This report examines the intertwined challenges of drug use and imprisonment and their effect on health outcomes in Eastern Europe and Central Asia (EECA), with a specific focus on people who inject drugs. EECA countries exhibit some of the highest rates of incarceration in the world, largely driven by the criminalization of drug use. The harsh policies result in disproportionately high rates of incarceration among people who inject drugs, creating significant public health issues, including the spread of HIV, hepatitis C, and tuberculosis. This report synthesizes key findings from the region, explores effective interventions, and outlines strategic recommendations for improving health outcomes within criminal justice settings.

EECA has some of the highest rates of incarceration globally, especially for drug-related offenses. In particular, Ukraine has one of Europe’s highest incarceration rates. The HIV epidemic in EECA is closely tied to the stringent criminalization of opioid use and resulting high rates of injection drug use among people in prisons, with prisons becoming focal points for the spread of HIV, hepatitis C, and tuberculosis.

The conditions within EECA prisons are challenging, exacerbating the health risks for incarcerated people, particularly those already vulnerable to infectious diseases. High prison populations, overcrowding, inadequate healthcare infrastructure, and chronic underfunding contribute to poor living conditions and the spread of infectious diseases. Health services, particularly for HIV prevention and treatment, are inadequate, and prisons remain a critical site for addressing the HIV epidemic.

The criminal subculture in EECA prisons plays a significant role in shaping the success of public health interventions like opioid agonist therapy (OAT). Resistance to methadone treatment and stigma associated with drug use within the prison population makes it essential to account for social dynamics when implementing OAT programs. Addressing the interdependence between prison authorities, healthcare providers, and informal leaders within the prison population is key to overcoming these barriers and improving the uptake of treatment.