Harm reduction services in prison - An issue for the drug

policy agenda

in central and eastern Europe? (Final Session)

In the final plenary discussion, important information that was

exchanged through the presentations and in discussions was drawn together.

Surveys in prisons in Europe, supported by expert-information from

the level of prison administration, show that:

. Drugs are available in most (if not all) prisons;

. Drug supply in prisons can only be limited but not completely

eliminated;

. A large number of prisoners in the European Union is or has been

injecting drugs;

. A high percentage of injecting drug users who entered EU-prisons did

not stop using drugs;

. Injecting drug use in prison is connected with high health risks

(patterns and circumstances of use create high risks of HIV and

Hepatitis C infections, mainly through contaminated injecting

equipment);

. Drug use in prison is a problem that cannot be tackled with legal

means only;

. There is general agreement that services for imprisoned drug users

should be comparable to services outside - in the community (and thus

include HR);

. HR measures that are applied in prisons include drugs/sex/health

education; opiate substitution programmes, distribution of sterile

syringes and needles or the distribution of disinfectant substances

(bleach);

. Experience shows that HR strategies in prison can be successfully

implemented if the prison staff supports them - and that they will

fail if they are not supported.

Interventions from participants showed that policy-makers, prison

health and administrative staff and other experts are interested to obtain

further detailed information on HR in prison. In particular, the following

topics were mentioned: practice of HR service delivery in prison, research

on prevalence of IDU and risk behaviour among prisoners, and evaluation of

HR measures among IDU prisoners.

The need for more information on further subjects within the broader

theme of "Drug use among prisoners" was also expressed (see: Chapter 5 of

this report).

Discussions indicated that in most countries public opinion was not

in favour of HR measures in prison. In many countries - including the EU

countries -, drug counselling or drug-free treatment were not available to

all drug-using inmates; and HR services were still seen by the public and

by some policy makers as "optional" rather than "necessary" component of

drug demand reduction action. It became clear that there is a need for

better information about various aspects of "HR in Prison", including the

dissemination of international recommendations, among prison

administration, health care staff and among the public. To obtain political

support by the Government, practical support by prison administration and

staff as well as by drug-services outside prison, discussions on national

level need to be intensified in the future.

It is also necessary, to obtain more information on the situation in

prisons in Phare partner countries. Research studies on prevalence of IDU

and risk behaviour should be undertaken and the collection of data on

imprisonment of drug users in general should be improved. In this context,

the possibility of collaborative studies between prisons in the EU and in

Phare partner countries was also mentioned.

In many countries, there is "room for improvement" in the whole

prison system. It was mentioned that prison staff needed more training on

drug issues, and multidisciplinary teams (doctors, nurses, social workers,

pedagogues, psychologists, and psychiatrists) should ideally be established

to work with the addicts. HR measures, like opiate substitution programmes,

the distribution of condoms, or the distribution of sterile needles and

syringes are only one aspect. Another one is the improvement of general

drug service provision to prisoners and the opening of special services

which take care of the addicts after they are released from prison by

helping them to find job, accommodation, and to become equal with the other

members of the society.

All this mainly means a profound change of attitude and a change of

role for prisoners and for those who work in prison. It was said that it

would help to reduce the harm caused by drug use, if "the role of patient

was put ahead of that of prisoner".