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Final Report on Prevention, Treatment, and Harm Reduction Services Drug policy and harm reduction SANCO/2006/C4/02 Final Report on Prevention, Treatment, and Harm Reduction Services in Prison, on Reintegration Services on Release from Prison and Methods to Monitor/Analyse Drug use among Prisoners April 2008 WIAD Wissenschaftliches Institut der Centre for Interdisciplinary Ärzte Deutschlands gem. e.V. Addiction Research (CIAR) Neither the European Commission nor any person acting on its behalf is responsible for the use which might be made of the information contained herein. H. Stöver1, C. Weilandt3, H. Zurhold2, C. Hartwig1, K. Thane1,2 1 Bremen Institute for Drug Research (BISDRO), University of Bremen 2 Centre for Interdisciplinary Addiction Research (CIAR), University of Hamburg 3 Scientific Institute of the German Medical Association (WIAD gem. e.V.), Bonn Corresponding address: WIAD Ubierstrasse 78 D-53173 Bonn Germany tel 49 228 8104 182 fax +49 228 8104 1736 home www.wiad.de Executive Summary 1. Status-quo of prevention, treatment and harm reduction services for people in prisons, reintegration services for persons on release from prisons The main objective of this work package was to analyse the status-quo of prevention, treatment and harm reduction services for people in prisons and in reintegration services for persons on release from prisons. The report is based on data on health interventions targeting imprisoned drug users as well as on relevant information included in the national action plans on social inclusion prepared by the Member States within the context of the open method of coordination on social protection and social inclusion. A key result of this work package is that there is a need for more systematic research on the effectiveness of treatment for drug users in prison, as there is hardly any high-quality research in this field, especially in the EU. Although there exist a range of interventions for drug using inmates, the implementation is often sporadic and not sufficient to meet the needs. To promote and secure health in prison, testing for infectious diseases and vaccination is a major opportunity, and does have an impact on the health of the incarcerated, the correctional employees and the communities to which the inmates return. Vaccination for Hepatitis B and A is highly recommended for prisoners. Drug testing on the other hand, in particular mandatory drug testing in prison can have adverse effects, e.g. encourage people to switch from smoking drugs like Cannabis to injecting drugs like heroin, in order to avoid detection. It has been observed that mandatory drug testing is rather expensive and can be counterproductive, due to an increasing tension in the prison. Treatment for prisoners involves the treatment for drug dependency and infectious diseases. Upon entering the prison, prisoners with AIDS should be offered treatment with highly active anti-retroviral therapy (HAART), which is an effective treatment. Hence existing HAART should not be discontinued and prisoners not yet receiving HAART should be encouraged to start HAART. Similar to AIDS, treatment for HCV is safe and feasible. Although the establishment of prison-based substitution treatment proved to be as effective in reducing mortality, crime and re-incarceration rates and HCV as in the community, the implementation of prison-based substitution treatment is still not equally well accepted and realized. Concerning harm reduction measures in prison the implementation is fragmentary and often problematic, despite existing research on the topic. Evidence for the effectiveness of prison needle exchange programmes (PNEP) has been gathered in a number of very different prison settings: PNEP reduces needle sharing very effectively, can increase uptake of drug treatment as well as the safety in the prison, and can reduce abscesses and fatal overdoses. It does not increase injecting drug use, nor has it shown any other negative effects. No research was found explicitly evaluating the distribution of sterile tattooing equipment. Still this measure should be recommended to reduce the risk of transmitting diseases, as tattooing often occurs in prison. Condoms are likely to be the most effective method for preventing sexually transmitted diseases (STDs). No serious negative effects of condom distribution in prisons have been found, and the free availability of condoms seems feasible in a wide range of prison settings. The full report is attached (Annex 1: Final report [WP 4]. The status-quo of prevention, treatment and harm reduction services for people in prisons and in reintegration services for persons on release from prisons). 2. Report on current approaches to monitor/analyse drug use among prisoners The main objective of this work package was directed to report on current approaches to monitor/analyse drug use among prisoners, based on data and methods available from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the World Health Organization (WHO) and the European Network on Drugs and Infections Prevention in Prison (ENDIPP) and current literature, assessing the data quality and analysing ways to improve availability and reliability of such information. Many countries are reporting an increase in the use of illicit drugs in prisons, but national routine data on drug use in prison is rare. Prison related data collected by the EMCDDA come from a range of sources, which are often not comparable in terms of the methods used. Variations across countries and across surveys make comparisons between and within countries difficult and are related to issues such as sampling strategy, sample size, geographical coverage, population selection, and methods of measurement of drug use (self- report, medical assessment). Moreover, studies in different countries use different measures of prevalence (lifetime or last year or month prevalence), and frequency of drug use. Compared to the data on the prevalence and dynamics of drug use inside prisons, the data on the availability of harm reduction services and facilities collected by EMCDDA are more comprehensive and of a higher quality. However, information on the accessibility, coverage rates, quality and the utilisation of such facilities, with a particular focus on at-risk populations, need to be improved in order to obtain an overview of the situation in the different countries with clear indications on coverage as a core-element in policy evaluation. In 2006, the Health in Prison Project (HIPP) of the World Health Organization Regional Office for Europe (WHO) has launched a Prison Health Database, which has been developed in collaboration with the EMCDDA and the Scientific Institute of the German Medical association (WIAD). The development and implementation of this database has been cofunded by the European Commission under the framework of the Public Health Programme 2003-2008. This prison health database was developed in order to increase the knowledge of drug related problems inside prisons, trends in prison health and their importance for public health. The indicators of this database cover four subjects: Penal Statistics, General Population Epidemiology, Interventions Monitoring and Penal Epidemiology. However up to now the data reported from Member States to the WHO Health in prison database is quite limited. Overall, there is an obvious lack of systematic monitoring and research on drugs and health issues in European prisons. There are some valuable starting points in gathering information, which could support health planning and policy making, but these systems have to be improved and need strong support from national authorities. It is a future challenge to develop and implement an EU standard protocol to collect data on drug use, infectious diseases and risk behaviours in prison population that could then be used by countries to assess these issues in prison. Such a protocol would have to include a standard questionnaire but also methodological and ethical recommendations about how to implement a prison survey on health and drug-related issues. The full report is attached (Annex 2: Final report [WP 5]. Current approaches to monitor/analyse drug use among prisoners). Annex 1 Drug policy and harm reduction SANCO/2006/C4/02 Final report (WP 4) The status-quo of prevention, treatment and harm reduction services for people in prisons and in reintegration services for persons on release from prisons April 2008 WIAD Wissenschaftliches Institut der Centre for Interdisciplinary Ärzte Deutschlands gem. e.V. Addiction Research (CIAR) 2 Heino Stöver1, Caren Weilandt2, Heike Zurhold3, Christine Hartwig1, Katja Thane1, 3 1 Bremen Institute for Drug Research (BISDRO), University of Bremen 2 Scientific Institute of the German Medical Association (WIAD gem. e.V.), Bonn 3 Centre for Interdisciplinary Addiction Research (CIAR), University of Hamburg Corresponding addresses: Institute for Drug Research Bremen (BISDRO) University of Bremen FB 06 Postbox 330 440 D-28334 Bremen tel +49 421 218 3173 fax +49 421 218 3684 e-Mail: [email protected] Scientific Institute of the German Medical Association (WIAD gem. e.V.) Ubierstraße 78 D-53173 Bonn tel +49 228 8104-182 fax +49 228 8104-1736 e-Mail: [email protected] 3 Contents Executive Summary........................................................................................................ 8 1. Introduction .......................................................................................................... 10 2. Methodology and definitions ..............................................................................
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