1. Harm Reduction and Drug Policy in Western European Prisons “HIV, Hepatitis C, and Harm Reduction in prisons: Evidence, Best Practice and Human Rights“ – Irish Prison Reform Trust and Merchant‘s Quay Ireland, Dublin 11.12.2003 Dr. Heino Stöver (University of Bremen/Germany)

2. Assistance to Drug Users in Prisons (www.emcdda.org/responses/themes /assistance_prisons.shtml) Prevalence of Drug Use in 15 EU- Countries Drug Using Patterns Prevention and Treatment Responses

3. ”Prisons are mostly overcrowded, stressful, hostile, and sometimes violent places, in which individuals coming from lower classes, ethnic and social minorities are overrepresented (Farbring)”

4. Prevalence of Infectious Diseases in European Prisons According to European networks: prevalence of Hepatitis C among i.v. drug users is 50-90% prevalence of HIV varies from 0-17% of the total prison population (average 5%)

5. Transmission of Infectious Diseases (HIV, Hep.) in Prisons Drug users highly vulnerable group HIV outbreak in a Scottish and a Lithuanian prison staff at risk of acquiring Hepatitis Seroconversions in a Women‘s Prison in Germany (Hepatitis B + C)

6. Drug Use in Western European Prisons: What Do We Know? /1 Dating back to the 70ies drug market/supply comparable to the outside prevalence of drug consumption varies depending on the institution most common drug beside nicotine is cannabis approx. half of i.v. drug users continues injecting while in prison some take opportunity to ‚take a break‘ changes in patterns of drug use (volume, frequency, type of drug, routes of administration)

7. Drug Use in Western European Prisons: What Do We Know? /2 Needle-sharing and common use of injection equipment is inevitably connected with i.v. drug use „Hygienic relapse“ Some prisoners are initialising drug use while in prison Discover new substances and mixtures High risk of death from overdose after release

8. Estimation of the number of drug users in Prisons 8 million people incarcerated worldwide >50% in Russia, China und the USA ( 458,000 non-violent drug charges) 350,000 prison inmates in Europe at any time 15-50% ‚problematic drug users‘ Turn-over rate (x 3,5) 180,000-600,000 annually

9. Proportion of Drug Users among Prisoners in Europe

10. Characteristics of drug use in prison: High discontinuity in the availability of drugs That means steady change of withdrawal and consumption Widespread poly-drug use to bridge periods of inability to finance drugs Quality, purity is even harder to calculate

11. Prevention abstinence oriented information material drug free zones therapeutic communities

12. Harm-Reduction Measures: Target-group specific information material ‚Realistic‘ drug counselling Hepatitis A/B vaccination peer support/peer driven intervention safer use/safer sex training condom availability bleach methadone prescription provision of sterile syringes

13. Substitution Treatment in European Prisons – Throughcare? CountryDetoxificationMaintenanceRelapse Prevention short term prisonerlong term prisoner Austria Belgium Denmark Finland France Germany Greece Ireland Italy Luxembourg The Netherlands Portugal Spain Sweden England & Wales Northern Ireland Scotland Few PrisonsMost PrisonsAll PrisonsNo Prisons

14. Needle Exchange Programmes in Prisons: Feasability No threatening of staff members or other inmates Most of the prisoners followed the rules determining the supply of sterile needles - no exclusion of participants. Number of drug finds did not increase Increase in the utilization of other therapeutic measures

15. Acceptance - Personel Needle exchange programmes became in a very short period part of everyday life, the extraordinary character of the pilot project has vanished and a process of normalisation could be observed Persuasion by practical experiences of pilot project

16. Acceptance - Inmates Different acceptance of the needle exchange in the women‘s and the men‘s prison according to different modes of provision of syringes Doubts about anonymity in both prisons. Provision via slot machines provides a higher degree of anonymity

17. Obstacles of a Transfer of Harm- Reduction Strategies into Prisons drug free prison/denial of drug problem identical goal of prison sentence and prison drug service controllability of drugs and communicable diseases wrong message for inmates problematic signal for staff

18. The principle of equivalence Wishful thinking? Connection between community care and cure Development of transparency of practice and policies – for inmates and the community professionals Health care standards and clear guidelines

19. Further Information and Contact Final report available in English on: www.emcdda.org/responses/themes/as sistance_prisons.shtml heino.stoever@uni-bremen.de http://www.archido.de Further Informations under: