Why prisons in Slovakia lack opioid agonist treatment: literature review and expert interviews
Abstract
Background: Opioid agonist treatment (OAT) is a harm reduction intervention found to decrease the severity of withdrawal symptoms, overdose death, and rate of infectious diseases. Slovakia remains the only country in the European Union (EU) without officially available OAT in prisons, despite its implementation in the community and the evidence of need for opioid use treatment. This study examined the reasons for this gap by investigating the perception of OAT, and the barriers and facilitators of introducing in-prison OAT in Slovakia.
Methods: Using Zinberg’s model as a theoretical framework, content analysis of qualitative data from three sources was performed. A scoping review of scientific literature as well as of digital/print media on OAT and drug use in Slovak prisons was conducted via PubMed, JSTOR, Central Library of the Slovak Academy of Sciences, and LexisNexis. Findings from this review informed semi-structured interviews with six experts from drug research, the Slovak Ministries of Healthcare and Justice, academia, non-governmental organizations (NGO) and prison psychiatry.
Results: While the literature review of 23 records (9 scientific and 14 journalistic) was mostly supportive of OAT, it lacked in-depth discussion. Interviews indicated low endorsement from the Ministry of Justice and prison psychiatrists, who deemed it unnecessary due to insufficient evidence on drug use in Slovak prisons, and low awareness thereof. Major barriers included political unwillingness, perceptions of irrelevancy and redundancy, lack of research, poor intersectoral collaboration, and limited resources. Potential facilitators included improved resource allocation, increased awareness, and the involvement of NGO and EU.
Conclusions: Increased knowledge of available evidence, strong intersectoral cooperation within the government and with NGO, and rigorous data collection are necessary to effectively provide harm reduction programmes such as OAT to the people most in need.
Key messages: • The study identified existing barriers for the lack of opioid agonist treatment in Slovak prisons, and facilitators able to stimulate the implementation process to ensure equal access to healthcare.
• Political unwillingness rooting from the perceived irrelevancy of the treatment could be shifted by more rigorous data collection on in-prison drug use and stronger intersectoral collaboration.
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BibTeX
@article{bodi2026prisons,
title = {{Why prisons in Slovakia lack opioid agonist treatment: literature review and expert interviews}},
author = {R Bódi and L Montanari and PHHM Lemmens},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1911},
url = {https://doi.org/10.1093/eurpub/ckag169.1911},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Why prisons in Slovakia lack opioid agonist treatment: literature review and expert interviews
AU - R Bódi
AU - L Montanari
AU - PHHM Lemmens
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1911
UR - https://doi.org/10.1093/eurpub/ckag169.1911
AB - Background: Opioid agonist treatment (OAT) is a harm reduction intervention found to decrease the severity of withdrawal symptoms, overdose death, and rate of infectious diseases. Slovakia remains the only country in the European Union (EU) without officially available OAT in prisons, despite its implementation in the community and the evidence of need for opioid use treatment. This study examined the reasons for this gap by investigating the perception of OAT, and the barriers and facilitators of introducing in-prison OAT in Slovakia. Methods: Using Zinberg’s model as a theoretical framework, content analysis of qualitative data from three sources was performed. A scoping review of scientific literature as well as of digital/print media on OAT and drug use in Slovak prisons was conducted via PubMed, JSTOR, Central Library of the Slovak Academy of Sciences, and LexisNexis. Findings from this review informed semi-structured interviews with six experts from drug research, the Slovak Ministries of Healthcare and Justice, academia, non-governmental organizations (NGO) and prison psychiatry. Results: While the literature review of 23 records (9 scientific and 14 journalistic) was mostly supportive of OAT, it lacked in-depth discussion. Interviews indicated low endorsement from the Ministry of Justice and prison psychiatrists, who deemed it unnecessary due to insufficient evidence on drug use in Slovak prisons, and low awareness thereof. Major barriers included political unwillingness, perceptions of irrelevancy and redundancy, lack of research, poor intersectoral collaboration, and limited resources. Potential facilitators included improved resource allocation, increased awareness, and the involvement of NGO and EU. Conclusions: Increased knowledge of available evidence, strong intersectoral cooperation within the government and with NGO, and rigorous data collection are necessary to effectively provide harm reduction programmes such as OAT to the people most in need. Key messages: • The study identified existing barriers for the lack of opioid agonist treatment in Slovak prisons, and facilitators able to stimulate the implementation process to ensure equal access to healthcare. • Political unwillingness rooting from the perceived irrelevancy of the treatment could be shifted by more rigorous data collection on in-prison drug use and stronger intersectoral collaboration.
SN - 1101-1262
SN - 1464-360X
ER -