1. Clinical Management of Substance Misuse Dave Marteau Prison Health David.marteau@dh.gsi.gov.uk

2. Drug-motivated offences are estimated to comprise around a third of the total cost of crime * Includes: security expenditure, property stolen, emotional impact on victim, lost output and expenditure on criminal justice system ** This is an estimate within a range of £14-20bn Source: Team analysis, based on NEW ADAM survey of arrestees 1999-2002, ‘Economic and social costs of crime’ Cost of drug-motivated crimes* £58bn £19bn**

3. Many high harm causing users enter prison each year, and most leave again within a year Source: Team analysis, based on Prison statistics 2001, NEW ADAM, ONS Psychiatric Morbidity of Prisoners 1998, Criminality Survey 2000 Nearly a quarter of high harm causing users are in prison at one point during any year Their average sentence length is around 4 months 15,000 50,00049,000 16,000 High harm causing users in prison, entering prison and leaving prison during a year

4. Characteristics of Injecting Drug Users (Matthews 2005) Entrenched (in their habits) Treatment resistant Poor physical & mental health Challenging behaviours High suicide and self-harm risk Very high post-release mortality risk Stigma Rewards for success

5. A 33 year follow-up of narcotic addicts (Hser et al., 2001) N 581 439 354242 Age 24.5 (3.9) 36.8 (5.4) 47.6 (5.1)57.4 (4.0)

6. National Confidential Inquiry study of 172 prison suicides 1999/2000

7. Death Rates in First Year of Liberty (v national mean average)

8. MMT non-MMT Follow-up study of mortality (Dole et al 2003) Probability of survival months

9. Re- incarceration up to May 2002 ContinuousMethadonen=45 Non- Continuous Methadone n= 216 p Mean total weeks in prison (sd) 4167.007 Source: Dolan, K

10. Methadone maintenance treatment [MMT] at 12 months after release from prison [Johnson van de Ven & Grant 2001]

11. % of released prisoners returning to same prison over 3.5 years [n = 3,606] (Levasseur et al, 1997)

12. Number of prisoners on methadone maintenance programmes in Spain

13. Incidence of AIDS cases per thousand prisoners in Spain (Pallas 2004)

14. Clinical Management of Drug Dependence Plan Individual assessments Care plans based on need Closer Integration of clinical & CARAT [DIP] teams Increased maintenance prescribing Aiming to Reduce Early suicides in prison Deaths on release Blood-borne virus transmission Re-Offending

15. Projected Clinical Interventions Total (red) and maintenance (blue)