In 2015, the Swedish Prison and Probation Service, under the authority of the Ministry of Justice, comprised 79 prisons (including remand prisons), with around 7 000 places, of which approximately 10 % were allocated to prisoners who use alcohol or drugs.
According to the latest annual census of prisoners, conducted in 2015, 51 % of males and 43 % of females had used illicit drugs during the year before their imprisonment. Drug use during imprisonment is related mainly to the misuse of prescribed medicines and illicit drugs smuggled into the prisons or used during a period of leave.
On admission, each new prisoner undergoes a medical assessment, which includes assessment of drug use status. Routine tests on drug use are mandatory. Initiatives have recently been undertaken to find new methods of detecting synthetic cannabinoid use, which represents an emerging challenge as these substances are particularly difficult to screen. It is estimated that three out of four prisoners are dependent on alcohol and/or drugs and that around the same proportion have a personality disorder (including antisocial personality disorder). A recent study estimated that up to 40 % of clients sentenced to one year or more in prison, suffer from attention deficit-hyperactivity disorder (ADHD), and that other neuropsychiatric disabilities are also common. Up to one third of the prisoners are infected with HCV but less than 5 % are infected with HIV.
The Swedish Prison and Probation Service provides healthcare in prison. However, the Health and Social Care Inspectorate is responsible for the supervision of prison healthcare services, and the guidelines for such care are issued by the National Board of Health and Welfare. These authorities are governed by the Ministry of Health and Social Affairs.
The guiding principle for the treatment of drug users in prison and during probation is that the prisoner has the same right to social or medical treatment as other people living in Sweden. Prisoners with drug use problems are offered drug treatment programmes; these are mainly abstinence oriented and based on cognitive-behavioural interventions and 12 steps programmes, adapted from Alcoholics Anonymous. The programmes are accredited and evaluated. OST is available in prison and can be either continued or initiated in prison prior to release, following a medical assessment. In Sweden, 14 prison places, distributed among three prisons, have been allocated to permit prisoners to receive OST for opiate dependence, although OST can also be provided in other prisons.
Infectious disease testing and vaccination is also available, and recently the new hepatitis C virus infection treatment has been offered in two regions.
Several specific pre-release measures exist in Sweden: parole, extended parole, halfway house and stay-in care. The last of these is aimed at clients in need of treatment for substance use and takes place on location in treatment centres or as outpatient care.
Routine tests on drug use are mandatory. Initiatives have recently been undertaken to find new methods of detecting synthetic cannabinoid use