Thank you for your letter Samsara. It can be very hard to get medications for opioid dependence in prison and in the community. This article will try to explain why. The best treatments available for heroin dependence in Australia are methadone and buprenorphine (given as the Suboxone film or the long-acting injectable). Unfortunately, we don’t have enough prescribers providing treatment across the country.

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Why is it hard to find prescribing doctors and nurses?

• Some doctors and nurses won’t prescribe the medications because of stigma and discrimination about people who use drugs.
• Some doctors and nurses are worried people will overdose which is a risk to their licence to practice as a doctor.

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Why is methadone and buprenorphine harder to get in prisons and corrections centres?

Prescribing and supervising people who are dosing on methadone and buprenorphine comes with its own set of rules and issues we don’t get with other medications. We know it isn’t fair, but in prisons and corrections settings, getting these medications to the people who need them is even more complicated than it is in the community.

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Some of the issues that make it difficult for prisons and corrections centres to give medication for heroin dependence include:

• Many prisons are in regional areas, where prescribing doctors and nurses are harder to find than in the bigger cities.
• Some of the short-term detention and remand centres don’t have systems in place that can quickly get people dosed or don’t have qualified health workers to provide the medications.
• Prisons won’t let people get any takeaway doses. That means people have to be supervised going to the clinic and getting dosed. This takes time and more prison and health workers.

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All of these issues mean that methadone and buprenorphine are expensive, time-consuming and difficult to organise. For people in prisons, it means a direct impact on their health, wellbeing and rights to choose what they need, because they face:

• Very long waitlists, sometimes several months long.
• Prisons that only offer treatment to people already on the program before they go into the prison.
• Places that will only let people have the long-acting injectable buprenorphine because it doesn’t require daily dosing, has less overdose risk, is less likely to have people stood over, and is easier for the prisons to provide.
• Prisons that don’t provide any of these medications even if the person has been on them for a long time.

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How can we make change in prisons?

There are a lot of reasons and issues that result in people having no access to methadone and buprenorphine while in prison in Australia.

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The good news is that there are people who are working hard to make positive changes, and you can join us in speaking out.

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The Australian Injecting and Illicit Drug Users League (AIVL) is a national organisation made up of people who use drugs and state Drug user Organisations (DUOs) across every state and territory in Australia. We’ve been fighting for the rights of our community of people who use drugs since 1989, along with other organisations, doctors, nurses, and even government officials.

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We have worked to create policies and campaigns calling for:

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Fast Access to Treatment

You should be able to get medications soon after entering prison.

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The Right Medication for You

Everyone deserves the choice of treatment that works best for their body and needs.

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Training and Resources for Prisons

Prisons and other corrections services should have well-trained health workers and staff who understand why these medications are important.

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Respect, Equity and Dignity

People who use drugs who are in prison have the right to the same healthcare other people can get in the community, and should be able to access it without judgement, fear or disrespect.

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AIVL will continue to work alongside others to ensure the best healthcare for people in prisons, corrections centres, and the community. To learn more about our work and how you can get involved, visit www.aivl.org.au, call 1800-692485 (MYAIVL), and mail at A1/35-39 Bourke Road Alexandria NSW 2015.

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You are not alone. There are people who believe you matter. Together, we will keep fighting to get everyone in prison access to the life-changing treatments they deserve.