On 25 May 2007 the World Health Organization regional office in Europe published Health in prisons, a guide for the provision of health care in prisons.1 The guide outlines steps that prison services can take to reduce public health risks associated with compulsory detention and outlines internationally recommended standards for prison health. The authors provide guidelines on assessing prisoner needs and providing evidence-based prevention, care and treatment in the prison setting. A number of chapters are of interest to those working in the drugs area, such as ‘drug use and services in prisons’, ‘substitution treatment in prisons’, ‘communicable diseases’ and ‘HIV infection and human rights in prisons’. This article highlights the steps recommended to deal with drug-related issues and infectious diseases. 

Survey estimates indicate that half of the prisoners in the EU have used drugs and that many are problematic and/or injecting drug users. A number of European surveys indicate that the prevalence of blood-borne viral infections such as hepatitis B, hepatitis C and HIV is higher among prisoners than among the general population. Drug use is one of the main problems facing prison services; it leads to problems between prisoners themselves, between prisoners and their relatives and between prisoners and prison staff. The WHO guide emphasises that a wide range of drug services is required within prisons in order to deal with the demand for drugs. These services need to be linked with community drug services in order to ensure continued treatment at entry to prison and on release. Prison services need to ensure that measures to address the high risk of fatal overdose on release from prison are implemented. Prison-based drug services should participate in drug treatment monitoring systems and drug service evaluations. 

According to the WHO guide, opiate substitution is part of generic drug treatment services and is the gold standard for the management of opiate-dependent individuals. Methadone (or other substitution) treatment reduces the incidence of injecting drug use and HIV. Participation in opiate substitution treatment reduces the incidence of crime and the number of admissions to prison. In Europe, the most common form of substitution treatment is methadone. The numbers receiving opiate substitution treatment has increased substantially within the past 10 years. Continuity of methadone is required between community drug treatment services and prison services. Before methadone substitution is started in prison, participants must be provided with information about its interaction with other medications, risks associated with multiple drug use and risk of opiate and polydrug use overdose.

The infectious disease status of prisoners (particularly in relation to HIV) is confidential information and those with access to such information should respect this principle. All prisons should have easy access to confidential voluntary testing facilities so that early diagnosis and intervention is encouraged. 

The authors report that the spread of blood-borne viral infections can be reduced through implementing universal precautions, a combination of discouraging tattooing and providing sterile tattooing services, as well as a combination of drug treatment services and needle exchange services. 

In general, prison services should encourage external support for those with mental illness, substance misuse and long-term infectious diseases. 

1. Moller L, Stover H, Jurgens R, Gatherer A and Nikogosian H (2007) Health in prisons: a WHO guide to essentials in prison health. Copenhagen: World Health Organization.