Drug Use In Prison Research Articles

Analysis of drug-impregnated paper samples seized in English prisons between 2018 and 2020

Novel psychoactive substances (NPS) in the form of impregnated papers delivered to prisoners are of particular concern in prison settings, where they are commonly used by vaping. The purpose of this study was to create a qualitative method for identifying the various emerging NPS impregnated onto paper samples sent to prisoners. It helps to demonstrate that these findings can be used to predict drug prevalence and trends in prisons. Between 2018 and 2020, 1250 non-judicial paper samples seized from 12 English prisons were analysed to determine the NPSs being circulated. Approximately 1 cm2 paper were cut and added to 50 % (v/v) methanol in LCMS-grade water. Vortex-mixing was used to prepare extracts (30 min). Q-TOF LC/MS was used to screen the extracts. This study showed that synthetic cannabinoid receptor agonist (SCRA) was the most common drug group detected in impregnated paper seizures in English prisons between 2018 and 2020, followed by cocaine, heroin type drugs (A) and amphetamine, ketamine type drugs (B). Male prisons had a higher prevalence of SCRAs, whereas female prisons had a higher prevalence of A drugs. Furthermore, lower security prisons were found to have a higher prevalence of B drugs, pregabalin, gabapentin type drugs (C), and abused and prescription drugs than higher security prisons which unveiled a higher prevalence of nicotine. The findings of this study have revealed new information about drug use in prisons. This study will also aid in the identification of drug smuggling routes into jails, keeping prison staff up to date with the trends.

Extent and patterns of drug use in prison in Burkina Faso: findings from a cross-sectional study in central prison of Ouagadougou

PurposeDrug use in prisons remains a public health concern because it is often the place of drug initiation. The purpose of this study was to analyze the drug use in prison in Burkina Faso.Design/methodology/approachWe conducted cross-sectional study in the prison of Ouagadougou. The adult prisoners (male and female) incarcerated for more than one month at the largest prison of Burkina Faso were included in the study. Participants were selected using a systematic random sampling. Data were collected from October 28 to November 26, 2018. The face-to-face interviews were conducted in the prison grounds. Logistic multivariate regression was used to identify factors associated with in prison drug use. All analysis was done using Stata.FindingsA total of 379 prisoners were included in this study. Approximately one-third inmates (32.71%; n = 124) experienced illicit drug in lifetime. Nearly one-third (28.76%; n = 109) of the prisoners were drug users before incarceration and 11.87% (n = 45) used drug inside the prison, of which 33.33% (n = 15) initiated drug use in the prison. Cannabis was the first drug used by the prisoners (71.11%) followed by tramadol (62.22%), diazepam (13.33%) and cocaine (2.22%). Four prisoners (3.63%) had reported Heroin use before incarceration. Cannabis was mainly smoked. Tramadol, diazepam and amphetamines were swallowed or mixed with food. Cocaine is smoked and snorted. Case of injection of cocaine and heroin was reported before incarceration. Main factors independently associated with drug use in prison is drug use before prison and young age of inmates. Indeed, inmates who had reported drug use before prison had 4.01 time {adjusted odd ratio (AOR: 4.01 [95% CI: 1.91–8.41])} higher odds to use drug in prison.Research limitations/implicationsTo conduct the interviews in the prison grounds could be a limitation due to social desirability bias. Indeed, the prisoners may understate drug use in prison for the fear of likely additional sentence. Availability of biological tests for drug markers might help addressed this bias. Nevertheless, the findings of this study should help to plan effective drug use prevention and care programs for prisoners.Practical implicationsThe actions must include the implementation of a medical and psychological care in continuum of healthcare system in Burkina Faso. This system should include screening at entry and adequate health and psychological care in prison for drug users for an effective control of drugs use in prison.Social implicationsMost of these drug users in prison have a low level of education and are unemployed. Education activities and training on occupational activities to prepare drug users for a successful social reintegration less dependent on drugs is essential. This study can be a basis to explore more possibilities and find out what is available to help those with substance use disorder, manage these cases in prison and prevent relapse on release.Originality/valueTo the best of the authors’ knowledge, this study is the first study on drug use in prison in Burkina Faso. It indicates that the repressive strategy against drug use seems ineffective because former users continue their consumption inside and also new users are initiated to use drugs in prison.

