Understanding the Risk Environment Surrounding Drug Use in Prisons

Abstract

Qualitative research is uniquely positioned to advance understanding of the role of social and structural factors in shaping drug use and drug-related harms in prison settings and following release. This chapter critically reviews the qualitative literature examining drug use within the prison risk environment and following release, while identifying research gaps and directions for future inquiry. The extant literature has documented: (1) how drug use in prisons is shaped by which drugs are available, their pharmacological effects, and correctional policies; (2) how injection-related risk and syringe sharing are shaped by social and structural forces within prisons (including policies restricting syringe access) which increase the potential for drug-related harm; (3) how withdrawal and detoxification experiences in custody both foster participation in high-risk injecting practices (eg, syringe-sharing) and facilitate injection cessation and drug abstinence; (4) how inmates and staff view prison-based methadone maintenance therapy, the experiences of those receiving treatment, and barriers to scaling up methadone programs; and, (5) how transitions from prison to community shape health access, harms, and drug use patterns. By documenting prisoners’ drug-related experiences, and situating these experiences within their social, structural, and environmental contexts, these studies have generated insights beyond what is possible using other research approaches. In doing so, they have identified features of prison and post-release risk environments amenable to modification. There is an urgent need to scale up qualitative studies of prison and post-release risk environments, to better inform targeted public health interventions. Emerging interventions, including prison-based syringe exchange, should similarly be examined using qualitative approaches to more fully document their potential impacts on drug-related risks and harms.