Naltrexone therapy for heroin addiction and HIV in Mauritius is the most effective way to control the epidemic in their prisons and general community. Mauritius is in the midst of a crisis that is recognized by the United Nations, and represents a clear warning to the rest of the world.
The State of Mauritius has 8 prisons falling under the direct command of the Commissioner of Prisons. Currently there are about 2500 prisoners serving under sentence of which about 85% are for drug related offenses. While drug addiction problems remain in the prison system there can be no expectation for positive change in criminal behavior or in the ability of those incarcerated to reintegrate into society once out in the community.
Drug addicts, if not treated properly and given the required therapy, have a 97% chance of relapse. This is a major concern as they return to their habits of taking illicit drugs, engaging in criminal activity to support their habit, and re-incarceration. There are accurate records of prisoners who, once addicted to drugs, become entrenched in the prison system where they are distanced even further from the possibility to engage in normal community activity.
Treating Drug Addiction in Prisons
Naltrexone is one of three major pharmacotherapies used to assist opiate-dependant patients or prisoners to manage their drug addiction. Changi Prison in Singapore has more than 13 years experience in providing excellent services to prisoners using Naltrexone to help exclude the craving for opiates in Singapore’s jails. The Go Medical sustained release Naltrexone implant pioneered by Dr George O’Neil in Western Australia is ideal for prison environments because the implant is inserted under the skin and lasts up to 6 months. In this type of preparation the prisoner would be unable to divert the medication.
The other two pharmacotherapies used in jails include Methadone and Buprenorphine which are both opiates that maintain an opiate level aimed at keeping the person comfortable enough to reduce crime in the prison. Unfortunately Buprenorphine (Subutex) has earned a bad reputation in prisons because the formulation takes too long to dissolve under the tongue and is easily diverted. For this reason many prisons do not allow Buprenorphine.
Methadone is used in many European, Australian and USA prisons. Diversion of the drug is better controlled than with Buprenorphine. Unfortunately maintaining the person’s addiction in prison removes the right of escaping from opiate dependence while in prison unless they are strong enough to undergo harsh and unassisted withdrawal illness. Some pro-active authorities believe that using Methadone in prison prevents or significantly delays recovery and delays a return to the normal non-opiate dependant community.
Increased Risk of HIV
In Mauritius, there has been a 400% increase in the incidence of HIV infections since 2004. This alarming rate of new infections has been linked to endless cycles of drug addiction and prison sentences for related offences. Approximately 86% of known HIV cases are attributable to intravenous drug use. In addition there is an increased risk of death by 5% due to overdose on release back into the community. Those who survive are at significant risk of re-offending and re-entering the prison system due to continued drug addiction. The length of time these people remain addicted to opiates is directly proportional to their risk of acquiring HIV and other viral infections. It is imperative that this cycle of drug addiction and HIV spread be broken as soon as possible by appropriate interventions.
Officials in Mauritius believe that Dr O’Neil’s proposed methods of intervention and treatment could revolutionize the way society manages the treatment of people with opiates abuse disorders. While the gold standard for treatment currently is maintenance therapy that allows addicts to substitute legal analogues for illegal opiates and manage their disorder to varying degrees, it is far from ideal. Unfortunately many countries which opted for substitution treatment with Subutex or Methadone now have to battle against illegal trade of these legal opiates. Furthermore, the rate of overdose has gone far higher than for any other drug.
Dr O’Neil’s treatment model in Perth, Western Australia, is based on abstinence and reversal of physiological addiction. It is only after complete relief from addiction that the individual may cease drug taking and be returned to a normal state of physical and mental health. In this way the drug related crimes will also diminish, relieving the pressure on the criminal justice system, and limiting the drain on health resources and state budgets as well as to increase security within the general community. This treatment will remove the market for drugs in prisons since Naltrexone is an opioid antagonist and therefore injecting heroin has no effect. By removing the benefits of, and the requirement for, opiates the practice of intravenous drug administration will diminish and consequently limit the spread of HIV and other viral infections.
At the time of writing this article the proposed project in Mauritius had been put on hold due to absence of support by funding organizations. Further information can be obtained by directing enquiries to freshstart.org and registering your interest. People that are HIV positive can visit positivesingles.com review to mingle with other people. This is a great way to make them feel like a part of the community. They can share their feelings and experience with other as well.