“They’re Just Watching You All the Time”: The Surveillance Web of Prison Needle Exchange

In 2018, the federal prison authority in Canada began implementing Prison Needle Exchange Programs (PNEPs) at select institutions. Despite longstanding and successful models of prison-based syringe distribution internationally, Canada’s correctional service introduced a highly restrictive security-based approach, placing prisoners who access the program into a surveillance web that implicates diverse actors and relies on methods such as bio-surveillance and security risk assessments. We examine these and other surveillant functions of the PNEP through the first-hand experiences of thirty former prisoners who were incarcerated at one of the prisons with such a program. These experiences point to how the surveillance web is constituted by multiple lines of sight and flows of information across health and security fields. It is further comprised of risk management practices and discretionary punishment carried out by correctional officers as well as the targeting and social sorting of people who use drugs. Former prisoner narratives also demonstrate how the PNEP is reflective of emerging forms of exclusion and processes of securitization that operate through the identification, management, and containment of specific groups. As a whole, the PNEP model implemented in Canada, and the practices that undergird it, target people who use drugs for increased surveillance, resulting in extremely low rates of program enrollment despite pervasive drug use in prison, and undermining access to an essential health care service to which prisoners are entitled. The study findings point to novel forms of carceral surveillance that enmesh observational, technological, and bureaucratic practices, and demonstrate how prisoner health and therapeutic objectives can be subsumed by securitarian logics.

Leaving Their Drugs at the Gate? Exploring Changes in Drug Use From Before to During Incarceration in Norway.

As the number of incarcerated persons who use drugs increases in many countries, it is important to understand the nature of drug use in prison by exploring how substance use patterns change from before to during incarceration. In this study, we rely on cross-sectional, self-report data from The Norwegian Offender Mental Health and Addiction (NorMA) study to identify the nature of changes in drug use among incarcerated respondents who reported having used either narcotics, non-prescribed medications, or both, during the 6 months before their incarceration (n = 824). Results show that about 60% (n = 490) stop using drugs. Of the remaining 40% (n = 324), about 86% changed their use patterns. Most commonly, incarcerated people stopped using stimulants and started using opioids; switching from cannabis to stimulants was the least common change. Overall, the study illustrates that the prison context leads most individuals to change their use patterns, some in unanticipated ways.

Prevalence of injected drug use and access to OAT in prison: survey in 7 EU countries, 2014-2018

Abstract Background People in prison report high rates of drug use and drug-related problems and people who use or inject drugs (PWUD) have higher rates of offending and an increased likelihood of spending part of their lives in prison. They represent a vulnerable population with high burden of diseases, socio-economic disadvantages and limited access to healthcare. In this study, we aimed to describe the lifetime prevalence (LTP) of heroin use, injected drug use and opioid agonist therapy (OAT) among people living in prison. Methods Individual data collection was carried out in seven European countries (Czech Republic, Latvia, Lithuania, Poland, Portugal, Slovenia, Spain) between 2014 and 2018 with a model European Questionnaire on Drug use among people in Prison. Risk factors analysis was carried out using multivariate logistic regression model. Results The analysis of EQDP data found that the LTP of heroin use was overall 22.4% (ranged from 7.3% in Poland to 27.5% in Spain). Female, recidivist offenders, individuals aged below 44 and with an history of mental health condition had a higher likelihood of being heroin user (p-value<0.05). The LTP of injected drug use was overall 20.6%(2176/10,587), while the prevalence of injected drug use in prison was 8.1%(745/9273) (with higher prevalence in countries that did not allow OAT initiation in prison: 17.5% in Latvia, 22.1% in Lithuania and 26.7% in Czech Republic). Among those who used heroin, 44.5%(772/1735) had access to OAT and among them 95.8(566/591) had access to OAT in prison. Conclusions Despite the heterogeneity of the results, there is a clear evidence that people in prison have a high prevalence of heroin and injected drug use. Prisons are an important point of access to OAT, and where treatment is available there is a reduction in risk behaviour. It is also important to implement tailored preventive interventions among vulnerable social groups at the community level. Key messages • People in prison in Europe have a high prevalence of heroin and injected drug use. Prisons can represent a point of access to integrated prison-community healthcare and social services for PWUD. • In order to plan adequate healthcare interventions, there is an urgent need to assess and monitor the prevalence of drug use also in other European countries.

