Communicable diseases such as HIV/AIDS, hepatitis, STDs, and tuberculosis, spread rapidly within prison populations through the drug injections that occur at detention facilities, and the spread of these diseases upon prisoners’ release is a matter of concern to the general public. Focusing on drug use within prisons specifically, the author describes drug substitution programs, such as methadone treatment, as consistently utilized within the prison community. Even with the problematic issues involved in methadone prescription in prisons, there is a need for the continuation of methadone treatment for former inmates following their release from prison. In addition, some countries where substitution drugs are prescribed in prison lack standardized prescription policies. A series of figures and tables are presented indicating prescribing guidelines for methadone maintenance and needle exchange programs in prison. Describing two needle exchange pilot programs in German men’s and women’s prisons, the article suggests that despite the programs’ successes, needle exchange programs have experienced much resistance from staff members, politicians, trade unions, and political lobbies. Tables, figures, references