Daniela Jamin
Wouter Vanderplasschen
Orphée Sys
Marie Jauffret‑Roustide
Laurent Michel
Philippe Trouiller
Andreia Neisa
Mariana Homen
Vânia Mendes
Heino Stöver
Harm reduction Prison Overdose Drug use Risk behaviour Release Recovery
“My first 48 hours out”: drug users’ perspectives on challenges and strategies upon release from prison

Background: Prisoners report much higher prevalence rates of drug use and more harmful consumption patterns than the general population. People who use drugs have above-average experiences with the criminal justice system in general, and the prison system and subsequent release situations in particular. Release from prison is associated with increased mortality rates among drug users due to the risk of overdose. The EU-funded project ‘My first 48 hours out’ aimed to address the gaps in continuity of care for long-term drug users in prison and upon release, with a special focus on drug user’s perspectives on needs and challenges upon release.

Methods: A multi-country (Belgium, France, Germany and Portugal) qualitative study was set up to explore drug users’ perceptions of drug use and risk behaviour upon prison release, experiences of incarceration and release, and strategies to avoid risks when being released. In total, 104 prisoners and recently released persons with a history of drug use participated in semi-structured interviews and focus groups discussions on these topics.

Results: Respondents pointed out that there are numerous challenges for people who use drugs when released from prison. Lack of stable housing and employment support were frequently mentioned, as well as complex administrative
procedures regarding access to services, health insurance and welfare benefits. Besides structural challenges, individual issues may challenge social reintegration like ‘old habits’, mental health problems and disrupted social networks. As a result, (ex-)prisoners adopt individual strategies to cope with the risks and challenges at release.

Conclusion: Measures to prepare prisoners for release often do not focus on the individual and specific challenges of persons who use drugs. Psychosocial and medical support need to be improved and adjusted to drug users’ needs
inside and outside prison. To improve the quality and continuity of care around release, the perspectives and coping strategies of people who use drugs should be used to better address their needs and barriers to treatment.

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Nasrul Ismail
Audrey Lazaris
Éamonn O'Moore
et al.
Leaving no one behind in prison: Improving the health of people in prison as a key contributor to meeting the Sustainable Development Goals 2030

Worldwide, approximately 11 million people are currently being held in prison, a sizeable population which has been growing steadily since the turn of the 21st century. The prison population is more likely to suffer from physical and mental ailments both during and prior to their imprisonment, underpinned by poverty, social exclusion and chaotic lifestyles. Recognition of people in prison is noticeably absent from the Sustainable Development Goals (SDGs), which seek to predicate positive health outcomes for all populations, particularly the ‘left behind’.

Underpinned by the ethos of ‘leaving no one behind’, this paper represents the first interdisciplinary analysis as to how improving the health of people in prison can contribute to the fulfilment of the SDGs. Furthermore, our normative conceptual framework illustrates that meeting 15 of the 17 SDGs will also help to meet existing international prison health standards. Acknowledging that the scope of prison health transcends incarceration, brokering the involvement of cross-sector stakeholders and co-producing solutions with both the prison workforce and people in prison are all critical factors in ensuring a systemic buy-in to the SDGs.

Future research is proposed to develop relevant indicators and to encourage the sharing of best practices which can promote the real-world impact on policy and practice. In order to reach the ‘furthest behind first’, it is crucial that prison health is at the forefront of the SDGs.

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Treatment and care for people with drug use disorders in contact with the criminal justice system

Alternatives to Conviction or Punishment.

This initiative is developed, inter alia, considering resolution 58/5 of the Commission on Narcotic Drugs (CND) entitled “Supporting the collaboration of public health and justice authorities in pursuing alternative measures to conviction or punishment for appropriate drug related offences of a minor nature”. The Commission on Narcotic Drugs invited UNODC - in consultation with States and, as appropriate, other relevant international and regional organizations - to “provide guidelines or tools on the collaboration of justice and health authorities on alternative measures to conviction or punishment for appropriate drug-related offences of a minor nature”.

In response to this, UNODC and the World Health Organization (WHO), launched the initiative “Treatment and Care of People with Drug Use Disorders in Contact with the Criminal Justice System: Alternatives to Conviction or Punishment” at the 59th session of the Commission on Narcotic Drugs in 2016. This initiative aims to enhance the knowledge, understanding, scope and potential for alternative measures to conviction or punishment. In line with the international drug control conventions2 and other relevant international instruments, including human rights treaties and UN standards and norms in crime prevention and criminal justice,3 it explores options to divert people with drug use disorders who are in contact with the criminal justice system to treatment.

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Kate Dolan
Effat Khoei
Cinzia Brentari
Alex Stevens
Prisons and Drugs: A global review of incarceration, drug use and drug services

Prisons play an important role in drug policy. They are used to punish people who break drug laws and they also hold a large number of people who have experience of drug use and drug problems. They therefore have an important part to play in attempts to reduce the harm caused by drugs. Imprisonment itself can be seen as one type of harm, as it causes problems for prisoners and their families and creates a large fi nancial burden for taxpayers. These harms and costs are diffi cult to calculate, but there is little evidence that large scale imprisonment of drug offenders has had the desired results in deterring drug use or reducing drug problems (Bewley- Taylor, Trace, & Stevens, 2005).

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.

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