The Irish Prison Service (IPS), which manages the country’s prison system, operates as an executive agency under the responsibility of the Ministry of Justice, Equality and Defence. It also cooperates with the Probation Service in reducing offending and improving rehabilitative outcomes. In Ireland, prisoners are entitled to receive the same care as that available in the community. The 3-year strategic plan 2016-18 committed the IPS to providing prisoners with access to the same quality and range of healthcare services available to people entitled to General Medical Scheme (GMS) health services in the community.
The latest studies conducted on drug use and drug-related problems in Irish prisons date back to 2008. A 2018 meta-analysis of the prevalence of major mental illness, substance misuse and homelessness among Irish prisoners shows that around half of prisoners have a substance use disorder. As rates of substance use are significantly higher than in the general population, the need to develop diversion services and integrated treatment plans addressing psychiatric and psychological needs is highlighted.
Among people entering drug treatment in prison, most are entering treatment for opiates use, mainly heroin, followed by cocaine, benzodiazepines and cannabis use. Since 2011, an increase in the number of new treatment entrants for primary cocaine use and a decrease in the number of primary cannabis users have been observed. The figures for other substances, including opiates, are relatively stable, although the small numbers make trend analysis difficult to interpret.
Six community-based organisations provide services in prisons. Drug-related interventions available in Irish prisons include structured assessments, individual counselling, therapeutic group work, harm reduction interventions, multidisciplinary care and release-planning interventions. Drug treatment modalities include brief interventions, motivational interviewing and motivational enhancement therapy, such as the 12-step facilitation programme. The Medical Unit in Mountjoy Prison has 18 beds specifically allocated for an 8-week drug-free programme. Opioid substitution treatment is available in prison, for both maintenance and detoxification. In 2016, there were around 2 000 prisoners receiving methadone in prison, mainly for opioid use. Methadone maintenance treatment was the most common treatment provided.
A recent 2017 report by a non-governmental organisation working on prison reform has identified short-term actions to tackle drug dependency in prison from a public health perspective. These include (i) collecting information on waiting lists for treatment access in prisons and post-release; (ii) reducing reliance on methadone maintenance in prisons and increasing the number of alternative treatment options; (iii) increasing the number of drug treatment residential places in the community that accept former prisoners; (iv) implementing harm reduction recommendations; and (v) further evaluating the effectiveness of Drug Treatment Courts.