Assistance and treatment for drug users in prison

In all Member States and candidate countries, there are systems of one kind or another in place to ensure that assistance for drug users in prison is available, although the variety of services and their availability differs considerably. A notable trend is the increasing acknowledgement of the fact that prisoners have the same rights as the rest of the population concerning access to healthcare, including assistance and treatment for drug users (WHO Regional Office for Europe, 2002; Irish, Lithuanian and Finnish national reports). Among the services that should be made available to prisoners are strategies for prevention, including drug-free programmes, detoxification treatments, methadone and other substances treatments, counselling and education.

However, countries report various problems with the provision of adequate assistance. For instance, the availability of services is precarious in Estonia; no specific services are available for drug users in Latvia; Poland has long waiting lists for treatment; Sweden reports overcrowded prisons and reduced prison staff levels; and, in Romania, appropriate legislation is lacking. In Cyprus, even though there is no integrated support programme for imprisoned drug users, some prevention measures are taken.

Education and training activities represent general prevention strategies. In most EU and candidate countries, such activities have been carried out for both drug users in prisons and prison staff. Among the countries reporting such activities are Estonia, Spain, Cyprus, Hungary, Romania and Slovenia (Reitox national reports).

Another preventative element is the establishment of drug-free units within prisons. Participation is on a voluntary basis, generally after written declarations to accept certain conditions, for example periodic urine testing, have been signed by imprisoned drug users. Such units exist in all EU-15 Member States. In the ‘new’ Member States, drug-free units have been established in most countries. An evaluation of the drug-free zone in one Austrian prison showed that prisoners released from the drug-free zone were sentenced again significantly less often than prisoners released from normal units in the prison (35 % compared with 62 %).

The most common treatment modality in prisons is drug-free treatment, which exists in all Member States (except Cyprus and Latvia), although availability varies. Treatment centres within the community provide support and treatment as well as aftercare in many countries, e.g. Belgium, the Czech Republic, Greece, Luxembourg and the United Kingdom.

In most countries, the availability of substitution maintenance treatment inside prison is not the same as its availability outside prison. Only in Spain is maintenance treatment widespread, with 18 % of all prisoners, or 82 % of problem drug users in prison, receiving this treatment. Luxembourg also has high coverage. Countries reporting considerable increases in the availability of medically assisted treatment include France, mainly with buprenorphine, and Ireland (Reitox national reports). In the Netherlands, medically assisted treatment is available only for short-term detainees who used methadone before imprisonment, whereas in Poland the first programme of methadone treatment with 14 clients was introduced in a remand prison.