Drug treatment and harm reduction in prisons

Key points • Estimates suggest that half the prisoners in the EU have a history of drug use, many with problematic injecting drug use. • Drug use is one of the main problems facing prison systems. It threatens security, dominates relationships between prisoners and staff and leads to violence, bullying and mobbing for both prisoners and often their spouses and friends in the community. • The prevalence of infectious diseases (particularly HIV and AIDS, hepatitis B and C, and TB) is often much higher in prisons than outside and often related to injecting drug use. • High rates of injecting drug use, if coupled with lack of access to evidence-based prevention measures, can result in a frighteningly rapid spread of HIV and hepatitis B and C. • Drug dependence services and measures to address infectious diseases in prisons should be equivalent to the services provided outside prisons. Continuity of treatment for prisoners entering and leaving prison necessitates close cooperation between prisons and external agencies. • Relapses into drug use and fatal overdoses after release are widespread. A wide range of drug services should be available to prisoners, based on local and individual needs. • Prison drug strategies require action for individual behavioural change as well as on the structural level. National and international networking and the exchange of good practice models seems to be a valuable method for all prison systems. Guidelines and detailed protocols are needed at national level in delivering adequate health care services (for example, for substitution treatment for opiate-dependent prisoners). • Drug services in prisons should be subject to monitoring and evaluation.