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People who use drugs and prison
In this video, Ehab Salah from UNoDC provides a global overview on people who use drugs and prison.
Every year, more than 30 million people spend time in prison or in detention. Almost 11 million are incarcerated on any given day. This number is continually rising, with a 20% increase in the male prison population, and a 53% increase in the female prison population since 2000.
And a significant number of these are in prison for non-violent drug related offences. It is clear therefore that a large percentage of people in prison are using or dependent on drugs even before they go there. Many continue to use drugs in prison, others may initiate drug use while incarcerated. When people inject drugs in prison, they often share injecting equipment. This sharing of contaminated needles and syringes contributes to transmission of blood-borne viruses, such as HIV and hepatitis B and C. Indeed, people in prison are up to 7 times more likely to be living with HIV than adults in the general population.
And in countries with high incarceration rates of people who inject drugs, the HIV prevalence rate in prisons can be 15 to 20 times that of the general population. With this in mind, access to prevention, treatment and care services for HIV and related health conditions is generally poor for those in prison.
One of the key issues is a
This not only increases the risk of transmission of blood-borne infections, but also the risk of fatal overdose during imprisonment and especially upon release. People released from prison are 40 times more likely to die from opioid overdose in the first 2 weeks after release, compared to people in the community. Mathematical modelling suggests that detention and reimprisonment of people who inject drugs contribute to the overall HIV epidemic. It also suggests that reducing the incarceration of people who inject drugs will reduce the incidence of HIV. Despite the evidence global responses to drug use remain predominantly punitive.
National laws and criminal justice policies have resulted in excessive incarceration of people who use drugs UNODC and partners advocate for non-custodial alternatives to imprisonment for minor, non-violent offences, and alternatives to punishment or conviction for drug use.
For example the United Nations has set out Standard Minimum Rules for the Treatment of Prisoners. These are also known as the Nelson Mandela Rules. And they emphasize that people in prison should enjoy the same standards of health care as those in the community. UNODC and partners advocate for a comprehensive package of 15 key interventions for HIV prevention, treatment and care in prisons and other closed settings.
These interventions include, among others :
And gender responsive services. should target both people in prison and prison staff. It should cover HIV and tuberculosis infection and other health conditions, drug use, and overdose prevention and management. Such services are best delivered by peers, who can also supplement programs conducted by authorities and civil society organisations. Regarding Needle and Syringe Programs, people who inject drugs in prison should have easy and confidential access to sterile injecting equipment, needles, syringes and paraphernalia. This can be realised in a number of ways. For example, hand-to-hand distribution by prison nurses or doctors, provision by trained peer workers, or automated dispensing machines.
When it comes to Opioid drugs, “everyone” in prison should receive information on the risks of opioid overdose and be trained to recognise the signs of overdose. They should respond immediately by providing first aid and calling for emergency professional assistance. Naloxone, which rapidly reverses the effects of opioids,
Opioid Substitution Therapy is considered the most effective treatment for people who are dependent on opioids. Studies have also found that OST, along with overdose prevention and management interventions, is associated with reduced overdose, both in prison and after release. Despite this figures show that in 2019, OST programmes were available in prisons in only 54 countries while Needle and Syringe Programs were available in prisons in just 11. To prevent transmission of HIV and other sexually transmitted infections, condoms and condom-compatible lubricant should be provided free of charge to both men and women in prison, and for intimate visits. These items should be made easily and discreetly accessible to people in prison at various locations.
Finally, Women in prison have health care needs that are different from men, but often poorer access to health services and commodities. So, it is important to sensitize prison management and staff on women’s specific needs, and implement gender-responsive interventions. These should include sexual and reproductive health care services, including prevention, of mother-to-child transmission of HIV, syphilis and hepatitis B. It is also crucial to protect staff from occupational hazards. Prison authorities and employees should implement adequate occupational health and safety procedures in prisons.
The reality is that harm reduction interventions in prison are lacking across the globe. Introducing or expanding them in prisons is challenged by political, legal and regulatory barriers. And addressing this situation cannot be separated from broader questions of criminal justice and prison reform, including those related to drug use, sex work, same-sex relations and transgender people. Health authorities should also be a part of prison reform to ensure the availability of high-quality health services in prison, as well as continuity of health services at all stages, from arrest, to post-release.
This must be prioritised and resourced by international societies, national leaders and prison authorities. Thank you very much
We have now covered a broad overview of how the principles of the human rights framework apply to harm reduction. After diving into some of the more specific human right issues that related to the war on drugs, let’s have a look at some other related topics. We have already heard overcrowding of prison being mentioned in Week 1 by Ruod.
One of the obvious direct consequence of repressive drug policies, is the very high rate of people being imprisoned for drug related crimes. Some estimations suggest that over half of people who inject drugs have a history of incarceration!
This video is featured by the United Nations Office on Drug and Crime (UNoDC). It expands further on the notion of disproportionate imprisonment in relation to drug use and discusses the minimum required harm reduction services inside prison settings, which have failed to be met globally in almost all cases.
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