\u201cMy first 48\xa0hours out\u201d: drug users\u2019 perspectives on challenges and strategies upon release from prison

Daniela Jamin,Wouter Vanderplasschen,Marie Jauffret-Roustide,Orphée Sys,Heino Stöver,Mariana Homen,Laurent Michel,Andreia Neisa,Philippe Trouiller,Vânia Mendes

doi:10.1186/s12954-021-00480-w

Abstract

BackgroundPrisoners 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.MethodsA 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.ResultsRespondents 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.ConclusionMeasures 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.

Highlights

Prisoners report much higher prevalence rates of drug use and more harmful consumption patterns than the general population
Sixty per cent of all drug-related deaths occur within 12 weeks after release from prison [8] and 20% of drug-related deaths are connected with prison release or leaving treatment [11]
In England and Wales, released female prisoners were 69 times more likely to die of drug-related causes during the first week after release, while released male prisoners were 28 times more likely to decease than people from the general population of the same age and gender [4]

Summary

Introduction

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. Prisoners report much higher prevalence rates of drug use and more harmful consumption patterns than the general population [1]. People who use drugs have above-average contacts with the criminal justice system in general, and the prison system and subsequent release situations in particular [3]. Preparing prisoners for release starts inside prison and needs to be continued after release, without interruption of health care and social support. Measures that focus on overdose prevention at prison release have only been reported in 15 out of 33 countries in the EU [11]

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Results

Discussion

Conclusion