Transcript 03_Montanari - Health Without Barriers

Drugs and Prison in Europe: State of Play
Linda Montanari, Luis Royuela, Dagmar Hedrich
Health Without Barriers
Cagliari, 3rd June 2015
Background information
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EMCDDA
(European Monitoring Centre on Drugs and Drug Addiction)
WHAT IS IT?
WHAT AREAS COVERS? ?
• EU decentralised Agency established in
1993 in Lisbon
• Epidemiology: use and consequences
• 28 MS + TK; NO; + candidate/potential
candidates, neighbouring countries
• Interventions drug users: prevention,
treatment, harm reduction, best
practices
• Mandate: provide factual, objective,
reliable and comparable information at
European level on drugs and drug
addiction and consequences
• Drug market and supply
• New drugs: early warning system
WHAT ARE THE MAIN OUTPUTS?
• EDR
• Statistical Bulletin
• Country overviews
• PODs
• Insights
• EU Action Plan Evaluation
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Available data sources on drugs and prison
(28 EU MS, NO, TK - Annual)
A) Quantitative data:
B) Qualitative data:
1. Workbook on Prison
1. Drug use among prisoners
(LTP before and during prison, regular
and current use, LT injecting
2. People entering drug treatment in
prison (TDI)
•
•
•
•
National profile and Organisation
Drug use and related problems
among prisoners
Drug-related health responses in
prison
Quality assurance of drug-related
health prison responses
New developments
3. Infectious diseases in prison settings
(HIV, HBV, HIV)
•
4. Drug Law offences
2. Legislation and policy:
•
Analysis on alternatives to
prison
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Drug Use among Prisoners in Europe:
a complex relation
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Problems drug users
Prison
European research on PDU and their experience with prison:
30%–75% of PDU have been in prison once (Ravndal,
Amundsen, 2010)
PDU increase the risk of imprisonment, especially because of
Crimes committed to support drug use (Gaffney, 2008, ACMD,
1996) and has disruptive effect on vulnerable populations
Imprisonment associated with higher risk of drug use and earlier
relapse after inpatient treatment (Smyth, 2010)
Prisons as places to reach drug users not in contact with other
services for research on PDU and interventions
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Drug Law Offences for use/possession and for supply
(~ 15% of all sentenced prisoners are for DLO)
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Source: EMCDDA data - last available data
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Drug users
Prison
Lifetime prevalence of drug use among prisoners
80% of prisoners use tobacco (20–30% gen. pop.)
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Source: EMCDDA data - last available data
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Drug use (ever) within prison:
heroin, cocaine, amphetamines (%out of all prisoners)
60
50
40
Heroin
30
20
Cocaine
Amphetamines
10
0
Source: Statistical bulletin 2014
In press a book on drug use in prison at global level.
Few studies existing, mainly from Europe, some from other parts of the world.
Only 59 studies found:
•
40 in EU
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11 in America (only 3 in US)
•
8 from other countries
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Infectious Diseases
HIV+ among IDUs in EU prisons:
up to 40%
HCV+ among IDUs in EU prison:
up to 91%
Odd Ratios for IDUs with Prison/No Prison experience:
• HIV:
• HCV:
up to 3 OR
up to 7 OR
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Mortality of EU drug users after prison release
• Extremely high risk of drug-induced deaths (‘overdoses’) in the first weeks
after release from prison
• European studies on excess mortality risk (SMR) after prison release:
• England/Wales (first week):
X 29 (M) X 69 (F)
• Denmark (first two weeks):
X 62 for males and females
• France (first year):
X 24 (M 15-34); X 274 (M 35-54)
• Ireland: comparison Drug Related Deaths with prison / with no prison:
- 28% of DRD had left prison since one week
- 18% of DRD had left prison since one month
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Drug related interventions in prison:
Policy, Treatment, Harm Reduction
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Treatment for drug users in prison:
EU policy framework
 Council Resolution Nov 2002 on drug treatment in prison
 4 EU Drugs Action Plans (2000-2004; 2005–2008; 2009-2012;
2013-2016)
• drug services for people in prison and develop alternatives to
prison
• provide access to health care for drug users in prison…”
• implement indicators to monitor drug use, problems and services”
 2004: EP recommendation on the Rights of prisoners in the EU
 EU Drug Strategy 2013-2020:
• “scale up and develop drug demand reduction measures in prison...
