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Needle Exchange Programmes in Two German Prisons

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Needle Exchange Programmes in Two German Prisons International Journal of Drug Policy 11 (2000) 325–335 www.elsevier.com/locate/drugpo The transfer of harm-reduction strategies into prisons: needle exchange programmes in two German prisons Jutta Jacob, Heino Sto¨ver * Carl 6on Ossietzky Uni6ersity, Faculty of Social Sciences, P.O. Box 2503, D-26111, Oldenburg, Germany Received 1 September 1999; received in revised form 12 January 2000; accepted 16 March 2000 Abstract In Autumn 1995, the Minister of Justice of Lower Saxony (a northern state of Germany) gave the green light for the implementation of a 2-year pilot project. This project provided for the distribution of sterile injection equipment and provision of communicative methods of prevention to drug addicted inmates in a women’s prison with 170 inmates (Vechta) and a men’s prison with 230 inmates (Lingen). The decision to go ahead with the project was based on positive experiences in Swiss prisons and the supporting recommendations of a panel of experts. The pilot project in Vechta started on 15 April 1996, using five dispensing machines which allow a needle exchange to guarantee an anonymous access. The project in the men’s prison started on 15 July 1996. Here the staff of the drug counselling service and of the health care unit hand out sterile syringes to inmates. The social scientific evaluation was carried out by the Carl von Ossietzky University in Oldenburg. The study focused on the aim of the project which is to assess the feasibility, usefulness and efficacy of the measures undertaken. Of special interest was whether and how changes occured in the prison system itself (i.e. acceptance of the measures by staff, medical service and management), and in the drug user’s behaviour and knowledge (i.e. development of needle sharing, change in drug use patterns). The study used a multi-methodological approach: documentation of the project practice, half standardized, longitudinal examination of inmates (n=224) and staff (n=153), qualitative examination of management, selected groups of prisoners, staff and external organisations (AIDS-Help-Groups; n=75) for at least two times. The evaluation intended to be dynamic, process accompanying, in order to communicate the empirical data and developments with the practice already during the pilot phase. Results of the final report of the study are presented here. Finally this paper discusses shortly what is known so far about the impact of needle exchange programmes in prisons in Germany and Switzerland. © 2000 Elsevier Science B.V. All rights reserved. Keywords: Injecting drug user; Prisons; HIV; Hepatitis; Risk behaviours This is an extended version of a paper presented to the 10th International Conference on Drug-Related Harm, March 1999, Geneva. * Corresponding author. Tel.: +49-441-7985143; fax: +49-441-7985180. E-mail address: [email protected] (H. Sto¨ver). 0955-3959/00/$ - see front matter © 2000 Elsevier Science B.V. All rights reserved. PII: S0955-3959(00)00050-5 326 J. Jacob, H. Sto¨6er / International Journal of Drug Policy 11 (2000) 325–335 1. Drug use and infectious diseases in prisons (through relief offers, especially by giving drug users access to drug-free in-patient ther- In the past 30 years and particularly in the apies). In general it is not possible in prison last decade the number of prisoners using to give drug users an individual treatment illegal drugs has risen sharply in Germany, according to their drug history. Neither the just like in all of Europe (particularly inject- personnel needed for this nor the material ing drug use of heroin or cocaine has in- resources are available. Apart from this a creased). Today drug users make up a major prison is not a very suitable place for under- part of the prison population. International going a treatment that looks into the causes organizations (UNO, WHO) assume that ap- of a person’s drug use. prox. 30–50% of the 300 000 detainees in Despite the well known risks involved, European prisons have experienced health- some drug users continue to inject drugs in hazardous drug use. prison. Contrary to the situation outside For Germany, experts estimate the share of prison, until recently sterile needles were not prisoners who have already used illegal drugs supplied in prison. This preventive measure prior to incarceration, particularly injecting (against the spreading of infectious diseases) drug use, at approx. 