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      Introducing methadone maintenance therapy into Ukrainian prisons: a qualitative study of criminal subculture, Russia’s full-scale invasion, and contested methadone objects

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          Abstract

          Background

          After pilot testing, methadone was newly being introduced into Ukrainian prisons in 2021 as part of a national scale-up strategy to treat opioid use disorder and prevent transmission of HIV and HCV infections. Opioid agonist therapy (OAT) scale-up in Eastern Europe and Central Asia prisons has been hampered by varying levels of influence of criminal subculture, an extralegal informal governance by a social hierarchy that operates in parallel to formal prison authorities. This study examined the socio-environmental factors influencing the uptake of methadone treatment in Ukrainian prisons, including changes that evolved during Russia’s full-scale invasion of Ukraine and the displacement of people deprived of liberty (PDL) from conflict to non-conflict regions.

          Methods

          In-depth qualitative interviews ( N = 37) were conducted from January 2021 to October 2022 in the only two Ukrainian prisons where methadone was being introduced with PDL ( N = 18). These two prisons continued to provide methadone after the full-scale invasion. Former PDL ( N = 4) were also interviewed and prison staff ( N = 15). Interviews were audio-recorded, transcribed, and translated into English. Four authors independently reviewed, coded, and applied a phenomenological framework for data analysis, delineating themes related to criminal subculture, drug use, methadone uptake, and evolving changes during the Russian invasion.

          Findings

          Criminal subculture perceptions varied, with some seeing it as strongly discouraging drug use among certain groups, while others described it as a residual and weak influence from a more distant past. The influence of the subculture on methadone treatment uptake, however, was less clear. PDL and prison staff struggled to identify and articulate differences between illicit street-bought methadone, used recreationally, and medically prescribed methadone. Thus, the meaning of “methadone” varies in interpretation as it is being introduced, making it potentially conflicting for patients to opt into this evidence-based treatment. As Russia invaded Ukraine in 2022, PDL from conflict zones were transferred to non-conflict regions where methadone was being introduced. The prison environment became more enabling for PDL to start methadone as they were segregated and not subject to the existing criminal subculture’s rules and lacked the social ties necessary to procure drugs illegally.

          Conclusion

          It appears that the criminal subculture is variable and evolving in Ukrainian prisons and appears to be impacted differently by the invasion of Russia. As methadone scale-up in prisons expands, it will be important to distinguish the meaning of methadone perpetuated negatively by the prison subculture versus that in which it is intended as a medical treatment by the formal prison authorities. The current invasion of Ukraine by Russia provides a potential disruption to alter this course.

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          Most cited references52

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          Three approaches to qualitative content analysis.

          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, -Generation Theory by Comparative Analysis, - the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data, - the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, -Implications of Grounded Theory, - Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                30 November 2023
                2023
                : 14
                : 1227216
                Affiliations
                [1] 1Yale School of Medicine, Yale University , New Haven, CT, United States
                [2] 2Department of Epidemiology of Microbial Diseases, Yale University , New Haven, CT, United States
                [3] 3Department of Social and Behavioral Sciences, Yale University , New Haven, CT, United States
                [4] 4European Institute on Public Health Policy , Kyiv, Ukraine
                [5] 5Ukrainian Institute on Public Health Policy , Kyiv, Ukraine
                Author notes

                Edited by: Yasser Khazaal, Université de Lausanne, Switzerland

                Reviewed by: Emilien Jeannot, Center Hospitalier Universitaire Vaudois (CHUV), Switzerland; Darshan Singh, University of Science Malaysia (USM), Malaysia

                *Correspondence: Tetiana Kiriazova, kiriazova@ 123456uiphp.org.ua
                Article
                10.3389/fpsyt.2023.1227216
                10720714
                38098632
                3d587931-7480-499b-a2cb-bad6df3a4231
                Copyright © 2023 Ponticiello, Azbel, Tate, Bromberg, Pykalo, Kiriazova, Saichuk and Altice.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 June 2023
                : 17 October 2023
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 55, Pages: 12, Words: 10100
                Funding
                Funded by: NIH
                Award ID: R01DA033679; R01DA043125; R01DA029910; R21DA047902; F31DA054861; D43010540; T32 MH020031; and T32 GM136651
                The study is funded by several a grant NIH: R01DA033679; R01DA043125; R01DA029910; R21DA047902; F31DA054861; D43010540; T32 MH020031; and T32 GM136651.
                Categories
                Psychiatry
                Original Research
                Custom metadata
                Addictive Disorders

                Clinical Psychology & Psychiatry
                ukraine,hiv prevention,qualitative,methadone,prisons,russia,war,conflict
                Clinical Psychology & Psychiatry
                ukraine, hiv prevention, qualitative, methadone, prisons, russia, war, conflict

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