(Session 6)

Presentations: Ms Rita Balthusene, Lithuania: "The possibilities of

reduction of drug use and harmful health consequences in large prisons in

Lithuania". Mr Harald Spirig, ARWO Unterkunftseinrichtung, Austria: "Harm

reduction from the point of view of prison administration". Ms Evita

Leskovcek, Institute of Public Health, Slovenia: Educational programmes on

HR in prison". Mr Arne Andresen, Pompidou Group, Council of Europe:

"Training of prison officers and bridging services to the outside world".

Mr Zoran Kanduc, Institute of Criminology, University of Ljubljana,

Slovenia: "Harm reduction (in prison) as a normative element of the concept

of rehabilitation".

Rita Balthusene's paper presented an important input to the regional

discussion, as Lithuania is one of the few countries in the region that

have experiences with HR in prison.

She referred to a research report by Kestutis Petrauskas, Deputy

Chief of Health Care Services at the Ministry of Internal Affairs, about

the situation of HR in prison in Lithuania (from 1995). Ms Balthusene gave

an overview on the programme for drug demand reduction and the decrease of

harmful health consequences among prisoners, which is being implemented by

the Lithuanian authorities since 1992. The main reason to start this

programme was the increasing prevalence of Hepatitis B and C among

prisoners - discovered through regular screening - which was seen, together

with overdoses and drug-related deaths, as an indicator for drug use in

prison.

Lithuanian prisons are very large: there are between 1.000 to 2.000

inmates in each prison, and between 20 and 70 prisoners share one cell.

The average age is 25 years, and it is estimated that 25% are alcohol- or

drug addicted. Drug use usually takes place in groups, new drug users are

quite easily recruited, drug dealing is uncontrollable in the large cells.

Main drugs used are home-made opiates, sedatives and sophorifics (sleeping

pills), also amphetamines, volatile substances and, sporadically,

hallucinogen and cannabis. Main route of administration is intravenous;

drugs are available and not much more expensive than in the community

(price for home-made opiates is only 10% higher than on the black market).

At the end of 1995, some heroin, cocaine, LSD and "crack" use was also

reported.

Goals of the programme are to transmit information on health damage

of drug use, to give training in hygienic precautions with regard to drug

use, and to make syringe- and needle disinfecting materials available (in 4

prisons with highest Hepatitis B and Hepatitis C morbidity). The programme

also includes training for prison officers and prison health staff.

Written materials are used (leaflets with health information, articles in

prison newspaper) as well as video films about drug addiction and safe sex.

The programme dealt with problems from the side of the prisoners (who

did not want to change their behaviour) as well as from prison

administration and from the community - and was carried out with limited

resources. Nevertheless, important conclusions with regard to reduction of

harmful consequences of drug use in prison were drawn. It would be useful

to improve the medical treatment of Hepatitis B and C infected prisoners

(interferon) as well as to immunise non-infected prisoners against

Hepatitis B. Methadone programmes, syringe-and needle exchange, separate

detoxification wards for drug addicts, special drug-related training for

newly employed prison officers, more employment opportunities for prisoners

were further important recommendations.

Harald Spirig presented his paper: >Harm reduction from the point of

view of prison administration<... He said that prison administration had to

face many challenges. It needs to have a pragmatic point of view - and be

able to manage difficult situations on all levels. As an institution it is

responsible for all prisoners, no matter if they are consuming drugs or

not. Prison administration has also certain possibilities: it can give back

responsibility to the prisoners, it can facilitate self-supporting acting

and foster active participation of all involved, no matter if they are

staff or inmates, whenever that is possible - and on all levels.

The prison administration has different tasks: It has to execute the

sentence, the punishment, and to protect society from unlawfulness. But it

has also to prepare the inmates for their release. It has to work

efficiently end cheap, but it needs a high number of staff , around the

clock, to do work that is a consequence of the sentence (even opening door

and windows is not done by the prisoners themselves). Prison administration

has also to take care of their own staff like in any other business. It is

expected that the work happens without complaints and as invisible as

possible. The bad public image that the prison system normally has, is

somewhat contradictory to its high status of power: it shares the state'

monopoly of violence. Consequently, it is difficult for the prison

administration not to be criticised.

There are different ways in which prison administration can deal with

drug using inmates. Drug free sections, which already exist in different

forms, facilitate the possibilities of the above-mentioned self-support. To

stay in such sections should also have some advantages for the inmates as a

motivation not to use drugs. Experiences with drug free sections showed

that the use of drugs decreased essentially, the number of inmates who had

to be taken to hospital for different reasons decreased too. That meant

also "saving" staff, who could do other work now. The staff got more

satisfied with their work, therefore less of them called in sick, and so

the staff situation as such improved once again.

Prison administration should also use possible support from outside,

which means an opening towards the outside world. It could bring some

relief to get some services done by people from outside: medical care,

social services, educational training for the inmates. Important is, that

the prison guards get actively involved and with share the responsibility

involved. Support for the inmates is not possible, if the guards are not

integrated into the process.