• proper health assessment of the health situation and needs of
prisoners at all stages including arrest, imprisonment and after
release”
 Two principles considered of by the EU countries:
• Equivalence of care between community and prisonemcdda.europa.eu
Source: 2012 Selected Issue on Drugs and Prison
• Continuity of care
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National policies
•
Governance of prison health: Trend towards prison health being
managed by Ministry of Health (7 countries);
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Partnerships with civil organisations in all countries (except Turkey)
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15 countries have specific prison objectives in national drugs strategy;
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10 countries have prison health strategies addressing drug use;
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Only 3 countries (ES, LU, UK) have dedicated prison-drugs strategies
(Source: Selected issue 2012)
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Drug Treatment and Harm Reduction
•
Detoxification as ‘default’ treatment for most opioid users
•
Low-intensity drug treatment available in all countries;
•
Mainstay: individual/group counselling; support by specialised
providers from community
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Inpatient treatment: abstinence-oriented/drug free, including TC
•
Increasing provision of OST in many countries
•
Needles/Syringes Exchange Programmes (NSP)
•
Infectious Diseases Interventions (ID)
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Estimated availability of residential drug-free
treatment in European prisons
Existing in most countries but
to a different extent
Not available in (3): FR, SK, BG
Level of availability:
• Available at an unknown level: (5) NO,
SP, BE, CY
• Full availability: 3 (LT, LU, HR)
• Extensive: 10 (PT, IT, MT, GE, AT, NL,
SK SI, PL, UK)
• Limited: 5 (NO, FIN, EE, CZ, GR)
• Rare: 3 (IE, LV, RO)
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Prisons — Opioid Substitution Treatment
Opioids >
• Cumulative number of EU
countries with OST in
community and prison
• Not available in CY, GR, LT, SK
• Can be initiated in prison in all
countries except 4
• (CZ, LV, PL, Northern Ireland)
• Coverage of all prisoners:
- >10% in 7 countries
- 3-10% in 9 countries
- <3% in the other countries
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Harm reduction in prisons
• Infectious Diseases Interventions
o Mainly information to prisoners and staff; structured programs, including
information on condom use and cleaning injecting equipment in few countries
o HIV, Hepatitis C, B, TB anonymous/voluntary testing offered in most countries
o Scarce data on provision of hepatitis C treatment - few prisoners treated
o Hepatitis B vaccination programs exist in 16 countries
o Condoms provision in 10 countries but with limitations
• Needles Exchange Syringes Programmes (NSP)
o Research shows reductions in risky injecting and sharing
o Modalities: machines, face-to-face, external workers, trained peers
o Existing in: SP, LU, RO, GE (Berlin), PT (pilot project) at varying provision levels
• Prevention of overdose
o
o
o
o
Pre-release counselling on overdose risk
Training on first aid and overdose management
Need to optimise referral to achieve continuity of care
Distribution of naloxone among opioid users leaving prison
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Summary points
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Highlights and issues….
• Big overlap between drug users and prisoners in Europe
• Drug related health and social correlates important problem
• High turnover and recidivism and links with the outside community
• European countries implementing treatment and HR measures, but to
limited and varying extent (coverage and flexibility)
• Data still scarce, data quality is limited and country comparability
poor
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Methodological EMCDDA developments
• EMCDDA contribution towards a methodological framework for
monitoring drugs and prison in Europe (COR-DROGUE
15/2/2014)
• Questionnaire on drug use among prisoners in Europe
(http://www.emcdda.europa.eu/publications/scientificstudies/eqdp) (EQDP) (piloting phase in CZ, PL, PT, IT,
SP)
• Survey of drug-related health facilities in European prisons
(EFSQ-P) (in liaison with WHO)
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THANK YOU FOR YOUR ATTENTION
[email protected]
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http://www.emcdda.europa.eu/
http://www.emcdda.europa.eu/activities/prison
http://www.emcdda.europa.eu/publications/scientificstudies/eqdp
http://www.emcdda.europa.eu/publications/selectedissues/prison
http://www.emcdda.europa.eu/topics/prison
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