The status-quo of prevention, treatment and harm reduction services for people in prisons and in reintegration services for persons on release from prison
There is a need for more systematic research on the effectiveness of treatment for drug users in prison, as there is hardly any high-quality research
in this field, especially in the EU. Although there exist a range of interventions for drug using inmates, the implementation is often sporadic and not sufficient to meet the needs.
To promote and secure health in prison, testing for infectious diseases and vaccination is a major opportunity, and does have an impact on the health of the incarcerated, the correctional employees and the communities to which the inmates return. Vaccination for Hepatitis B and A is highly recommended for prisoners. Drug testing on the other hand, in particular mandatory drug testing in prison can have adverse effects, e.g. encourage people to switch
from smoking drugs like Cannabis to injecting drugs like heroin, in order to avoid detection. It has been observed that mandatory drug testing is rather expensive and can be counterproductive, due to an increasing tension in the prison.
Treatment for prisoners involves the treatment for drug dependency and infectious diseases. Upon entering the prison, prisoners with AIDS should be offered treatment with highly active anti-retroviral therapy (HAART), which is an effective treatment. Hence existing HAART should not be discontinued and prisoners not yet receiving HAART should be encouraged to start HAART.
Similar to AIDS, treatment for HCV is safe and feasible.
Although the establishment of prison-based substitution treatment proved to be as effective in reducing mortality, crime and re-incarceration rates and HCV as in the community, the implementation of prison-based substitution treatment is still not equally well accepted and realized. Concerning harm reduction measures in prison the implementation is fragmentary and often problematic, despite existing research on the topic.
Evidence for the effectiveness of prison needle exchange programmes (PNEP) has been gathered in a number of very different prison settings: PNEP reduces needle sharing very effectively, can increase uptake of drug treatment as well as the safety in the prison, and can reduce abscesses and fatal overdoses. It does not increase injecting drug use, nor has it shown any other negative effects. No research was found explicitly evaluating the distribution of sterile tattooing equipment. Still this measure should be recommended to reduce the risk of transmitting diseases, as tattooing often occurs in prison. Condoms are likely to be the most effective method for preventing sexually transmitted diseases (STDs). No serious negative effects of condom
distribution in prisons have been found, and the free availability of condoms seems feasible in a wide range of prison settings.
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