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Please note that the information on this page is based on the EMCDDA Annual report 2010: the state of the drugs problem in Europe. Most statistical data relate to the year 2008 (or the last year available).


Annual report 2010: the state of the drugs problem in Europe
Responding to drug problems — an overview

Published: 10 November 2010

Health and social responses in prison

On a given day, there are over 600 000 people in penal institutions in the European Union (1), giving an average rate of about 120 prisoners per 100 000 population (2). National prison population rates range from 66 to 285 prisoners per 100 000 inhabitants with most Member States from central and eastern Europe reporting higher than average rates. Nevertheless, the national figures and the EU average remain considerably below the rates reported from Russia (609) and the USA (753) (3).

Among sentenced prisoners, those incarcerated for drug law offences make up somewhere between 10 % and 30 % of the prison population in most EU countries. An unknown proportion of others are sentenced for property crimes to support a drug addiction, or other drug-related crime.

Drug use in prison populations

There is still a lack of standardisation of definitions, research questions and methodologies used in studies on drug use in the prison population (Directorate-General for Health and Consumers, 2008; Vandam, 2009), though existing studies show that drug use continues to be more prevalent among prisoners than among the general population. Data from several studies carried out since 2003 show that there are considerable variations in the prevalence of drug use among prisoners: for example, regular drug use in the month before imprisonment was reported by as few as 3 % of respondents in some countries and by up to 77 % in others. Studies also indicate that the most harmful forms of drug-use may be more frequent among prisoners, with between 6 % and 38 % of those surveyed reporting to have ever injected drugs (4).

On admission to prison, most users reduce or stop consuming drugs, mainly due to problems in acquiring the substances. However, the fact that illicit drugs find their way into most prisons, despite all the measures being taken to reduce their supply, is recognised by both prison experts and policymakers in Europe. In studies carried out since 2003, estimates of drug use in prison vary from 1 % to 56 % of inmates. Regular drug use during the last month in detention was reported by 12 % of detainees in a national study carried out in Portugal in 2007 (5). A study among 246 prisoners in Luxembourg found that 31 % had injected drugs in prison, while studies in three other countries reported levels of injecting of 10 % or more (6). Injecting drug users in custody appear to share their equipment more often compared to users not in prison. This raises issues around the potential spread of infectious diseases among the prison population.

Prison health in Europe

Prisoners are entitled to the same level of medical care as persons living in the community, and prison health services should be able to provide treatment for problems related to drug use in conditions comparable to those offered outside prison (CPT, 2006; WHO, 2007). This general principle of equivalence is recognised in the European Union through the Council Recommendation of 18 June 2003 on the prevention and reduction of health-related harm associated with drug dependence (7), and the new EU drug action plan (2009–12) calls for its implementation.

Cooperation between prisons and health and social services is developing in Europe. Examples of this are the transfer of responsibility for prison health from national justice to health administrations in France, Italy, Sweden, Norway and England and Wales (it is also planned in Scotland); the integration of community-based health agencies into multi-disciplinary prison teams in Luxembourg, Portugal, Slovenia and Sweden; and the growing provision of intramural services by community-based drugs agencies, which now exists in most countries.

National drug strategies and action plans often include objectives for care in prisons, such as improvements in the equivalence, quality and continuity of prison treatment and care. Some countries have elaborated specific strategies for the prison system. Spain and Luxembourg have implemented prison health policies for more than ten years and documented their effectiveness. More recently, prison drug policy coordinators have been nominated in Belgium, and a central unit, where prison staff and drug specialists cooperate to link prisoners with treatment upon release, was set up. A committee for drug affairs was established within the Hungarian prison service in 2008. The drug policy action plan 2007–09 of the Czech prison service guides the implementation of new services and includes a monitoring and evaluation component. In the United Kingdom, the drug strategy 2008–11 of the National Offender Management Service (NOMS, 2009) seeks to provide early interventions for young people and to manage offenders with drug misuse problems in order to reduce the harm caused by drugs and alcohol.

Assistance to drug users in prison

Prisoners in Europe may access a range of services related to drug use and its associated problems. These include information on drugs and health, health care for infectious diseases, treatment for drug dependence, harm-reduction measures and preparation for release (8).

