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

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)
• 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
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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
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services
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Prison
Drug users
Lifetime prevalence of drug use among prisoners
80% of prisoners use tobacco (20–30% gen. pop.)
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Source: Statistical bulletin 2014
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Drug use (ever) within prison: heroin, cocaine,
amphetamines (% out of all prisoners)
60
50
40
Heroin
30
Cocaine
Amphetamines
20
10
(S
co
tla
nd
)
Po
rtu
ga
l
Be
lg
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m
La
tv
ia
Li
th
ua
ni
a
U
ni
te
d
Ki
n
C
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c
h
Sp
ai
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ep
ub
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R
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la
nd
an
ia
om
R
Bu
lg
ar
ia
H
un
ga
ry
0
Source: Statistical bulletin 2014
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Drug injecting among prisoners (before and within
prison) (% out of all prisoners)
35
30
25
20
15
10
5
Ki
ng
do
m
an
y
ni
te
d
I ta
ly
vi
a
La
t
Sp
ai
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G
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U
C
ze
ch
R
ep
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Po
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Be
lg
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un
ga
ry
H
an
ce
Fr
Bu
lg
ar
ia
an
ia
R
om
an
d
Po
l
C
ro
at
ia
0
LTP injecting
Injecting in prison
Source: Statistical bulletin 2013
BG: heroin; LV: amphetamines; UK: females
Different years
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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:
• HCV:
up to 3 OR
up to 7 OR
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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
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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
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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
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Treatment and harm reduction for drug users
in EU countries
Treatment
1. Low intensity drug treatment (counselling, short terms
interventions in outpatient regime)
2. Medium or high intensity drug-free treatment (inpatients wards)
3. Medium or long term opioid substitution treatment
Harm Reduction
1. Prevention of infectious diseases
2. 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
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Estimated availability of residential drugfree treatment in European prisons
• Existing in most countries but
to a different extent
• In 21 out of 25 providing
information
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Prisons — implementing substitution treatment
Opioids >
Cumulative number of
EU countries with
opioid substitution
treatment in
community and prison
settings
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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)
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http://www.emcdda.europa.eu/
http://www.emcdda.europa.eu/activities/prison
http://www.emcdda.europa.eu/publications/scientificstudies/eqdp
http://www.emcdda.europa.eu/publications/selectedissues/prison
http://www.emcdda.europa.eu/topics/prison
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THANK YOU FOR YOUR ATTENTION
[email protected]
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