20–30% of the total had proved effective outside prison. Not only prison community. A considerable number of the need to protect prisoners against the them continue to use drugs in prison. spreading of diseases but also the positive It is particularly problematic that the drug experience gained with this mesure in two users’ general state of health is poor which pilot projects in Switzerland induced deci- results from health-hazardous lifestyles prior sionmakers in Germany to implement such to, during and after detention. Health risks measures in German prisons as well. mainly arise from continued use of various substances which have partly strongly been diluted by foreign substances; frequently drug users try to start a withdrawal by themselves 2. Pilot project: ‘needle exchange programme and fail; in many cases drug consumers who in two prisons in Lower Saxony/Germany’ have just been released from prison mistak- enly take overdoses. Moreover the prevalence In Autumn 1995, the Minister of Justice of of infectious diseases like hepatitis B or C Lower Saxony (a northern state of Germany) and HIV among drug users in prison is very gave the green light for the implementation high. Particularly the disregard of hygienic of a 2-year pilot project. Under this project standards during drug injection is a great sterile injection needles were distributed source of infection. Prisoners are exposed to among drug users and communicative meth- considerable risks of infections because drugs ods of prevention were made available to are used secretly and injecting equipment is drug addicted inmates in a women’s prison shared. with a population of 170 prisoners (Vechta) Drug consumption in prison and its impli- and a men’s prison with a population of 230 cations are a major problem in the prison prisoners (Lingen). The decision to go ahead system. The problem is tackled by applying with the project was based on positive experi- measures that are aimed at reducing the sup- ences gained in two Swiss prisons and on the ply of drugs in prison (security and control supporting recommendations of a panel of measures) and the demand for drugs experts. J. Jacob, H. Sto¨6er / International Journal of Drug Policy 11 (2000) 325–335 327 The pilot project in Vechta started on 15 spective prison and the conditions prevailing April 1996. At five dispensing machines set up in the two institutions during the project, the in places which allow anonymous access, drug needle exchange project was-in principle-con- users can exchange a used needle for a sterile sidered feasible. one. The project in the men’s prison in Lingen In both prisons attacks on staff or fellow started on 15 July 1996. Here the staff of the inmates by drug-users using needles as a drug counselling service and of the health care weapon did not occur. It was not necessary unit hand out sterile syringes to inmates. The to exclude participants from the needle ex- following Table 1 (synopsis) gives an overview change project because they did not observe over the practical issues: the regulations agreed upon prior to the start of the project. In both prisons the number of used needles returned was high; the fear that 3. Results of the scientific monitoring of the drug users might not handle injection equip- project ment adequately or that they might store it in unsuitable places was not confirmed. The Social scientists of the Carl von Ossietzky only violations of the regulations that oc- University in Oldenburg monitored the pro- curred during the project were that the sy- ject. This monitoring was aimed at assessing ringes were not stored in the places that had the feasibility, usefulness and efficacy of the been agreed upon and that prisoners partici- measures undertaken by also taking the vari- pating in methadone programmes had sy- ous interests of the persons and institutions ringes in their possession. During the project involved into account. the controls of cells were not increased; the It was of special interest to determine if and number of drug finds did not rise either so in which way changes occurred in the prison that the fear that the availability of clean system itself. The focal points were: needles resulted in an increased drug use was feasibility of the Needle Exchange Pro- not confirmed. gramme in a closed women’s and men’s The implementation of the needle exchange prison; acceptance of the measures by prison programme as part of the general health ser- officers, medical service staff, management vice for addicts in detention did not have a and drug using inmates; negative effect on the onward referral of drug changes in the drug use patterns of the drug users to follow-up treatments. On the con- using inmates trary, it can be stated that after the project promoting health-oriented attitudes among has started the number of drug users under- drug-users, improvement of knowledge on going follow-up treatments has increased. As health and of health-oriented behaviour regards relaxations in detention, the partici- familiarizing drug-users with the signifi- pants in the needle exchange programme cance of the preventive measures accompa- were not treated differently from other drug nying the project. users in prison: controls of the cells of project participants were not increased. 3.1. Feasability of the needle exchange The managements of the two prisons could programme in a closed women’s and men’s decide for themselves which of the two modes prison of distribution – manually or dispensing ma- chine – they wanted to implement.
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