Analysis of drug-impregnated paper from English prisons between 2018 and 2020

Drug misuse is a global concern that has become increasingly widespread across all levels of society. Its use in prisons contributes to greater disruption and violence, as well as having a negative influence on prisoner safety, rehabilitation, and recovery. Novel psychoactive substances (NPS) in the forms of impregnated papers posted to prisoners are of a particular concern in prison settings where they are commonly used by vaping. This study was conducted to develop a spectral database and a qualitative method to identify the variety of emerging NPS impregnated onto paper samples sent to prison inmates. The aim was to help rapid detection and identification and to demonstrate that these findings can be a good indicator of the drug prevalence and trends in prisons. In total, 1250 non-judicial paper samples seized from twelve English prisons between 2018 and 2020 were analysed to determine the NPSs circulating in the prisons. From each piece of paper, from different locations, believed to be impregnated with drugs, approximately 1 cm 2 of paper was cut. Samples were placed into separate 1.5 mL Eppendorf tubes with 1 mL of 50% (v/v) methanol in LCMS-grade water. Extracts were prepared from the samples by vortex-mixing (30 min). A mobile phase blank was injected between the analysis of each extract to check for carryover. Extracts were screened using an Agilent Technologies 1290 Infinity II - 6545 Q-TOF LC/MS instrument with electrospray ionization in positive ion mode. It uses an Agilent Eclipse Plus C18 1.8 mm 2.1 × 100 mm column, maintained at 40 °C. Drug separation was performed over a total of 13 min using a simple linear gradient of water (A), and methanol (B), both contained 0.01% (v/v) formic acid in 5 mmol/L ammonium formate, at a flow rate of 400 μL/min. Sample injection volume was 0.2 μL. The research findings showed that SCRA was the most prevalent drug group detected in drug-impregnated paper seizures in English prisons between 2018 and 2020 and followed by Class A drugs and Class B drugs. SCRAs had higher prevalence in male prisons whereas female prisons presented a higher prevalence of Class A drugs. Furthermore, male prisons with lower security level (category C) were appeared to have a higher prevalence of Class B, Class C and abused prescription drugs compared to category B prisons, which had a higher prevalence of nicotine. Associations between drug group and sex, prison category and geographical locations were statistically analysed by Pearson chi-square test using Minitab software. The outcomes of this study have provided new information regarding drug use in prison. These findings may be significant as police information and could be utilised to aid drug policymakers in prisons, particularly in the development of treatment plans addressing the most commonly misused drugs in each prison. This analysis would help in the identification of drug smuggling ways into jails, enables prison staff to pay more attention on these sites.

Harm reduction: a public health approach to prison drug use.

As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs. This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution. A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community. Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations' rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.

