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Treatment of drug addiction in prisons
Experiences from Germany and EU
Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg
zurhold@uke.de
Heike Zurhold
Problem drug users in prisonsA
ustr
ia
Bel
gium
Den
mar
k
Eng
land
Est
onia
Fra
nce
Ger
man
y
Latv
ia
Lith
uani
a
Net
herla
nds
Por
tuga
l
Slo
vaki
a
Slo
veni
a
Spa
in
Bul
garia
Cyp
rus
Fin
land
Gre
ece
Hun
gary
Irel
and
Ital
y
Nor
way
Pol
and
Rom
ania
Sco
tland
Sw
eden
Data (n=14) Estimation (n=12)
0
10
20
30
40
50
60
70
80
90
% of PDU in prisons
In 24 countries (86%) an initial screening for drug use problems is conducted
Germany and Serbia (2012)
GermanyPrison population rate:
80186 prisonsCapacity: 78,00066,000 prisonersOccupancy: 85%15,000 drug addicts
SerbiaPrison population rate:
15328 prisonsCapacity: 7,00011,000 prisonersOccupancy: 158%4,500 drug addicts
World prison brief: http://www.prisonstudies.org
Overcrowding: limited access to treatment and healthcare, increase of infectious diseases
Prevalence of drugs problems
In Europe – about 1 million prisoners per year
10-30% sentenced for drug related offences
Drugs problems are overrepresented in the prison population10-45% 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
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 themHIV testing and counsellingCondom programmesDrug dependence treatmentNeedle and syringe programmesVaccination, diagnosis and treatment of viral hepatitisPrevention of transmission through tattooing, piercing
and other forms of skin penetration
Time gaps in the official introduction of OST in prisons: about 7-8y (Source: EMCDDA, Statistical Bulletin 2)
SE
NL, UKDK
FI
IT
PTMT, AT LU
SI, ES, HR
DE, IE
PL,GRBE
FR, HU
LV, LT,BG
SK
CZ, RO,NO
CYTR
NL AT
DKIT
DE
FR, SIES
PT
LU, IE, NO HU
UK Scot
BE
PL, UK E&W,CZ, SE
HR
FI, RO,BG, EE TR
0
5
10
15
20
25
30
1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
OST in the community OST in prison
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
Detox
ificat
ion
with o
piat
e ag
onist
s
Provis
ion
of n
alox
one
OST
Contin
ued
OST at p
rison
ent
ry
Initia
ted
OST at p
rison
ent
ry
Initia
ted
OST bef
ore
rele
ase
0
8
16
24 21 1924 25
19
13
Number of countries providing
Healthcare in prisons in Germany
Responsibility: Ministry of JusticeFinances 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 treatmentLegal framework in place
Promoted by prison administration and the whole prison staff
Access of NGOs to prisons – complementary drug services
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 OSAvailable in 3 of 4 prisons
Mainly if OST was started in community – rarely initiated in prison
Best practice in NRWRecommendations 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
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 objectiveTo initiate drug treatment in community (treatment instead of
punishment)
Main servicesIndividual 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
What works - evidenceEvidence
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): Systematic review of OST in prisons. Addiction (105)
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 BUTAbstinence is dominant approachOST not fully implementedNSP still an exception Condom provision not available in all EU countriesSafer tattooing?
Alternatives to imprisonment = better healthcare
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