During Phase I, available placement slots were reserved for those inmates who had been receiving MMT in the community immediately prior to their incarceration. Eligible prisoners included:

• current opioid drug user[s]; assessed as having an extensive and chronic history of opioid dependence; or
• current opioid drug user[s] who [are] HIV positive, ha[ve] AIDS, hepatitis B or C; or
• current opioid drug user[s] who [are] pregnant (CSC 1998b).

Anecdotal evaluations of Phase I have been noted by NIDA (1999). Generally:

The results of urine drug screening suggest that participants are no longer engaging in injection drug use…. Parole officers and unit staff reported dramatic improvements in institutional behaviour once participants were stabilized on methadone treatment…. CSC’s Offender Management System and participants report improvements in institutional performance and reintegration potential. Although anecdotal in nature, the above statements indicate that CSC’s MMT program is proving effective in reducing relapse to opio[i]d drug use, thereby reducing the risk of transmission of infectious diseases and contributing to improvements in offender health (p. 3).

Now that Phase II has been initiated, inmates who wish to begin MMT during incarceration are permitted to participate (CSC 1998a). Eligible prisoners are required to meet the following three criteria:

• a diagnosis of dependence to opiates as established in the DSM-IV or a well-documented history of opiate addiction indicating a high risk of relapse as confirmed by a certified institutional physician; and
• a small likelihood of benefit from non-methadone treatment as evidenced by a past history of treatment failures; and
• agree[d] to terms and conditions of the Methadone Maintenance Treatment Program as evidenced by acceptance and willingness to sign the Methadone Treatment Agreement (CSC 2002).

Unfortunately, the current demand for MMT, both in the community and in Canadian prisons, exceeds available services. As a result, treatment is being provided on a prioritized basis. Within federal institutions, eligible inmates seeking MMT must not only meet the three criteria outlined above, but they must further be included in one of the following five categories of inmates:

• federally sentenced women who are pregnant and currently opioid dependent or were previously opioid dependent and are a high risk of relapse.
• inmates who are HIV positive and currently opioid dependent.
• inmates who have been determined to require treatment for Hepatitis C. A period of abstinence from all drugs including alcohol is required prior to initiation of Hepatitis C treatment.
• inmates who are currently opioid dependent with a recent history (within the past 3 months) of a life-threatening opioid overdose, endocarditis, septicemia, septic arthritis and/or suicidal behaviour directly related to their opiate dependence.
• inmates who are opioid dependent and will be released within the next 6 months with successful release plans for a community methadone provider (CSC 2002).

This last category of inmates necessarily raises important questions regarding the availability of MMT programs in the community. Unfortunately, federal inmates who receive MMT while institutionalized often experience a lack of continuity of care upon release. In fact, obtaining methadone by prescription in some places in Canada is extremely difficult, if not impossible. Accordingly, it is suggested that long-term success will best be achieved in helping heroin-addicted individuals, only if the community follows the nation’s lead in both providing and expanding existing MMT programs.