Drug injection in Iranian prisons: evidence from the National Rapid Assessment and Response (RAR) survey, 2017

ABSTRACT Objective: In this rapid assessment and response (RAR) survey, the demographic and behavioral differences between two sub-groups of people with incarceration histories are described. Data from those who report injecting in prison and those who do not were analyzed. Methods: Analysis of data from a sub-set of 1,240 participants recruited to a RAR national survey and reporting a history of incarceration. Results: The prevalence of ever drug injecting in prison was 15.08% (N = 187, CI: 13.3–17.4). Participants with only primary school education were more likely to report injecting (p < .001), were more frequently imprisoned (p < .001) and reported having never heard about HIV (p < .001). The multivariable logistic regression model showed that participants who reported injecting in prison were different in terms of their education (never attending school, OR = 2.29, 95% CI: 1– 5.23) and the number of times they had been in prison (> twice OR = 1.96, 95% CI: 1.15– 3.29). Conclusions: Identifying the factors influencing injection drug use in prison can help design effective strategies to prevent harms in vulnerable prisoners. Alternatives to prison for people who use drugs require further consideration in Iran.

More evidence or stronger political will: exploring the feasibility of needle and syringe programs in Ukrainian prisons

IntroductionIn 2007, the World Health Organization (WHO) recommended for prison authorities to introduce prison needle and syringe programs (PNSP) if they have any evidence that injecting drug use is taking place in prisons. This article presents descriptive evidence that injecting drug use takes place in Ukrainian prisons, it discusses how (denial of) access to injection equipment is regulated in the current system and what changes should be considered in order to implement PNSP.BackgroundUkrainian prisons still live by the laws and policies adopted in the Soviet Union. Besides laws and regulations, these legacies are replicated through the organization and infrastructure of the prison’s physical space, and through “carceral collectivism” as a specific form of living and behaving. Inviolability of the prison order over time helps the prison staff to normalize and routinely rationalize punishment enforcement as a power “over” prisoners, but not a power “for” achieving a specific goal.MethodsThe Participatory Action Research approach was used as a way of involving different actors in the study’s working group and research process. The data were gathered through 160 semi-structured interviews with prison health care workers, guards, people who inject drugs (PWID) who served one or several terms and other informants.ResultsThe “expertise” in drug use among prisoners demonstrated by prison staff tells us two things—they admit that injecting use takes place in prisons, and that the surveillance of prisoner behavior has been carried out constantly since the very beginning as a core function of control. The communal living conditions and prison collectivism may not only produce and reproduce a criminal subculture but, using the same mechanisms, produce and reproduce drug use in prison. The “political will” incorporated into prison laws and policies is essential for the revision of outdated legacies and making PNSP implementation feasible.ConclusionPNSP implementation is not just a question of having evidence of injecting drug use in the hands of prison authorities. For PNSP to be feasible in the prison environment, there is a need for specific changes to transition from one historical period and political leadership to another. And, thus, to make PNSP work requires making power work for change, and not just for reproducing the power itself.

Evaluation of a framework for safe and appropriate prescribing of psychoactive medications in a UK prison.

The widespread use of drugs in prisons leads to avoidable deaths, poorer health and a poor living environment. The contribution of psychoactive prescription drugs to this problem has received little attention in prison policy or at individual prescriber level. To determine the extent of unsafe and inappropriate prescribing of psychoactive medications in one UK prison using a newly developed medicines optimisation framework. A medicines optimisation framework was developed based on principles of good prescribing. It was initiated on the opening of a new prison-HMP Berwyn-in February 2017. During the study period, all prisoners at HMP Berwyn were transferred from other prisons. The safety and appropriateness of psychoactive medications were evaluated de novo on reception at HMP Berwyn and during follow up, using the medicines optimisation framework. About 1941 sentenced men arrived at HMP Berwyn between February 2017 and November 2018. Nearly one-third (634, 33%) were on a prescribed psychoactive medication. Seventy-five percent of these (474/634) required a prescription change due to appropriateness or safety concerns. Nearly half (295, 46.5%) received changes at reception despite having already undergone medicines reconciliation at their previous prison. Forty-three percent (275/634) received changes at follow up, most commonly those who had no prior risks identified at reception. Inappropriate and unsafe prescribing of psychoactive medications is occurring in prisons despite mandatory medication reviews. Ongoing monitoring is required to reduce the risk from these medications. A medicines optimisation framework such as this could be adopted across other prisons, worldwide, to help contribute to risk reduction from drug use in prisons. Appropriately modified, a similar framework might help reduce inappropriate and harmful prescribing in hospitals and in the community.

