Provision of harm reduction and drug treatment services in custodial settings – Findings from the European ACCESS study

Abstract

Aims: The aim of the study was to survey the availability, coverage and quality of harm reduction and drug treatment services delivered to drug users in prisons across Europe. Methods: A survey was conducted between 2012 and 2013 among the 29 European countries. An electronic semistructured questionnaire was sent to the national institutions responsible for prison services, and 27 countries responded. In addition, good practice interventions for drug offenders have been collated by 15 national experts covering 15 European countries. The interventions were described and assessed as to their quality through using European monitoring centre for drugs and drug addiction (EMCDDA) standard tools for reporting and quality assessment. Findings: Drug treatment including detoxification and opioid substitution treatment (OST) is available in prisons of most European countries. However, OST is unavailable in five countries. Almost all countries provide prison-based harm reduction measures to prevent and treat infectious diseases among prisoners. Especially, testing and treatment for HIV and tuberculosis are provided, while other measures, such as the distribution of condoms or bleach, and especially needle and syringe programmes are still rare. Conclusions: Access to and coverage of OST in prisons is higher in countries with a long history of OST provision, while in countries that introduced OST more recently the scale of OST is usually lower. Access to hepatitis C treatment is often limited in prisons due to the lack of drug abstinence or a health insurance.

• Drug dependence
• European prisons
• good practice
• harm reduction
• survey

Acknowledgements

A number of institutions and experts contributed to the ACCESS study. The Ministries of Justice from 29 European countries responded to the survey of harm reduction and drug treatment services available in their prison systems. Furthermore, 15 experts from 15 EU countries have been appointed to collate systematic information on good practice in harm reduction implemented in the national prison system.

Declaration of interest

The authors declare that they have no competing interests, neither in terms of financial relationships nor in terms of personal relations.

The ACCESS study was funded by the European Drugs Prevention and Information Programme of the European Commission (JUST/2009/DPIP/AG/0950). The contents of this publication are the sole responsibility of authors of this paper and can in no way be taken to reflect the views of the European Commission.

Supplementary material available online Inventory of harm reduction in prisons (2012). Questionnaire developed for the prison research within the ACCESS project.

Notes

¹The ACCESS study was implemented by COMPASS, a leading UK charity in the problem drugs and alcohol field, together with five European partners representing Germany, Romania, Portugal, Italy and France. The research within the study was conducted by the two authors of this paper.

²For more details see EMCDDA, Statistical Bulletin 2010, HRS-9 (http://www.emcdda.europa.eu/stats10/hsrtab9).