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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).


Annual report 2011: the state of the drugs problem in Europe
Responding to drug problems — an overview

Published: 15 November 2011

Health and social responses for drug users in prison

In the European Union, the proportion of sentenced prisoners convicted of drug law offences ranges from 3 % to 53 %, with half of the countries reporting proportions between 9 % and 25 % (1). These figures do not include those sentenced for acquisitive crimes committed to support their drug addiction, or other drug-related offences.

Drug use in prison populations

There is still a lack of standardisation in the methodologies used in studies on drug use in the prison population (Carpentier et al., 2011). Research, nevertheless, shows that drug use is more prevalent among prisoners than among the general population. Data from several studies carried out since 2006 show that there are considerable variations in the prevalence of drug use among prisoners: ever-use of an illicit drug before entering prison was reported by as few as 8 % of respondents in some countries and by up to 65 % in others. Studies also indicate that the most harmful forms of drug use may be more frequent among prisoners, with between 5 % and 31 % of those surveyed reporting to have ever injected drugs (2).

On admission to prison, most users reduce or stop consuming drugs, mainly due to difficulties 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. In studies carried out since 2006, estimates of levels of drug use within prison vary from 1 % to 51 % of inmates. The drug most frequently used by prisoners is cannabis, usually followed by cocaine and heroin (3). Prison may be a setting for initiation into drug use or into more harmful forms of use. For example, a Belgian study carried out in 2008 found that more than a third of drug-using prisoners had initiated use of a new drug during detention, with heroin being the drug most frequently mentioned (Todts et al., 2009). Injecting drug users in custody appear to share their equipment more often than users in the community, which raises issues around the potential spread of infectious diseases among prison populations.

HIV and viral hepatitis among injecting drug users in prison

Data on HIV infection among injecting drug users in prison are scarce in Europe. In particular, they are unavailable for those countries reporting the highest prevalence levels of infection related to injecting drug use. Generally, among the eight countries providing data since 2004 (Bulgaria, Czech Republic, Spain, Hungary, Malta, Finland, Sweden, Croatia) (4), no large differences can be observed in HIV prevalence between injecting drug users in prison and those in other settings in the country, although this may be partly due to the limitations of the data. HIV prevalence among injecting drug users in prisons was mostly low (0-7.7 %) in seven countries, while Spain reported a prevalence of 39.7 %. Data on hepatitis C virus (HCV) prevalence among injecting drug users in prison were reported by eight countries, where it ranged from 11.5 % (Hungary) to 90.7 % (Luxembourg). In the Czech Republic, Luxembourg and Malta, HCV appears to be more prevalent among injectors tested in prison compared to those tested in other settings. Data on HBV infection (hepatitis B surface antigen) among injecting drug users in prison are available for four countries: Bulgaria (11.6 % in 2006), the Czech Republic (15.1 % in 2010), Hungary (0 % in 2009) and Croatia (0.5 % in 2007).

Prison health in Europe

Prisoners with a history of drug injecting, in particular, often have multiple and complex health needs, requiring a multi-disciplinary approach and specialist medical care. Prisoners are entitled to have access to the health services available in the country without discrimination on the grounds of their legal situation (5), and prison health services are expected to be able to provide treatment for problems related to drug use in conditions comparable to those offered outside prison (CPT, 2006). Although 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 (6), and the current EU drugs action plan (2009-12) calls for its implementation, the provision of services in prisons often lags behind that in the community.

Assistance to drug users in prison

A range of services related to drug use and its associated problems may be provided in European prisons. These include information on drugs and health, health care for infectious diseases, detoxification and treatment for drug dependence, combined with psychosocial assistance, harm-reduction measures and preparation for release (7).

Most countries have established interagency partnerships between prison health services and providers in the community, including non-governmental organisations, to deliver health education and treatment in prison and ensure continuity of care upon release. Several European countries have gone one step further and have placed prison health under the responsibility of the Ministry of Health or organised delivery of health care through public health services, in order to reduce health inequalities. Pioneers in this respect were Norway and France, followed by Sweden, Italy, England and Wales and Slovenia. In Scotland and Spain, this reform is currently underway.

Opioid substitution treatment is increasingly accepted in the community, but its adoption within prison settings has been slow and coverage is highly variable (8). In 2009, drug users receiving substitution treatment in six EU countries (Estonia, Greece, Cyprus, Latvia, Lithuania, Slovakia) were unable to continue this treatment after arrest. Continuity and coherence of drug treatment between community and prison and vice versa is particularly important, given the high rates of overdose deaths on release (Merrall et al., 2010).

Hepatitis C in prison populations is a growing public health concern in Europe, and specific screening programmes are reported from Belgium, Bulgaria, France, some German Laender, Lithuania, Luxembourg, Hungary and Finland. Despite the importance of detecting these infections on prison entry (Sutton et al., 2006) and the documented cost-effectiveness of providing HCV treatment in prison settings (Tan et al., 2008), many inmates go untested and untreated.


(1) There were over 640 000 people in penal institutions in the European Union on 1 September 2009. Data on penal statistics in Europe are available from the Council of Europe.

(2) See Tables DUP-1, DUP-2 and DUP-105 in the 2011 statistical bulletin.

(3) See Tables DUP-3 and DUP-105 in the 2011 statistical bulletin.

(4) See Table INF-117 in the 2011 statistical bulletin, and the Reitox national reports of Malta (2005) and the Czech Republic (2010).

(5) UN General Assembly, Resolution A/RES/45/111, Basic principles for the treatment of prisoners.

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

(7) See Table HSR-7 in the 2011 statistical bulletin.

(8) See Table HSR-9 in the 2011 statistical bulletin.

Bibliographic references

Carpentier, C., Royuela, L., Noor, A. and Hedrich, D. (2011), 'Ten years of monitoring illicit drug use in prison populations in Europe: issues and challenges', The Howard Journal of Criminal Justice (in press).

Todts, S., Gilbert, P., Malderen, V.S., Huyck, V.C., Saliez, V. and Hogge, M. (2009), Usage de drogues dans les prisons belges: monitoring des risques sanitaires, Service Public Fédéral Justice, Brussels.

CPT (European Committee for the Prevention of Torture and Inhuman or Degrading treatment or Punishment) (2006), The CPT Standards: 'Substantive' sections of the CPT's General Reports, CPT/Inf/E (2002)1-Rev.2006 (available online).

Merrall, E.L.C., Kariminia, A., Binswanger, I., Hobbs, M.S., Farrell, M., Marsden, J. et al. (2010), 'Meta-analysis of drug-related deaths soon after release from prison', Addiction 105, pp. 1 545-54.

Sutton, A.J., Edmunds, W.J. and Gill, O.N. (2006), 'Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison', BMC Public Health 6, p. 170.

Tan, J.A., Joseph, T.A. and Saab, S. (2008), 'Treating hepatitis C in the prison population is cost-saving', Hepatology (Baltimore, Md.), 48(5), pp. 1 387-95.

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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: Friday, 28 October 2011