Reduced Hepatitis C Incidence Associated with Rapid Treatment Scale-Up in Australian Prisons: Treatment-as-Prevention in the SToP-C Study

Background: Limited empirical evidence exists for hepatitis C virus (HCV) treatment-as-prevention. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study assessed HCV treatment-as-prevention in four Australian prisons. Methods: Prisoners in two maximum- (male) and two medium-security prisons (one male, one female) were enrolled from late-2014 to 2019. Following HCV testing, participants were monitored for risk behaviors and HCV, among three sub-populations: 1) uninfected (HCV antibody negative); 2) previously infected (HCV antibody positive, HCV RNA negative); 3) infected (HCV antibody and HCV RNA positive). Uninfected and previously infected (at-risk) participants were followed every 3-6 months for HCV primary infection and re-infection, respectively. Infected participants were assessed for treatment, initially standard of care treatment (by prison health services), followed by direct-acting antiviral (DAA) treatment scale-up from mid-2017 (12 weeks sofosbuvir/velpatasvir, through SToP-C). HCV incidence was compared between pre- and post-treatment scale-up periods. Findings: Of 3,691 participants, 719 (19%) had detectable HCV RNA and 2,965 were at-risk of primary infection (n=2,240) or re-infection (n=725) at baseline. DAA treatment was initiated in 349/499 eligible participants during scale-up. Among at-risk population with longitudinal follow-up (n=1,643; median age 33 years; 82% male), 31% reported injecting drug use in prison. HCV incidence declined by 48%, from 8.31 to 4.35/100 person-years between pre- and post-treatment scale-up periods [Incidence Rate Ratio (IRR): 0.52, 95%CI: 0.36, 0.78]. The incidence of primary infection declined from 6.64 to 2.85/100 person-years (IRR: 0.43, 95%CI: 0.25, 0.74), while incidence of re-infection declined from 12.36 to 7.27/100 person-years (IRR: 0.59, 95%CI: 0.35, 1.00). Adjusted analysis indicated 50% reduction in HCV risk between pre- and post-treatment scale-up periods (adjusted Hazard Ratio: 0.50, 95% CI: 0.33, 0.76). Interpretation: DAA treatment scale-up was associated with reduced HCV incidence in prison, indicative of HCV treatment-as-prevention. The findings support broad DAA treatment scale-up among incarcerated populations. Trial Registration: Clinicaltrials.gov Identifier: NCT02064049. Funding Statement: The SToP-C study was funded by an Australian National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1092547), including support from Gilead Sciences. Declaration of Interests: GJD is a consultant/advisor and has received research grants from Gilead, Abbvie, Merck, Bristol-Myers Squibb, and Cepheid. ARL a consultant/adviser and has received investigator-initiated research grants from Gilead, Merck, and Bristol-Myers Squibb. JG a consultant/advisor and has received research grants from Gilead, Abbvie, Merck, and Cepheid. PV has received investigator-initiated untied grants from Gilead and honorarium from Gilead and Merck. NKM has received unrestricted research grants from Gilead and Merck. JGMc is a stockholder and ex-employee of Gilead Sciences. DMB is a stockholder and employee of Gilead Sciences. None of the other authors has commercial relationships that might pose a conflict of interest in connection with this study. Ethics Approval Statement: All participants provided written informed consent before study procedures. The study protocol was approved by New South Wales Justice Health and Forensic Mental Health Network Human Research Ethics Committee (HREC/14/JH/7), Aboriginal Health and Medical Research Council Human Research Ethics Committee (1047/14 and 1253/17) and New South Wales Corrective Services Ethics Committee. The study was conducted according to the Declaration of Helsinki and International Conference on Harmonization Good Clinical Practice (ICH/GCP) guidelines.

