A Literature Review of International Implementation of Opioid Substitution Treatment in Prisons: Equivalence of Care?
by The Editorial TeamHeroin dependence is associated with severe negative outcomes such as HIV and hepatitis C transmission, criminal activity, imprisonment and death from opioid overdose. Opioid substitution treatment (OST) is the most effective treatment available for heroin dependence, resulting in reduced heroin use, HIV transmission, criminal activity and mortality. It is cost-effective and has higher retention rates than other forms of treatment for drug dependence. OST is available in at least 66 countries and territories, including low- and middle-income nations such as China, Indonesia and Iran. The World Health Organization, the Joint United Nations Programme on HIV/AIDS and the United Nations Office on Drugs and Crime have recommended the implementation of OST in prisons as an essential part of HIV prevention programming. It is argued that, as in the community, heroin-using inmates treated with opioid substitution will inject drugs less often, thus reducing the risk of HIV transmission between prisoners sharing needles and syringes. Other grounds for implementing OST in prisons include improvements in inmate manageability and prison safety and reductions in postrelease criminal activity and re-incarceration.
Suicide rates in prisoners are considerably higher than in the general population, both in the United States and the United Kingdom and internationally. In the United States, the rate of suicide in jails is estimated to be 8 times higher than in the general population, and in England and Wales, the age-standardized rate of suicide among all male prisoners is 5 times higher than in the general population - a proportionate excess that has been increasing since 1978. In addition, these rates remain high after leaving prison - a recent study of all inmates released in 1 U.S state found an increased suicide risk 3- to 4- fold higher than in the general population after adjustment for age, sex, and race.
Mental Disorders among Adolescents in Juvenile Detention and Correctional Facilities: A Systematic Review and Metaregression Analysis of 25 Surveys
by The Editorial TeamAdolescents younger than 19 years constitute 5% of all those detained in custody in Western countries, including about 100,000 individuals in the United States. They are usually detained in separate closed facilities or prisons. High prevalence of both undiagnosed and untreated physical and mental health problems have been reported, with current mental disorders estimated to affect 40% to 70% of the adolescents who come into contact with the justice system. Deliberate self-harm and repeat offending are common,and some of these disorders, such as substance misuse and conduct disorder, are risk factors for criminal recidivism. In the United States and the United Kingdom, it has been argued that there is insufficient screening for mental disorders, that sentencing does not account for mental health issues, and that custodial and secure facilities lack qualified staff and appropriate treatment.
The Prevalence of Intellectual Disabilities among 12,000 Prisoners: A Systematic Review
by The Editorial TeamHigh prevalence of HIV infection and the over-representation of injecting drug users (IDUs) in prisons combined with HIV risk behaviour create a crucial public-health issue for correctional institutions and, at a broader level, the communities in which they are situated. However, data relevant to this problem are limited and difficult to access. We reviewed imprisonment, HIV prevalence, and the proportion of prisoners who are IDUs in 152 low-income and middle-income countries. Information on imprisonment was obtained for 142 countries. Imprisonment rates ranged from 23 per 100 000 population in Burkina Faso to 532 per 100 000 in Belarus and Russia. Information on HIV prevalence in prisons was found for 75 countries.
Risk Factors for Adverse Perinatal Outcomes in Imprisoned Pregnant Women: A Systematic Review
by The Editorial TeamAlthough women make up only a small proportion of the 9 million people imprisoned worldwide, their numbers are increasing rapidly and consistently across a number of countries. For example, the number of women imprisoned in England and Wales has risen almost threefold over the past decade. Most of these women will be of childbearing age and an estimated 6% of imprisoned women are pregnant. This implies that in England and Wales alone there are about 240 pregnant women in prison at any one time, and in the United States of America over 6,000.
A Randomised Controlled Trial of Methadone Maintenance Treatment Versus Wait List Control in an Australian Prison System
by The Editorial TeamObjectives: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. Methods: All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. Results: Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. Conclusions: Consideration should be given to the introduction of prison methadone programs particular where community based programs exist.