Drug treatment in prisons: recent evidence Jessica Harris, RDS NOMS, Home Office Malcolm Ramsay, DSPD Programme, Home Office.

Structure of the presentation:  The need for treatment – prisoners’ drug use pre-prison, in prison and after prison  What’s available and what works?  Current issues and evaluation plans.

Prisoners’ drug use pre-prison  69% tested positive for one or more illicit drug;  36% tested positive for two or more;  31% tested positive for opiates;  22% tested positive for cocaine;  38% tested positive for either or both; High probability of testing positive for: females, year olds, white arrestees, property offences. [NEW–ADAM programme, 2004 ]

 At least 93% prisoners had used drugs in the 30 days before custody;  62% heroin, 49% crack and 42% cannabis  74% took two or more different drugs  Heroin: 46% white prisoners, 16% black;  Crack: 8% white prisoners, 30% black;  Average spend of £600 a week on drugs. [CARATs assessment, 2004/05]

Offending  Criminality Survey 2000: money to buy drugs most commonly cited reason for offending;  (55%) reported that they had committed offences connected to their drug taking;  CARATs: theft and handling (24%), burglary (17%), drug offence (11%);  NEW-ADAM: 75% of arrestees committing one or more acquisitive crime in the last 12 months had used heroin and/or cocaine and/or crack.

Prisoners’ drug use in prison  MDT Survey: About 16% prisoners reported using drugs in week before interview;  Cannabis and opiates (usually heroin) most commonly used;  0.7% prisoners had initiated/resumed heroin use, having used no illicit drugs in the year prior to custody;  Criminality Survey: Only half of pre-prison drug users reported continuing to use drugs in prison.  Use of stimulants (cocaine/crack) relatively uncommon in prison.  Levels of re-offending post-release were significantly higher for drug users (62%) than for abstainers (36%).

 Heroin is the white offender’s drug of choice?  Crack is the black offender’s drug of choice? Drug use was particularly widespread among:  short-term prisoners;  property offenders;  white prisoners. [Source: ‘Tackling Prison Drug Markets: An exploratory Qualitative Study’ 2005]

Prisoners’ drug use after prison  In the week following release, prisoners were about 40 times more likely to die than a member of the general population;  male prisoners were about 29 times and female prisoners 69 times more likely to die;  immediately post-release, over 90% of deaths were associated with drug related causes;  deaths from drug use post-release reflect lowered levels of tolerance. [Source: ‘Drug-related mortality among newly released offenders’ 2003]

 Opiates were involved in almost all (97%) drug related deaths;  just over half of deaths were recorded as involving only one drug;  mortality rates for women were generally higher than those for men;  Prisoners aged 25 to 39 at the time of release were most at risk;  odds of drug-related deaths higher for ‘white’ prisoners than for those in other ethnic groups.

Risk factors for drug mortality include:  separated, divorced or widowed;  had used drugs in the month before entry into prison;  had not used drugs in prison. [Source: Office of National Statistics,1997]

What treatment is there and what works?  Detoxification  CARATs  Intensive treatment programmes –(Cognitive behaviour, therapeutic communities,’12-step’ programmes and methadone provision).

White women:  higher dependency rates than black women (60%)  more likely dependent on heroin (a ‘depressant’) Black/ mixed race women:  Lower dependency rates (29%) than white women  More likely dependent on crack (a ‘stimulant’) [Source: The ‘treatment needs of white and black/mixed-race female prisoners’ 2003]

Some obvious needs…  to continue to develop the prison drug strategy in a way that brings together treatment and security;  to increase provision for crack and poly-drug users;  to make further efforts to reach short-term prisoners.

What now? Current issues and evaluation plans  Data - much is out–of–date;  Continuity of care – currently difficult to link prison data to community data;  More research needed on the impact of interventions in reducing reoffending;  Effectiveness of methadone versus detoxification;  Evaluation of IDTS – enhanced CARATs.