As the use of drugs in prison cannot be completely prevented - but

the risks for oneself and for others can, the provision of

methadone-maintenance programmes is an important option for prison

administration, which allows to deal more adequately with drug use in

prison.

Prison administration has to make sure that the inmates stay or get

as healthy as possible, so that they are not a higher risk for society once

they are released. This is why harm reduction cannot be only for drug

users, it has to include every inmate. A long-term efficient harm reduction

has to happen in the whole context of the institution prison and involve

all those concerned: inmates, prison staff, prison administration and

society.

Evita Leskovsek started her speech about Educational programmes on HR

in prison with a description of prisons as a social environment with a very

high HIV and Hepatitis risk. Even though there are not yet any reliable

data on the HIV or Hepatitis status of inmates, it is estimated that the

prevalence is much higher among drug users in prison than among those

outside prison, and that there is considerable risk behaviour among

prisoners. The percentage of prison inmates who are using drugs is

estimated at 25% - a figure, which is comparable to prisons in western

European countries. In the past few years, this percentage seems to have

increased.

Methadone maintenance treatment is not offered to Slovenian

prisoners. Those who are participating in such a programme at the time of

their imprisonment are, in general, detoxified within one month and obliged

to end this treatment. In some special cases, however, exceptions to this

rule are possible. In prison, possession of syringes and needles is

forbidden; the prison staff does not supply disinfecting materials, such as

bleach, to the prisoners.

Activities that were undertaken with regard to the prevention of HIV

in prisons in Slovenia were: the publication by the Ministry of the

Interior of basic recommendations on HIV/AIDS, written by the Ministry of

Health; participation of an official delegation at the 1993 European

Conference on Drugs and HIV in Prisons (Athens); and organisation of a

seminar for prison directors in 1995 which resulted in an agreement of the

prison authority to implement from 1996 onwards an educational programme

for inmates and professionals working in prisons.

In all prisons, this programme includes presentations and counselling

offers on the situation of HIV positive inmates - highlighting in

particular human rights issues -, which have led to a major improvement of

the relations between professionals and inmates. A booklet on HIV/AIDS in

prison was also published, which contains educational information and is

distributed through the nurse or other health care staff of the prisons.

Prisoners with risk behaviour are offered and encouraged to be tested for

HIV, which is voluntary and confidential. Based on the principle that

equivalent services to those in the community should be offered inside

prisons, a possibility of anonymous testing is also offered. During the

prevention programme, topics such as homosexual intercourse in prison,

availability of condoms, disinfecting fluids and 'women and AIDS' are

addressed.

In 1997, a strategy paper for the prevention of HIV and Hepatitis in

Prison was written, which was endorsed by the AIDS Commission of the

Republic and will soon become a part of the legislation. In 1998, an

educational programme on Hepatitis B and C was also started. Discussions

were organised and the issues of introducing specific harm reduction

measures, such as needle and syringe exchange in prison, was raised.

Arne Andresen presented the Tyrili Pathfinder Project for male

inmates with serious, long term problematic drug use. His presentation

focussed on the planning and organisation of the project as a drug free

unit in the men's prison of the city of Oslo (Norway). Furthermore he

explained the structures established for a gradual re-entry process back

into society. Finally attention was given to the training of prison staff

in order to prepare them for new functions and basically a new role as

prison officers.

Norwegian legislation opens the possibility of conditional release

for drug using inmates if they enter an extra-mural treatment facility in

the last months of their sentence. The programme described, called "The

Pathfinder" accepts inmates who still have 6 - 12 months to serve. In

co-operation with the Tyrili Foundation, which offers an extensive range of

treatment and work-training possibilities for drug addicts, the prison for

men in Oslo supported a staff training programme. Two (later three) social

workers trained prison staff, and worked on a daily basis in the drug free

unit, hosting the pilot project "The Pathfinder". The main challenge was to

change the unit and the staff from a rule-oriented approach to a

process-oriented one. Much attention was given to create a feeling of

ownership to the project among the prison administrators and officers.

Zoran Kanduc talked about harm reduction - also in prison - as a

normative element of the concept of rehabilitation, which have a lot in

common. Rehabilitation has potential for humanising social reaction against

crime. Harm reduction has the potential for civilising social reaction

against use of illegal drugs. The rights-oriented model of rehabilitation

logically comprises also the right to harm reduction measures. The drug

problem currently seems a central issue as regards penal reform. Many

social problems associated with the consumption of illegal drugs are really

products of the policy of prohibition. The lost "war on drugs" has had

catastrophic consequences for users, for the community and for the criminal

justice system. It's a classic case of the cure being worse then the

"disease" it purports to cure. The community is still not ready to regard

the production, distribution and consumption of drugs as a legal right.

Harm reduction is basically a compassionate and pragmatic response to

potentially dangerous behaviours. It should be defined also in legal terms,

namely as a legal right, which could be interpreted as a conceptual

"derivation" from the more general right to self-determination.