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. 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.
The 2016 survey on drug use among Spanish inmates used some of the questions included in the European Questionnaire on Drug Use among Prisoners. It indicated that around 40 % of inmates had used cannabis during the 30 days prior to imprisonment, with cocaine and heroin the next most commonly used drugs. Around 6 % of inmates had injected an illicit drug in the 30 days prior to being admitted to prison, with heroin, heroin combined with cocaine, and cocaine the drugs most frequently injected. Around 20 % reported cannabis use in prison, while use of other drugs was less common. Most respondents were polydrug users before entering prison. Around 27 % of those who were injecting drugs at the time of prison entry were human immunodeficiency virus (HIV) positive and 70 % were hepatitis C virus (HCV) positive; one third had an HCV + HIV co-infection. In 2016, more than 200 overdose episodes in prisons were reported.
Prevention and health education programmes are implemented in all prisons and 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. 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 available in Spanish prisons. In 2017, almost 8 000 inmates received MMT, with about one quarter combining it 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 (NSPs) and the distribution of condoms, disinfectant and aluminium foil. NSPs have been available in prisons in Spain since 1997, covering 47 prisons. This number has decreased in recent years, accompanying the reduction in intravenous users and the consequent decreasing demand. The NSPs in prisons received the first European Prize for Good Health Practices in Prisons, awarded by the European Prison and Health Network of the World Health Organization.
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.