Women offenders in Europe: drug problems and drug offences and/or gender-based violence

Abstract Worldwide the proportion of women in prison for drug-related offences is higher than that of men. In Europe (27 Member States, Norway, United Kingdom and Turkey) it varies considerably, between 5 % in Bulgaria, approximately 25 % in Denmark, Finland and Sweden, 33 % in Italy and 40 % in Spain. Women are reported to have less dominant roles in drug trafficking, often occupying the lowest level of the drug supply chain. There are, however, recent indications of involvement of women in higher levels of supply chains The prevalence of illicit drug use before incarceration is much higher among prison population as compared to the general population. This excess is substantially higher among women. The patterns of drug use among women in prison are similar to those reported by men, with majority reporting having used cannabis in their lifetime. Prevalence is also high for other illicit substance use, such as heroin (19% - 49%), cocaine (21% - 41%), and amphetamines (17% -64%). Inside prison drug use is often reduced, but exists. The reduction in drug use is in many countries smaller among women then among men. Reasons for this high prevalence of drug use among women in prison are likely to be related to the high proportion of women incarcerated for drug related offences and their high level of vulnerability. Targeted interventions for women with drug related problems who experience imprisonment are needed and should be implemented with a comprehensive and multidisciplinary approach to tackle their physical, mental health and social needs. The presentation will discuss the latest European data on drug related problems among women in prison and available targeted interventions.

Factors associated with drug use in prison \u2013 results from the Norwegian offender mental health and addiction (NorMA) study

BackgroundRemarkably little is known about drug use during imprisonment, including whether it represents a continuation of pre-incarceration drug use, or whether prison is also a setting for drug use initiation. This paper aims to describe drug use among people in prison in Norway and investigate risk factors associated with in-prison drug use.MethodsWe used data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of 1499 individuals in Norwegian prisons. Respondents reported on drug use (narcotics and non-prescribed medications) both before and during imprisonment. We used multivariate logistic regression to investigate the associations between drug use in prison and demographics, previous drug use, mental health, and criminal activity.ResultsSixty-five percent of respondents reported lifetime drug use, and about 50% reported daily use of drugs during the 6 months before incarceration. Thirty-five percent reported ever using drugs in prison, but initiation of drug used during incarceration was uncommon. In a multivariate model, factors independently associated with drug use in prison included lifetime number of drugs used (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI] 1.12–1.23; p < 0.001), daily drug use in the 6 months before imprisonment (aOR = 7.12; 95%CI 3.99–12.70; p < 0.001), and being intoxicated while committing the crime related to current imprisonment (aOR = 2.13; 95%CI 1.13–4.03; p = 0.020).ConclusionsIn-prison drug use is independently associated with high-risk drug use before imprisonment. To reduce drug use in prison, correctional services must systematically screen for pre-prison drug use and offer effective drug treatment for those in need.

Evaluation of a Framework for Safe and Appropriate Prescribing of Psychoactive Medications in Prison

