The General Secretariat of Penitentiary Institutions of the Ministry of the Interior is responsible for prison administration in Spain, except in Catalonia. Healthcare provision in prisons is the responsibility of the Ministry of the Interior, although in Catalonia and the Basque Country it is provided by the health services of these autonomous communities.
Data on drug use among the prison population originate from four periodical surveys conducted in 1994, 2000, 2006 and 2011. The 2011 survey on drug use among Spanish inmates indicated that around 4 out of 10 inmates had used cannabis during the 30 days prior to imprisonment; cocaine and heroin were the next most commonly used drugs. Around 5 % of inmates had injected an illicit substance during the 30 days prior to imprisonment. Around 2 out of 10 inmates reported cannabis use in prison, while use of other drugs and injecting drug use were much less common. Around one third of those who injected drugs in prison were human immunodeficiency virus (HIV) positive and three quarters were hepatitis C virus (HCV) positive. These studies have identified that polydrug use patterns are common among inmates.
Upon entry into prison, the physical and mental health of a detainee is assessed, and this includes an evaluation of drug use and drug-related problems, drug-related infectious diseases and risk of suicide. Following the assessment, a treatment plan is established and the detainee may be assigned to a relevant programme.
Drug dependency in prisons is addressed through prevention, assistance and social reintegration. Prevention and health education programmes are implemented in all penitentiary centres, including by the health mediators recruited among inmates. Health programmes implemented in prisons include counselling, drug treatment and harm reduction measures. Drug treatment in prisons is provided in partnership with various prison services (health, psychology, safety, etc.), and in close cooperation with services available outside prison, such as drug treatment facilities, social services and non-governmental organisations. Detoxification programmes are available and may be undertaken on an outpatient basis, in a day-care centre or in a ‘therapeutic’ module. Methadone maintenance treatment (MMT) is an important part of the drug treatment on offer in Spanish prisons. In 2016, almost 8 000 inmates received MMT, with about one quarter receiving MMT combined with psychosocial support. Harm reduction measures available in Spanish prisons include prevention, vaccination and treatment of infectious diseases (HIV and hepatitis), needle and syringe exchange programmes, and the distribution of condoms, disinfectant and aluminium foil. The first needle and syringe exchange programme in a Spanish prison was introduced in Bilbao in 1997, and such programmes are now available in 47 prisons in Spain. In 2016, more than 4 000 syringes were distributed in 20 prisons. Since 2014, overdose prevention programmes have been implemented to address overdose risk inside prison and in the post-release period.
Social reintegration programmes offered in prisons provide people who use drugs with the necessary skills to maintain treatment following release and support their reintegration into society.