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Treatment of drug addiction in prisons

zurhold@uke.de. Treatment of drug addiction in prisons. Experiences from Germany and EU. Heike Zurhold. Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg. Problem drug users in prisons. In 24 countries (86%) an initial screening for drug use problems is conducted.

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Treatment of drug addiction in prisons

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  1. zurhold@uke.de Treatment of drug addiction in prisons Experiencesfrom Germany and EU Heike Zurhold Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg

  2. Problem drug users in prisons In 24 countries (86%) an initial screening for drug use problems is conducted

  3. Germany and Serbia (2012) World prisonbrief: http://www.prisonstudies.org Germany • Prison population rate: 80 • 186 prisons • Capacity: 78,000 • 66,000 prisoners • Occupancy: 85% • 15,000 drug addicts Serbia • Prison population rate: 153 • 28 prisons • Capacity: 7,000 • 11,000 prisoners • Occupancy: 158% • 4,500 drug addicts Overcrowding: limited accesstotreatmentandhealthcare, increaseofinfectiousdiseases

  4. Prevalenceofdrugsproblems In Europe – about 1 million prisoners per year • 10-30% sentenced for drug related offences • Drugs problems are overrepresented in the prison population • 10-45% report regular drug use in prison • 1-31% inject at least one time in prison • 3-26% first used drugs while incarcerated • 90% relapse to heroin after release

  5. 15 Key Interventions to address HIV in prisons UNODC (2012) has defined a comprehensive package of essential interventions for effective HIV prevention and treatment Among them • HIV testing and counselling • Condom programmes • Drug dependence treatment • Needle and syringe programmes • Vaccination, diagnosis and treatment of viral hepatitis • Prevention of transmission through tattooing, piercing and other forms of skin penetration

  6. Time gaps in the official introduction of OST in prisons: about 7-8y (Source: EMCDDA, Statistical Bulletin 2)

  7. Provision of drug treatment (28 countries) OST-based detoxification is not available in: Bulgaria, Cyprus, Finland, Latvia, Lithuania, Portugal, and Slovakia - OST is not available in: Bulgaria, Cyprus, Lithuania, Slovakia, Greece, Hungary

  8. Healthcare in prisons in Germany Responsibility: Ministry of Justice • Finances all physicians and treatment services in prison (including HIV; HCV treatment) • Finances also staff of community services providing counselling in prison • Prisoners: have the legal right of health care according to the standards of the health insurance Development of drug treatment • Legal framework in place • Promoted by prison administration and the whole prison staff • Access of NGOs to prisons – complementary drug services

  9. OST in German prisons • In community – increase in OST to 50% of heroin addicts (80,000 OST patients) • In prison: about 1,500 prisoners in OST (less than 10%) - In UK and Luxembourg: about 20% in OS • Available in 3 of 4 prisons • Mainly if OST was started in community – rarely initiated in prison • Best practice in NRW • Recommendations for OST in prison (2010) • Prison physicians have to argue if they not accept continuation of OST • General problem: abstinence as target of prisons, resistance of physicians due to ideological attitudes

  10. Drug counselling in prison • Provided by community NGOs with staff specifically dedicated to work with drug dependent prisoners • Easy access to prisons with fixed dates in prison – supported by prison administration • Main objective • To initiate drug treatment in community (treatment instead of punishment) • Main services • Individual counselling to motivate for residential treatment • Groups for treatment preparation or relapse prevention • Cooperation with internal drug services, courts, residential rehabs • Continued care during imprisonment and after release

  11. Whatworks - evidence Evidence OST - Reduces mortality by one third, reduces injecting by 55-75% and sharing of injecting equipment by 47-73%1, reduces criminal offenses Therapy for HCV, HIV - Cost-effective, in case of HCV effective prevention TC- effective in all settings, reduces re-offending, relapse to drug use, supports community integration NSP – reduces sharing of drugs and injecting equipment Drug counselling – increases self-efficacy with regard to risk reduction NO Evidence Drug-free units supports during imprisonment, but persisting effect after release unclear Information, education on infectious diseases - no clear decrease in injecting, no decrease of sexual risk behaviour 1 Larney, S. (2010): Systematicreviewof OST in prisons. Addiction (105)

  12. Conclusions • High prevalence of PDU in prison does not mean to address this adequately • For implementation OST there is a time gap of several years • Principle of equivalence = driving force BUT • Abstinence is dominant approach • OST not fully implemented • NSP still an exception • Condom provision not available in all EU countries • Safer tattooing? • Alternatives to imprisonment = better healthcare

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