Transcript Hier Titel eingeben - Irish Penal Reform Trust

Harm Reduction and Drug Policy
in Western European Prisons
“HIV, Hepatitis C, and Harm Reduction in prisons: Evidence,
Best Practice and Human Rights“ – Irish Prison Reform Trust
and Merchant‘s Quay Ireland, Dublin 11.12.2003
Dr. Heino Stöver
(University of Bremen/Germany)
Assistance to Drug Users in Prisons
(www.emcdda.org/responses/themes/
assistance_prisons.shtml)

Prevalence of Drug
Use in 15 EUCountries
 Drug Using
Patterns
 Prevention and
Treatment
Responses
”Prisons are mostly overcrowded, stressful,
hostile, and sometimes violent places, in
which individuals coming from lower
classes, ethnic and social minorities are
overrepresented (Farbring)”
Prevalence of Infectious
Diseases in European Prisons
• According to European networks:
• prevalence of Hepatitis C among i.v. drug
users is 50-90%
• prevalence of HIV varies from 0-17% of
the total prison population (average 5%)
Transmission of Infectious
Diseases (HIV, Hep.) in Prisons
• Drug users highly vulnerable group
• HIV outbreak in a Scottish and a
Lithuanian prison
• staff at risk of acquiring Hepatitis
• Seroconversions in a Women‘s Prison in
Germany (Hepatitis B + C)
Drug Use in Western European
Prisons: What Do We Know? /1
• Dating back to the 70ies
• drug market/supply comparable to the outside
• prevalence of drug consumption varies
•
•
•
•
depending on the institution
most common drug beside nicotine is cannabis
approx. half of i.v. drug users continues
injecting while in prison
some take opportunity to ‚take a break‘
changes in patterns of drug use (volume,
frequency, type of drug, routes of
administration)
Drug Use in Western European
Prisons: What Do We Know? /2
• Needle-sharing and common use of
•
•
•
•
injection equipment is inevitably
connected with i.v. drug use
„Hygienic relapse“
Some prisoners are initialising drug use
while in prison
Discover new substances and mixtures
High risk of death from overdose after
release
Estimation of the number of drug
users in Prisons

8 million people incarcerated worldwide
>50% in Russia, China und the USA
(458,000 non-violent drug charges)
 350,000 prison inmates in Europe at any
time
 15-50% ‚problematic drug users‘
 Turn-over rate (x 3,5) 180,000-600,000
annually
Proportion of Drug Users among
Prisoners in Europe
80
70
Country Proportion of drug users among
prison population (minimum)
60
50
40
30
20
10
En
d/
W
al
es
Sc
ot
la
nd
gl
an
ed
en
ia
Sw
at
al
on
ai
n
C
Sp
al
rtu
g
ds
Po
rla
n
ur
g
et
he
N
m
bo
Ita
ly
xe
Lu
ce
G
er
m
an
y
G
re
ec
e
Ire
la
nd
Fr
an
d
Fi
nl
an
m
ar
k
en
D
el
gi
um
B
tri
a
0
Au
s
% of population
Country Proportion of drug users among
prison population (maximum)
Characteristics of drug use in
prison:
• High discontinuity in the availability of
drugs
• That means steady change of withdrawal
and consumption
• Widespread poly-drug use to bridge
periods of inability to finance drugs
• Quality, purity is even harder to calculate
Prevention abstinence oriented
• information material
• drug free zones
• therapeutic communities
Harm-Reduction Measures:
•
•
•
•
•
•
•
•
•
Target-group specific information material
‚Realistic‘ drug counselling
Hepatitis A/B vaccination
peer support/peer driven intervention
safer use/safer sex training
condom availability
bleach
methadone prescription
provision of sterile syringes
Substitution Treatment in
European Prisons – Throughcare?
Country
Detoxification
short term prisoner
Maintenance
long term prisoner
Austria
Belgium
Denmark
Finland
France
Germany
Greece
Ireland
Italy
Luxembourg
The Netherlands
Portugal
Spain
Sweden
England & Wales
Northern Ireland
Scotland
Few Prisons
Most Prisons
All Prisons
No Prisons
Relapse
Prevention
Needle Exchange
Programmes in Prisons:
Feasability
• No threatening of staff members or other
inmates
• Most of the prisoners followed the rules
determining the supply of sterile needles no exclusion of participants.
• Number of drug finds did not increase
• Increase in the utilization of other
therapeutic measures
Acceptance - Personel
• Needle exchange programmes became in
a very short period part of everyday life,
the extraordinary character of the pilot
project has vanished and a process of
normalisation could be observed
• Persuasion by practical experiences of
pilot project
Acceptance - Inmates
• Different acceptance of the needle
exchange in the women‘s and the men‘s
prison according to different modes of
provision of syringes
• Doubts about anonymity in both prisons.
Provision via slot machines provides a
higher degree of anonymity
Obstacles of a Transfer of HarmReduction Strategies into Prisons
• drug free prison/denial of drug problem
• identical goal of prison sentence and
prison drug service
• controllability of drugs and
communicable diseases
• wrong message for inmates
• problematic signal for staff
The principle of equivalence
• Wishful thinking?
• Connection between community care
and cure
• Development of transparency of
practice and policies – for inmates
and the community professionals
• Health care standards and clear
guidelines
Further Information and Contact
• Final report available in English on:

www.emcdda.org/responses/themes/ass
istance_prisons.shtml
• [email protected]
Further Informations under:
http://www.archido.de