Addiction treatment and harm reduction programs in prisons: lessons from Iran.

Purpose: Substance use disorder is one of the most prevalent health issues among prison populations. In this regard, addiction treatment and harm reduction programs have been implemented in Iranian prisons since 2002. The purpose was to describe the practical experience of implementing harm reduction programs in Iran's prisons, emphasizing the impact of policy decisions on it.

Design/methodology/approach: The study was qualitative study. In addition to analyzing 16 documents, the authors conducted face-to-face semi-structured interviews with 11 key informants who were asked questions about the evolution of treatment and harm reduction programs in prisons. The authors analyzed the data using the content analysis method and MAXQDA-10 software.

Findings: The HIV outbreak in Iranian prisons in the late 20th century posed a significant challenge. Initially, policymakers' responses were varied from denying the issue to solving it, reflecting the prevailing abstinence paradigm among drug experts and politicians. However, a legal amendment was eventually issued based on evidence-based health literature. Despite initial obstacles such as financial constraints and lack of human resources, the successful implementation of large-scale harm reduction measures, including methadone maintenance treatment and interventions targeting infectious diseases, has led to the development of a unique health model in the Persian Gulf region. This model, born out of the Iranian experience, offers hope for the future of prison health.

Originality/value: Lessons from the Iran case could provide valuable insight for countries about the role of policy in implementing harm reduction programs in prisons. Policy advocacy and reform is one of the main measures to provide evidence-based health interventions in prisons.