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. 2 emcdda.europa.eu 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. 3 emcdda.europa.eu 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. 4 emcdda.europa.eu Prison Drug users 80% of prisoners use tobacco (20–30% gen. pop.) Lifetime prevalence of drug use among prisoners Source: Statistical bulletin 2014

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

6. 6 emcdda.europa.eu 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. 7 emcdda.europa.eu 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. 8 emcdda.europa.eu 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. 9 emcdda.europa.eu 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. 10 emcdda.europa.eu 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. 11 emcdda.europa.eu 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 Source: 2012 Selected Issue on Drugs and Prison 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

12. 12 emcdda.europa.eu 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. 13 emcdda.europa.eu Prisons — implementing substitution treatment Opioids > Cumulative number of EU countries with opioid substitution treatment in community and prison settings

14. 14 emcdda.europa.eu 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 EuropeQuestionnaire 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 prisonsSurvey of drug-related health facilities in European prisons (to be developed in 2014)

15. 15 emcdda.europa.eu http://www.emcdda.europa.eu/publications/selected- issues/prison http://www.emcdda.europa.eu/activities/prison http://www.emcdda.europa.eu/publications/scientific- studies/eqdp http://www.emcdda.europa.eu/ http://www.emcdda.europa.eu/topics/prison

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