Background: The widespread use of drugs in prisons leads to avoidable deaths and a poor living environment. The contribution of psychoactive prescription drugs to this problem has received little attention in prison policy and at individual prescriber level. To the best of our knowledge this is the first study to evaluate a framework for safe and appropriate prescribing of psychoactive prescription drugs in a prison setting. Methods: A medicines optimisation framework was developed based on principles of good prescribing. It was initiated on the opening of HMP Berwyn in February 2017. During the study period, all prisoners at HMP Berwyn were transferred from other prisons. The safety and appropriateness of psychoactive medications were evaluated de novo on reception at HMP Berwyn and during follow up, using the medicine optimisation framework. Data was collected retrospectively from the online prison database. Key outcomes were proportion of unsafe and inappropriate prescriptions. Findings: 1941 men arrived at HMP Berwyn between February 2017 and December 2018. 32·6% (634/1941) were on a prescribed psychoactive medication. Overall 75·2% (477/634) required a prescription change due to appropriateness or safety concerns. 46·5% (295/634) received changes at reception despite having already undergone medicines reconciliation at their previous prison. 43·7% (277/634) received changes at follow up, most commonly in those who had no prior risks identified at reception. Interpretation: Inappropriate and unsafe prescribing of psychoactive medications is occurring in prisons despite mandatory medication reviews. Ongoing monitoring is required to reduce the risk from these medications. A medicines optimisation framework such as this could be adopted across other prisons in England and Wales to help contribute to risk reduction from drug use in prisons. Appropriately modified, a similar framework might help reduce inappropriate and harmful prescribing in hospitals and in the community. Funding Statement: Betsi Cadwaldr University Health Board. Declaration of Interests: Dr. Bebbington reports grants from Betsi Cadwaladr University Health Board during the conduct of the study. Dr. Lawson reports I contributed to the design of the medicines optimisation framework, completed some of the drug reviews, and completed data collection. I am the Medical Director of Gables Medical (Offender Health) Ltd which is contracted to provide primary care services to HMP Berwyn. Dr. Nafees reports grants from Betsi Cadwaladr University Health Board during the conduct of the study. Prof. Robinson reports grants from Betsi Cadwaladr University Health Board during the conduct of the study. Prof. Poole reports grants from Betsi Cadwaladr University Health Board during the conduct of the study. Ethics Approval Statement: As this study uses an anonymised routinely collected dataset, the Betsi Cadwaldr University Health Board (BCUHB) (NHS) research and development department recommend that the project is exempt from ethics approval. This project is registered with the BCUHB Clinical Audit and Effectiveness office.

The spice trail: transitions in synthetic cannabis receptor agonists (SCRAs) use in English prisons and on release

Since 2010, synthetic cannabinoid receptor agonists (SCRAs) have dominated concerns about drug use in prison; particularly as their use increases in custody and has profound impacts on users, non-users and prison staff. However, far less is known about whether SCRA use continues on release, when ex-prisoners are under the supervision of Community Rehabilitation Companies or resident in Approved Premises (APs). This study, the first of its type, examined experiences of SCRAs amongst recently released ex-prisoners and found that, most often, use discontinues on release, suggesting that SCRAs are seen predominantly as a ‘prison drug’ or, for those continuing use, as a way to avoid a positive drug test and/or breaching their licence whilst living in an APs. Awareness of SCRA use amongst their clients differed notably between Community Rehabilitation Company staff and APs staff; with the former having far less awareness and thus, also far less experience of the associated problems for supervision of their clients.

“A spray bottle and a lollipop stick”: An examination of policy prohibiting sterile injecting equipment in prison and effects on young men with injecting drug use histories

BackgroundAustralian young male prisoners with histories of injecting drug use are more likely to report injecting in prison, to do so more frequently, and to be involved in more un-safe injecting-related practices than their older counterparts. Despite international evidence that prison needle and syringe programs are both feasible and effective in reducing the harms associated with injecting drug use in prison, these young men do not have access to such equipment. MethodsWe critically analyse the interview transcripts of 28 young men with histories of injecting drug use who were recently released from adult prisons in Victoria, Australia, and prison drug policy text. We use Bacchi’s ‘What’s the problem represented to be?’ approach to examine how the ‘problem’ of injecting drug use in prison is represented in prison drug policy, including the assumptions that underpin these problematisations, and the subjectification and lived effects that are produced for the young men in our study. ResultsOur analysis reveals how prison drug policy enables the creation and re-use of homemade injecting equipment crafted from unsterile items found in prison, and that in doing so the policy produces a range of stigmatising subjectification effects and other harmful material effects (such as hepatitis C virus transmission and injecting related injury and harms). Findings highlight, how injecting drug use is represented in policy silences other ways of understanding the ‘problem’ that may have less harmful effects for incarcerated young men who inject drugs. ConclusionWe argue that somewhat paradoxically, the approach of prohibiting access to sterile injecting equipment in prison—which is constituted as a solution for addressing such harms—in fact helps to produce them.

