Prisons & Drugs: a global review of incarceration, drug use and drug services

This brief review concludes that coverage and quality of drug services in prison should be improved, aiming to offer drug services that are at least equivalent to those outside of prison, given the importance of prison as an environment for the development of drug problems and the transmission of HIV.

In this paper, we examine the international prevalence of drug users, drug use and related problems in prisons and we report on the problems that are related to the issue of drugs in prison. We go on to examine the international guidelines and effective responses that have been developed in this area in the last decade. The paper is a review of the literature, based on a search of bibliographic databases including Medline, PubMed, ISI as well as EMBASE and contacts with researchers and practitioners in the fi eld up to January 2007. We hope that this paper provides an accessible guide to policymakers and service designers who are considering the appropriate responses, or evaluating and refi ning existing responses, to drug use in prisons in their own country.

CONCLUSION This brief review has demonstrated that drug use poses serious problems for prisons and that prisons are an important setting for the provision of drug and HIV services. Several international recommendations and guidelines have now pointed the way to increasing the coverage and quality of drug services in prison. The minimum standard to which prison drug services should aim is to provide an equivalent range and standard of drug services to that which is available outside the prison. Given the importance of prison as an environment for the development of drug problems and the transmission of HIV, consideration should also be given to providing drug services that are specifi c to the prison population. A range of services that are effective outside prison have also been demonstrated to be valuable within prisons. These include detoxifi cation, maintenance prescribing, the provision of therapeutic communities and needle exchange. A variety of services will be necessary to meet the diverse needs of prisoners, who have different experiences and patterns of drug use. All these services will be most effective where they are integrated into a system that provides continuity of treatment as people enter and exit the prison environment. Drug use in prison is a serious problem which was, for a long time, neglected. Many countries are now taking up opportunities to provide effective services. There is still potential to improve prison drug services in order to reduce the damage done by drug use to the health and safety of prison staff, of prisoners and of the communities to which the prisoners will return