Sweden Country Drug Report 2018

Drug use and responses in prison

According to the latest annual census of prisoners, conducted in 2016, around half of inmates had used illicit substances during the 12 months before their imprisonment. Drug use during imprisonment is reported to be low and is related mainly to the misuse of prescription medicines, and illicit substances smuggled into 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. Available data from drug screening carried out in prisons in 2016 indicate that about 1.5 % of prisoners tested positive for illicit substances, which is slightly lower than the previous year. Based on the initial assessment at prison entry, it is estimated that three out of four prisoners have alcohol and/or drugs problems and that around the same proportion have a personality disorder. It is estimated that up to 40 % of clients sentenced to one year or more in prison suffer from attention deficit hyperactivity disorder and that other neuropsychiatric conditions are also common. Up to one third of prisoners are infected with hepatitis C virus (HCV) but less than 5 % are infected with human immunodeficiency virus (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-step programmes, adapted from Alcoholics Anonymous. The programmes are accredited and evaluated. Opioid substitution treatment (OST) is available in prison and can be either continued or initiated in prison prior to release, following a medical assessment. The decision to continue OST in prison is taken in agreement with the prescribing doctor and the treatment agency that provides the treatment. Initiation of OST can be conducted in some prisons with specialised staff.

Infectious disease testing and vaccination is available and new treatment for HCV infection has been offered in prisons in two regions as part of study trials.

Several specific pre-release measures exist in Sweden: parole, extended parole, halfway house and stay-in care. The latter is aimed at clients in need of treatment for substance use and takes place on location in treatment centres or as outpatient care.

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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.