Prisons and drugs in Europe: the problem and responses

Over the last decade, Europe has seen an increase in the size of its prison population. As of 1 September 2010, there were an estimated 635 000 inmates in prison in EU Member States (Aebi and Del Grande, 2012; Walmsley, 2012). Most of those in Europe’s prisons are from poor communities and vulnerable social groups (WHO Regional Office for Europe, 2007), with the proportion of inmates who are immigrants or from minority ethnic backgrounds on the increase (Ronco et al., 2011). Drug users form a large part of the overall prison population, with studies showing that a majority of prisoners have used illicit drugs at some point in their life and many have chronic and problematic drug use patterns. Because of the illegality of the drugs market and high cost of drug use, which is often funded by criminal activity, the more problematic forms of drug use are accompanied by an increased risk of imprisonment.

Although some prisoners do stop or reduce their use of drugs on prison entry, others initiate drug use or engage in more damaging behaviours when they are incarcerated (Lukasiewicz et al., 2007). In addition to high levels of drug problems, prisoners also experience poorer health than the general population, with higher prevalence of blood-borne infections, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV), as well as mental illness. Reported rates of self-harm and suicide among prisoners are particularly high compared with the general population of the same age. In addition, overcrowding and poor hygienic conditions may further aggravate the stress, social and health problems experienced by prisoners.

For opioid users, the risk of dying from drug overdose greatly increases in the period after release from prison — due to high rates of relapse and lower opioid tolerance (Farrell and Marsden, 2008). This is a critical time for action, when ensuring continuity of care and targeted interventions can both support recovery and save lives. The services offered to prisoners, however, have historically compared poorly with those provided in the community (Stöver and Weilandt, 2007). In general, services provided for prisoners have tended to mirror those provided in the community, but with a considerable time lag.

Nevertheless, when appropriate drug services are in place, periods of incarceration may provide an opportunity for some to reduce their drug use and engage with treatment, and, in recent years, many European countries have increased the provision of services for drug users in prison, particularly substitution treatment.

Recent years have also seen an increasing acknowledgement from international and European institutions of the importance of treating prison health as an inseparable component of public health. The Council Recommendation of 18 June 2003 and the 2009–12 EU action plan on drugs have both called for the development and implementation of prevention, harm reduction and treatment services in prison that are equivalent to services outside prison.

This Selected issue approaches the important topic of prisons and drugs in Europe from two perspectives. The first section aims to provide an insight into patterns and levels of drug use among the European prison population, the health profile of prisoners and risk behaviours while incarcerated. The second section examines Europe’s prison health policies and models of delivery of drug-related healthcare to detainees, including the provision of prevention, treatment and harm reduction services. The report concludes with reflections on ways forward.

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