New EMCDDA report underlines need to scale up drug services in prisons

International Day against Drug Abuse and Illicit Trafficking — 26 June

Current insights and future challenges on drugs and prison in Europe are explored today in a major new study published by the EU drugs agency (EMCDDA)(1). Released on the eve of International day against drug abuse and illicit trafficking, the report, Prison and drugs in Europe: current and future challenges, takes an in-depth look at a wide range of issues in the prison setting, including drug use and harms, health and social responses and drug supply. It notes that, while, in several European countries, services in prison for people with drug problems have increased, treatment and care options available to this group remain limited and need to be scaled up.

On any given day, there are over 856 000 individuals in prison in Europe. People in prison are more likely than their peers in the community to have used drugs, to use drugs regularly or to experience drug-related problems. They also have higher rates of infection of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV) and tuberculosis. For those injecting opioids, the risk of dying from a drug overdose increases markedly in the initial period after release. Given that people in prison come from, and eventually return to, the community, interventions delivered in this setting are likely to have a significant impact on overall public health.

EMCDDA Director Alexis Goosdeel says: 'It is vital that we have a sound understanding of the patterns and prevalence of drug use among the prison population and identify what kind of responses are available and work best. Often, it is in prison that people who use drugs access health and social services for the first time. This report highlights some of the challenges, but also the opportunities, arising in this setting to intervene and provide support to reduce drug-related harm. It also outlines how EMCDDA tools are helping to strengthen monitoring, exchange best practice and inform countries in their policy decisions and service planning in this area'.

The importance of the prison setting for tackling drug problems is underlined in the new EU Drugs Strategy 2021–2025 (2), which includes a strategic priority aimed at addressing the health and social needs of people who use drugs in prison and after release. The EMCDDA has developed a methodological framework to monitor drugs in this setting, including tools such as the European questionnaire on drug use among people in prison (EQDP).

Based on data from 30 countries, today’s report presents the latest developments in the field of drugs and prison, identifying knowledge gaps and implications for policy, practice and research.

Key findings

  • People who use drugs are over-represented in prison and the prevalence of drug-related problems in this population is substantially higher than in the general population.
  • Women in prison are especially vulnerable and at risk of problem drug use.
  • Although many people stop using drugs when they enter prison, some continue, or start, to use drugs in this setting. Drug use inside prison is indicated by all 11 countries reporting data on this topic.
  • The use of new psychoactive substances (NPS) in prison has been a growing challenge in recent years, particularly the use of synthetic cannabinoids.
  • New technologies are increasingly used to supply drugs to prisons (e.g. deliveries by drone), but are also employed to restrict supply (e.g. new scanning technology to examine the contents of post).
  • People in prison have poorer physical and mental health and social well-being than their peers in the community and a lower life expectancy.
  • While prison conditions can negatively affect the already impaired health of people who use drugs, these are also settings that may provide health services to those previously hard-to-reach.
  • Opioid substitution treatment (OST) is available in prison in 29 of the 30 countries but, in most of the countries, coverage in this setting is low.
  • Access to testing and treatment for infectious diseases is available in most countries, although coverage needs to be expanded. Other harm-reduction interventions (e.g. needle and syringe programmes, take-home naloxone at release from prison) are available in a few countries.
  • Alternatives to coercive sanctions have been implemented in many European countries. Diverting offenders with problem drug use towards rehabilitation may have a number of positive effects (e.g.  avoiding the harmful effects of detention and contributing to reducing the costs of the prison system).
  • Providing equity and continuity of care, as people move between prison and the community, is key to achieving sustainable and effective treatment outcomes; yet this is not achieved in most countries. There is a need to scale up drug-related interventions in prisons, which have proven effective in other settings.
  • While the evidence base is gradually increasing, there is a need for greater data comparability across countries and for more studies on the outcomes of interventions targeting demand as well as supply reduction in prison.