The Belgian prison system comprises 34 prisons, two specific psychiatric centres and three closed centres for minors. The Directorate General of the Penitentiary Institutions is responsible for the Belgian prison system. The Ministerial Circular Letter of 18 July 2006 regulates the principles of an integral and integrated prison drug policy as implied by the Federal Drug Policy Note of 2001. It also stresses the importance of the active detection of drug use and related health and psychiatric problems.
Based on the latest available data from a survey conducted in 15 Flemish prisons between 2015 and 2016, more than half of prisoners used illicit drugs in the year prior to imprisonment. More than one third of the respondents declared having used drugs during imprisonment. Of those who did not use drugs in the year prior to imprisonment, 14 % started using drugs while in prison.
Healthcare in prison is the responsibility of the Federal Public Service of Justice. Members of the medical staff are responsible for the provision of information about drugs, drug-related infectious diseases and treatment options to every person entering prison and for checking whether or not a prisoner has been treated prior to detention. The Central Service for Healthcare provides healthcare services to inmates, while the Psychosocial Service provides medical and psychosocial advice as part of security measures in prisons and for those on probation.
Services for drug users in prison are provided by prison health teams and external caregivers. Information materials on drugs, harms and risk behaviour are available. The availability of drug-related health services, such as support from a psychologist, cognitive-behavioural interventions, opioid substitution treatment (OST), therapeutic communities and drug-free programmes, varies among prisons. Drug treatment is often restricted to those with a medical prescription. OST can be either initiated or continued in prison; both methadone and buprenorphine are available.
With regard to the prevention of drug-related infections, voluntary testing for hepatitis B and hepatitis C viruses and human immunodeficiency virus (HIV) is available in some Belgian prisons. Treatment for infectious diseases is available in all prisons. Condom distribution takes place at health services and through small vending machines.
In 2017, a pilot project aiming to develop a decision model to improve the treatment trajectory for inmates with drug-related problems, suicidal behaviour and dual diagnosis was implemented in three Belgian prisons.