Producing the ‘problem’ of new psychoactive substances (NPS) in English prisons

BackgroundThere has been a significant change in the types of substances consumed within English prison settings in the last eight years. There have been particular concerns regarding the acceleration in the use and availability of New Psychoactive Substances (NPS), mainly synthetic cannabinoids. Although NPS were identified as a ‘problem’ in prisons in 2011, government responses emerged only in 2015. As yet, there is no overarching policy document or strategy for dealing with NPS. This paper analyses the various strands of the response to NPS in prisons published from January 2015 to December 2016. MethodsDrawing on Bacchi’s ‘What’s the problem represented to be’ framework, the ways in which the NPS ‘problem’ in prisons has been represented is analysed through a number of related policy texts including press releases, new legislative and regulatory measures, government documents and training package. ResultsFrom the various measures introduced to deal with the ‘problem’, NPS use is produced primarily as a law, order and control ‘problem’ requiring regulation, penalties and control, rather than a ‘demand problem’ calling for prevention, education, treatment and harm reduction or a ‘regime problem’ demanding greater emphasis and resources for purposeful activities such as education, training and work opportunities. This problematisation of drug use in prisons has a history dating back to the 1995 prison drug strategy and has become entrenched and reproduced within policy development over time. ConclusionThe law, order, and control problematization blames the volatility of the substances and the individual prisoners who use them as key factors contributing to the current prison crisis, rather than as consequences of the wider practices, cultures, contexts, and conditions. Multiple representations of the problem of NPS in prisons are needed in order to address the regime and structural issues which lead those imprisoned to use substances.

The Global State of Harm Reduction in Prisons.

Despite the fact that a large portion of the prison population is made up of people who use and inject drugs, harm reduction continues to be extremely limited in prison settings. This article begins with a review of drug-related incarceration, drug use in prisons, and HIV and hepatitis C (HCV) prevalence among prisoners globally. It presents the scientific evidence, alongside legal and economic arguments supporting the provision of harm reduction to people who use drugs, both inside and outside of prisons. The article then provides a global overview of the availability, accessibility, and quality of harm reduction services in prisons-specifically needle and syringe programs; opioid substitution therapy; provision of the opioid agonist naloxone; and diagnosis, treatment, and care for HIV, HCV, and tuberculosis.

“I Lost Me Visits”

Utilizing Bacchi’s poststructuralist approach, “What’s the problem represented to be?,” we critically examine how the “problem” of drug use in prison is represented within a key initiative—the Identified Drug User program (IDUP)—of prison drug policy in one Australian jurisdiction. We use two data sources for our analysis: interview transcripts of recently incarcerated young men (aged 19–24) with histories of injecting drug use and selected prison drug policy and program documents. We examine how the “problem” of drug use in prison is problematized within the IDUP and question commonly accepted ways of thinking that underpin the program. We explore the discursive and subjectification effects of problem representations which produce young men as “rational” and “choosing” and, at the same time, as “untrustworthy” and “deserving of punishment.” We highlight how these effects have consequences for young men’s connections to family while incarcerated which can work against the very issues the IDUP is trying to address. We make two claims in particular: that the IDUP produces harmful effects for young men and their families and that the harmful effects produced are, paradoxically, those the IDUP aims to avoid. Our analysis offers insights into how drug use in prison could be thought about differently, including suggestions that might reduce at least some of its adverse effects.

Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates.

Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.