Themed Collections: International Day against Drug Abuse and Illicit Trafficking 2023

The 26^th June 2023 is the International Day against Drug Abuse and Illicit Trafficking. This is an important day for those living and working in prisons. Many people are imprisoned because of illegal activities related to drugs and criminalisation of drug use in many countries. Drug use, in particular, is related to a number of illnesses including mental health disorders and blood borne viruses.

Starting in June, WEPHREN is highlighting issues related to drug use. We hear from Linda Montanari who coordinates the monitoring of prison and drugs in the European countries at the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). We also hear from Dr Nadine Kronfli assistant professor in the Department of Medicine at McGill University and practising clinician.

Linda Montanari

People in prison are more likely to use and/or have used drugs compared with the general population, and they are more likely to have engaged in risky forms of drug use, such as injecting. Many of those in prison have complex health needs, including drug-related problems, and assessment and treatment of drug-related problems is important in prison.

The EMCDDA is working to produce evidence-based information on Drugs and prison in Europe, to make data on drugs and prison more available and comparable across countries in order to provide a robust base for decision making at European and national level. This Insight on Prison and Drugs, Current and future challenges report published in 2021 provides an overview of current knowledge and the latest developments in the field of drug use and prison in Europe. An update on the responses provided in prison setting in Europe has been recently released. You can watch a webinar on the report and related issues here. The EMCDDA is currently working on the definition of models of care for the elimination of hepatitis in prison and developing training material on drugs and prison in Europe targeting mainly prison security staff.

Linda Montanari is a health sociologist working at the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). In her role as Principal Scientist, she coordinates the monitoring of prison and drugs in the European countries. 

She was responsible for the publication "Prison and Drugs in Europe: Current and Future Challenges" released by the EMCDDA in 2021 and contributed to numerous scientific publications in the area of prison and drugs. Her aim at the EMCDDA is trying to improve the quality and comparability of information on drugs and prison in Europe regarding both drug use and possible related problems and interventions that target people with drug problems living in prison. She represents the EMCDDA in the WHO-HIPP steering group and in WEPHREN. Since some years she is also coordinating the areas of drugs and gender, as well as drugs and mental health more recently.

Nadine Kronfli MPH MD FRCP(C) DTM&H

Due to the criminalization of drug use, people who inject drugs (PWID) experience high rates of incarceration, with 58% of PWID ever incarcerated globally. (1) Although the number of PWID who inject within prison is lower than in the community, risk-taking is extraordinarily higher with increased sharing of limited injecting equipment, contributing to substantial intra-prison transmission of HIV and hepatitis C virus (HCV). Although treatment as prevention reduces the incidence of HCV in prison, (2) the rates of HCV re-infection remain high, underscoring high-coverage opioid agonist therapy and prison needle and syringe programs (PNSPs) for HCV elimination.

Only 9 of 173 countries worldwide provide PNSPs in at least one prison, including Canada. However, use of PNSPs remains low in Canadian federal prisons. Thirty qualitative interviews with people released from Canadian federal prison showed that uptake may be limited due to issues with confidentiality, privacy, and surveillance, punishment and removal of privileges, and lack of knowledge about how PNSPs work. (3) We are now conducting focus groups with correctional officers, healthcare personnel, and current and potential users of PNSPs to further understand barriers. We will then address these barriers using a bundle of implementation tools to understand “how” and “why” PNSP services work in Canadian federal prisons, thereby generating evidence to inform programs and support advocacy globally.  

Dr Nadine Kronfli is an infectious diseases doctor and assistant professor in the Department of Medicine, Faculty of Medicine and Health Sciences at McGill University.

Her research focuses on designing, deploying, and evaluating evidence-based models of care that aim to increase engagement along the HIV and hepatitis C virus care cascades for vulnerable populations, with a particular focus on incarcerated and migrant populations. During the COVID-19 pandemic, her research has expanded to include seroprevalence studies in correctional facilities and interventions to increase COVID-19 vaccine uptake among people in prison. The ultimate goal of her research is to support the development of evidence-based policies to improve population health with an emphasis on eliminating certain infectious diseases such as hepatitis C and SARS-CoV-2 among neglected populations.

https://rimuhc.ca/-/nadine-kronfli