(Session 2)

Presentations: Ms. Olga Perhavc, Ministry of Justice: "HR in prison:

aspects of social medicine" (on behalf of Evita Leskovcek, Institute for

Public Health) and: "Work strategy on harm reduction in Slovene prisons".

Mr. Dusan Nolimal, Institute of Public Health, Slovenia: "Researching drug

use in Slovenian prisons: project proposal, concept and design". Mr Andrej

Kastelic, Centre for Mental Health, Slovenia: "Treatment of drug users in

prison".

Olga Ursic Perhavec from the Ministry of Justice has started her

presentation with a description of the current situation in Slovenian

prisons. She mentioned a two-level approach in the field of health care of

imprisoned person in Slovenia: general health care for prisoners, and

treatment of drug and alcohol dependency. This is the main goal

of the co-operation between the Ministry of Health and the Ministry of

Justice to attain compatibility of the public health care policy with the

prison health care, and the compatibility of drug dependency treatment

programmes inside and outside the prison.

Until 1995, there were no systematic approach to drug

dependent person in prisons. Due to the increase in the number of person

with drug related problems in prisons, it was considered necessary to

start developing a principle strategy for treatment of drug dependency for

drug users. Taking into regard their specific circumstances, each prison should

develop it's own programme for the treatment of drug dependent person. A

common characteristic is, that all programs contain a medical and a

therapeutic part of treatment. At the present moment, very different groups

of imprisoned people are together: drug users, non-users, dealers - and in

this type of environment is hard to motivate individuals to stop using drugs.

A black market for drugs, needles and syringes exists inside institutions. In

addition, the existence of a pressure towards non-users to start using drugs is

evident. Non-users also prefer to be separate from drug users, because of

their fear from Hepatitis and HIV infection.

With the intention to overcome this difficult current situation, a

reform of the strategy for treatment of drug dependent person in prison was

accepted. The vision is to make possible for individuals who are

motivated to stop using drugs to stay in drug free wings inside the

institutions, and for dependent person who are still taking drugs

ensure harm reduction programme (like methadone, or needle exchange

schemes). Olga Ursic Perhavec emphasised that the introduction of needle

exchange programmes is still utmost provocative for the penalty system, as

it changes the role of convicted/imprisoned person to a medical patient. A

prisoner who possess a needle faces disciplinary sanctions: the

use of sterile needles in prison is in contradiction with the legislation.

However, some low threshold projects have already started in Slovenian

prisons. Olga Ursic Perhavec has mentioned the project "AIDS" and the project

"HEPATITIS". The discussion on how to establish services for drug users in

prison that are comparable with those "outside" is only in it's starting

point.

Dusan Nolimal presented a project proposal for researching drug use

in Slovenian prisons. He said that there was not yet a serious attempt to

measure the drug problem in Slovenian prisons. According to data from 1997,

more than one third of the prison population in Slovenia were diagnosed as

drug addicts. He said that the decision about which information to collect

in a prison depended on the purposes for which it was needed. Reliable and

comparable data regarding drug use among prisoners, including a clear

description of their actual situation in prisons was lacking. He proposed

to set up a data-collection system in order to provide a basis for sound

decisions on prevention, harm reduction and treatment activities in

prisons. The main objective would be to improve knowledge on the treated

drug users and drug use in prisons and to reduce drug use demand and supply

in prisons. To assess the extent and nature of drug use among prisoners

would help in the development of prevention, education and harm reduction

strategies, in planning health and social services for addicted prisoners

and would be a basis for evaluating prison interventions. The information

could also contribute to the development of training programmes for

different professionals. Furthermore, the data would complement the

existing epidemiological information system. He finished his paper with

the call for the authorisation of a data-collection system in Slovenian

prisons by the competent departments of justice and health administration.

Andrej Kastelic said that substance abuse among prisoner in Slovenia

was constantly increasing. Recommendations for treating withdrawal syndrome

were accepted three years ago but were out of date. Imprisoned drug users

do not have access to the same treatment possibilities as drug users at

large and efforts should be made to make all types of services -from

low-threshold to abstinence programmes - available to drug users. However,

many activities had already started and there was strong support for

changing legislation and providing the possibility to chose between

treatment and prison, he concluded.