key findings from 2017 National Population-Based Survey. International Journal of Environmental Research and Public Health, 19(13), 8125. 10.3390/ijerph19138125
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