Information and guidance regarding the management of infectious diseases in prison has been developed in recent years by international organisations. The UNODC, in collaboration with the WHO and UNAIDS, has published a series of information materials for prison administrations and other decision-makers, which explain how to draw up an effective national response to HIV/AIDS in prison settings (UNODC, WHO and UNAIDS, 2006). Another document provides guidance about how to convey information about infectious diseases counselling and testing more effectively in prison settings, and to improve the communication of results to inmates (UNODC, UNAIDS and WHO, 2010).

A clear set of health care areas and standards in prisons has been defined in a small number of countries, including the Czech Republic, Spain, Luxembourg and the United Kingdom, and steps in this direction are being taken by other countries. Several countries now report that they are assessing the availability and quality of health care for drug users in prisons. In Ireland, for example, the need to match the capacities of prison pharmacy services with the growth of substitution treatment provision was identified in a study (Irish Prison Service, 2009), while in France a new supervisory body (Chief inspectorate of Prisons and other Closed Institutions) found shortcomings in prison health care and identified risks of infection. The Netherlands introduced a new directive for the care of drug users in detention, which gives special attention to drug-related infectious diseases (9). The quality of prison services is also improving in several countries through investment in training. In Belgium, all prison staff received training on prison alcohol and drug policies; prison doctors in Croatia received training in substitution treatment; and a UNODC-led project provided training in HIV prevention and drug education to Latvian prison doctors, social workers and psychologists, who later trained the prisoners. In Finland, new prison treatment programmes require accreditation by the Criminal Sanctions Agency.

Following the scaling up of opioid substitution treatment in the community, many countries report increases in the number of opioid substitution clients entering prison. Continuity of care for substitution treatment is particularly important, given the high rates of overdose death on release (EMCDDA, 2009) and for reducing the risks of crimes carried out to fund illicit drug use. In 2008, the continuation of opioid substitution treatment in prisons became possible in Bulgaria, Estonia and Romania. However, this treatment option is not available in prisons in Greece, Cyprus, Lithuania, Latvia, Slovakia and Turkey. In six Member States, it can be estimated that more than 10 % of all prisoners receive opioid substitution treatment, while in another eight countries the corresponding figure is between 3 % and 10 % ('Figure 3: Proportion of prison population receiving opioid substitution treatment'). In most countries, detoxification is still the ‘default’ treatment for opioid users entering penal institutions.

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(1) Data on prisons in Europe are available from the Council of Europe.

(2) The term ‘prisoner’ covers both those who are on remand and those who have been sentenced.

(3) Source: World prison brief for rate in the United States of America and Russia.

(4) See Tables DUP-2 and DUP-105 in the 2010 statistical bulletin.

(5) See Table DUP-3 in the 2010 statistical bulletin.

(6) See Table DUP-4 in the 2010 statistical bulletin.

(7) OJ L 165, 3.7.2003, p. 31.

(8) See Table HSR-7 in the 2010 statistical bulletin.

(9) See the Best practice portal.

Bibliographic references

Directorate-General for Health and Consumers (2008), Final report on prevention, treatment, and harm reduction services in prison, on reintegration services on release from prison and methods to monitor/analyse drug use among prisoners, Directorate-General for Health and Consumers, Brussels (available online).

CPT (European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment) (2006), The CPT standards — ‘Substantive’ sections of the CPTs General Reports, CPT/Inf/E (2002)1-Rev.2006 (available online).

EMCDDA (2009), Annual report 2009, the state of the drugs problem in Europe, Publications Office of the European Union, Luxembourg.

Irish Prison Service (2009), Irish Prison Service annual report 2008 (available online).

NOMS (National Offender Management Service) (2009), National Offender Management Service drug strategy 2008–2011, Ministry of Justice, London.

UNODC, WHO and UNAIDS (2006), HIV/AIDS prevention, care, treatment and support in prison settings: a framework for an effective national response, United Nations Office on Drugs and Crime, Vienna.

UNODC, UNAIDS and WHO (2010), HIV testing and counselling in prisons and other closed settings, Technical paper, United Nations Office on Drugs and Crime, Vienna.

Vandam, L. (2009), ‘Patterns of drug use before, during and after detention: a review of epidemiological literature’, in Contemporary issues in the empirical study of crime, Cools, M. et al. (editors), Maklu, Antwerp.

WHO (2007), Health in prisons: a WHO guide to the essentials in prison health, WHO Regional Office for Europe, Copenhagen (available online).

About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>

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Page last updated: Monday, 25 October 2010