Linda Montanari, Luis Royuela, Dagmar Hedrich

1. 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

2. EMCDDA (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

3. Problems drug users (PDU) Prison • 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

4. Prison Drug users Lifetime prevalence of drug use among prisoners 80% of prisoners use tobacco (20–30% gen. pop.) Source: Statistical bulletin 2014

5. Drug use (ever) within prison: heroin, cocaine, amphetamines (% out of all prisoners) Source: Statistical bulletin 2014

6. Drug injecting among prisoners (before and within prison) (% out of all prisoners) Source: Statistical bulletin 2013 BG: heroin; LV: amphetamines; UK: females Different years

7. Infectious Diseases • 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

8. Mortality of EU drug users after prison release • 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

9. The EU policy framework • 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

10. National policies • 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

11. Treatment and harm reduction for drug users in EU countries • 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

12. 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

13. Prisons— implementing substitution treatment Opioids > Cumulative number of EU countries with opioid substitution treatment in community and prison settings

14. Methodological developments • 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)

15. http://www.emcdda.europa.eu/ 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

16. THANK YOU FOR YOUR ATTENTION • Linda.Montanari@emcdda.europa.eu