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Drug use, related problems and interventions targeting drug users in prison in the European countries: main issues and challenges for the future. Linda Montanari, Luis Royuela, Dagmar Hedrich

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Drug use, related problems and interventions targeting drug users in prison in the European countries:main issues and challenges for the future

  • Linda Montanari, Luis Royuela, Dagmar Hedrich

  • Prison Health in Europe: missions, roles and responsibilities of international organizations, Council of Europe, Strasbourg, 27 May 2014


Emcdda european monitoring centre on drugs and drug addiction
EMCDDA users in prison in the European countries:(European Monitoring Centre on Drugs and Drug Addiction)

  • EU decentralised Agency established in 1993 in Lisbon

  • 28 MS + TK; NO; + candidate/potential candidates and neighbouring countries

  • Mandate: provide factual, objective, reliable and comparable information at European level on drugs use, related consequences and responses to drug related problems

  • Information sources on drugs and prison:

    • Yearly national reports (1 section on drugs and prison)

    • Drug use before and during prison and drug injection among prisoners

    • People entering drug treatment in prison (demand for drug treatment)

    • Infectious diseases among drug users, including prison setting

    • Services targeting drug users in prison


Problems drug users pdu prison
Problems drug users (PDU) Prison users in prison in the European countries:

  • European research on PDU and their experience with prison:

  • PDU increase the risk of imprisonment

  • 30%–75% of PDU have been in prison at least once in their life (Ravndal, Amundsen, 2010)

  • Imprisonment associated with higher rates of heroin and cocaine use(Gaffney, 2008)

  • Imprisonment has an additional negative effect on already vulnerable populations (ACMD, 1996)

  • Imprisonment associated with higher risk of earlier relapse from treatment (Smyth, 2010)

  • Prisons as places to reach drug users not in contact with other services


Prison drug users
Prison users in prison in the European countries:Drug users

Lifetime prevalence of drug use among prisoners

80% of prisoners use tobacco (20–30% gen. pop.)

Source: Statistical bulletin 2014


Drug use ever within prison heroin cocaine amphetamines out of all prisoners
Drug use (ever) within prison: heroin, cocaine, amphetamines (% out of all prisoners)

Source: Statistical bulletin 2014


Drug injecting among prisoners before and within prison out of all prisoners
Drug injecting among prisoners (before and within prison) (% out of all prisoners)

Source: Statistical bulletin 2013

BG: heroin; LV: amphetamines; UK: females

Different years


Infectious diseases
Infectious Diseases out of all prisoners)

  • HIV+ among IDUs in EU prisons:

  • from 0% to 8% but up to 40%

  • HCV+ among IDUs in EU prison:

  • from 12% to 91%

  • Odd Ratios for IDUs with Prison/No Prison history:

    • HIV: up to 3 OR

    • HCV: up to 7 OR


Mortality of eu drug users after prison release
Mortality of EU drug users after prison release out of all prisoners)

  • Extremely high risk of drug-induced deaths (‘overdoses’) in the first weeks after release from prison

  • European studies on excess mortality risk (SMR) after prison release:

    • England/Wales (first week): X 29 (M) X 69 (F)

    • Denmark (first two weeks): X 62 for males and females

    • Ireland: analysis of cohort of Drug Related Deaths: - 28% of DRD had left prison since 1 week - 18% of DRD had left prison since 1 month


The eu policy framework
The EU policy framework out of all prisoners)

  • Council Resolution Nov 2002 on drug treatment in prison

  • 3 EU Drugs Action Plans (2000-2004; 2005–2008; 2009-2012)

    • develop alternatives to prison

    • develop drug services for people in prison

    • provide access to health care for drug users in prison…”

    • implement indicators to monitor drug use, problems and services”

  • EU Drug Strategy 2013-2020:

    • “scale up and develop drug demand reduction measures in prison based on health and needs assessment

Source: 2012 Selected Issue on Drugs and Prison


National policies
National policies out of all prisoners)

  • Historically health care within Ministry responsible for prison (Justice/Interior)

  • Prison health under Ministry of Health (7 countries -40% prison population)

  • Half countries have a specific prison objective in national drugs strategy

  • Most countries cover drugs in their prison health strategies

  • 3 countries have specific prison-drugs strategies


Treatment and harm reduction for drug users in eu countries
Treatment and harm reduction for drug users in EU countries out of all prisoners)

  • Treatment

  • Low intensity drug treatment (counselling, short terms interventions in outpatient regime)

  • Medium or high intensity drug-free treatment (inpatients wards)

  • Medium or long term opioid substitution treatment

Harm Reduction

Prevention of infectious diseases

Needles and syringe programmes (Ge, Lu, Pt, Ro, Sp)

  • Principles

  • Prison staff and community staff providing drug treatment

  • Continuity prison and community

Source: 2012 Selected Issue on Drugs and Prison


Estimated availability of residential drug free treatment in european prisons
Estimated availability of residential drug-free treatment in European prisons

  • Existing in most countries but

  • to a different extent

  • In 21 out of 25 providing

  • information


Prisons European prisons— implementing substitution treatment

Opioids >

Cumulative number of EU countries with opioid substitution treatment in community and prison settings


Methodological developments
Methodological developments European prisons

  • Limitations in data quality and comparability

  • EMCDDA contribution towards a methodological framework for monitoring drugs and prison in Europe (COR-DROGUE 15/2/2014)

    • Questionnaire on drug use among prisoners in Europe

      (to piloted in2015 an starting in 2016; 6 sections and methodological guidelines, international organizations and all EU discussed it)

    • Survey of drug-related health facilities in European prisons

      (to be developed in 2014)


http://www.emcdda.europa.eu/ European prisons

http://www.emcdda.europa.eu/activities/prison

http://www.emcdda.europa.eu/publications/scientific-studies/eqdp

http://www.emcdda.europa.eu/publications/selected-issues/prison

http://www.emcdda.europa.eu/topics/prison



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