Vietnam Introduces Methadone to Prisons, But Needle Exchange Severely Lacking

Vietnam has launched its first methadone maintenance therapy (MMT) program for prisoners in an effort to tackle drug dependency and the spread of blood-borne viruses (BBVs) such as HIV and hepatitis C among incarcerated people.

The program began in the capital Hanoi three months ago at the Phu Son Prison, according to the United Nations Office on Drugs and Crime (UNODC) who are supporting the project. There are already plans for expansion of similar programs to other sites, including the Than Xuan Prison, also located in the capital. 

Vietnam's Ministry of Public Service estimates that around 30 percent of prisoners use drugs, and in 2000, the last time data was comprehensibly collected, 28 percent of prisoners in Vietnam tested HIV positive

While no concrete figures exist for hepatitis C rates in the country's prisons, an estimated 74 percent of injecting drug users (IDUs) carry the virus, according to Harm Reduction International (HRI). Nearly 20 percent of IDUs are HIV positive.

Introducing methadone programs into prisons is an extremely progressive step, particularly in the regional context; only Indonesia and Malaysia currently offer opioid substitution therapy (OST), within which methadone falls, in prisons in Asia. However, while it is a step in the right direction, it is arguable that more needs to be done in conjunction with scaling up methadone provision in order to tackle BBVs.

For example, needle and syringe exchange programs (NSPs) are still absent in Vietnam's penitentiaries and could be more impactful in combating disease spread as it would significantly reduce the incidence of needle sharing, one of the key routes of virus transmission.

This is not to discount the importance of this move in Vietnam, though. Globally, OST programs are implemented in prisons in only 43 countries, according to data from 2014, a figure that is markedly lower than the 80 countries that offer programs to the general community. 

Furthermore, introducing methadone in prisons comes against the backdrop of broader OST scale-up in the country. Between 2012 and 2014 Vietnam increased their number of OST programs from 41 to 80 sites. 

However, if Vietnam is serious about tackling HIV and hepatitis C among IDUs then it must ensure that the harm reduction packages it provides are comprehensive. Alongside the increase in OST has been a decline in NSP provision, and the number of needles and syringes distributed to IDUs has almost halved since 2012, reported HRI. Introducing MMT in prisons must be applauded, but officials must be urged to ensure the country's harm reduction programs are meeting all needs.