experiential account experience in the prison
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Dr Sonali Jhanjee, Additional ProfessorNational Drug Dependence Treatment Centre,
AIIMS
National CME: OST , 19.04.15
Experiential account: Experience in the prison
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Why should we think about OST in
Prison?
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Why should we think about it?...
Strong connection between criminal activity and substance abuse.
Chaiken 1986; Inciardi 1979; Johnsonet al. 1985
Percentage of people with a drug problem in prison ranges from 40 to 80%
Dolan K,, Brentari, C, and Stevens A 2008
Problematic substance misuse is overrepresented in prison as compared to the community.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
There are drugs in prison…
Prisons are ‘secure’ establishments
However drugs are available in prisons throughout the world.
Presence of drugs can be a difficult issue for prison authorities to officially acknowledge.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Prisoners experience drug problems before, during and after imprisonment…
Pure criminal justice interventions, without associated drug treatment: Have very limited impact on drug-using behaviour Between 70 and 98 % of those imprisoned for drug-related crimes
and not treated relapsed within the year following release re-offending
(WHO, Status Paper on Prisons,2005) The risk of a fatal overdose in the first few days following
release from prison: In a UK study of 51,590 releases from prison, approx 35% of all male
and 12% of all female drug related deaths are from prisoners recently released.
(Farrell & Marsden 2005) Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Prisons and prisoners are part of our community…
A large percentage of prisoners serve short prison terms of lessthan one year.
Prisoner health is community health- rapid turnover, sharing, unprotected sex, both inside prison and back in the community
A significant number of these will reoffend and return to prison, creating a “revolving door” between prison and the community.
Prison health challenges do not ‘stay behind bars’…
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
A unique opportunity
Unique opportunity for health promotion, intervention anddisease prevention providing access to ‘hard to reach’ groups.
In the absence of effective treatment -high proportion of drugdependent prisoners will continue using drugs and persist incrime.
Drug dependence treatment works…
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Introduction
Criminal justice system
Drug abuse treatment system
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Attitudinal barriers
Denial of drug abuse problem in prison Common perception that prisons should be drug-free zones Moral failing of individual vs chronic relapsing disorder Treatment programs often encounter opposition because they run counter to the established punishment/ control
culture in correctional settings OST undermines their efforts to reduce the drug supply in
their institutions (ie, a black market for drugs)
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
AIIMS-UNODC-TIHAR project
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Background
UNODC-ROSA (funding agency)
Project: “Prevention of Spread of HIV amongst vulnerable groups in South Asia(RAS/H71)”
Component: Advocating for and Provision of Oral Substitution Treatment (OST) in Prisons of South Asia
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Advocacy
Breaking Denial
Training &Sensitization
Peer networking &
peer led intervention-
involving Prison staff,
inmates, NGOs
Building partnerships-
prison officials, civil
society,prisoners
Breaking the “Us”
and “Them” Divide
Hand Holding for acceptance of a comprehensive
packageof services for HIV prevention
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Study Intervention site (Tihar Prisons)
Delhi Prisons has two Prison Complexes Tihar one of the largest prison complex in the world comprising
of nine central prisons District Prison at Rohini Prison Complex
Houses 12000 prisoners against sanctioned capacity of 6250 prisoners
First intervention In a South Asian Prison
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Objectives
To test the feasibility and effectiveness of buprenorphine asmedication for long term treatment for opioid dependence inTihar prisons
To develop a manual/ protocol of guidelines for implementingOST in prisons settings
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Agenda
Overview of OST (opioid substitution therapy) Minimum standards of practice and best practices in OST
delivery Safeguards overdose prevention and management prevention and minimization of diversion
Issues related to implementation in prison setting Participative group session Drafting road map for implementation of OST in Tihar prison
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Human Resources and Training
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Human Resources and TrainingExisting health structure and human resources of the Tiharprison was utilized for training. Doctors and nurses already working in prison were deputed
for the programme and trained in the delivery of OST. Existing lab personnel of Tihar were trained to carry out urine
screening for morphine. Counselors to deliver psychosocial interventions were trained
from NGOs working in Tihar prisons. Personnel from the prison administration were sensitized to
address organizational issues and provide administrativesupport for the programme.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training
The trainings were provided by psychiatrists and faculty ofClinical chemistry from NDDTC, who had technical expertiseand wide experience in administration of OST in thecommunity setting in India.
The training was participatory and multi-modality and on-siteexposure to patients receiving Buprenorphine in thecommunity was provided.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Agenda
Role definition Detailed pharmacology of Buprenorphine Demonstration of Psychosocial interventions to be carried out Clarification of dispensing to doctors/nurses and prison
managers Explanation about maintenance of stock registers to nurs Interaction with patients already receiving OST in Trilokpuri
community clinic
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training
Formally inaugurated by hon,ble Mr. Tejendra Khanna, Lt. Governor, Delhi
Hands on practical training as and when required Weekly visits to Tihar jailPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Site of Implementation
The site of implementation was the de-addiction centerlocated in the premises of the Tihar Jail Complex of DelhiPrisons.
The deaddcition centre is a 120 bedded hospital. Prisoners onOST were housed exclusively in one ward of the hospital.
This was done with a view to make it easier for prisonadministration to coordinate and deliver OST services fromone single point
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Service Delivery
Three common situations where it is appropriate to initiateusers on to opiate maintenance in the prison setting areimmediately upon admission to prison during the sentence a period of time before release.
In this study, opioid dependent prisoners were identified atthe initial medical examination upon admission into prisonsand eligible opioid dependent inmates from Tihar prisonswere offered pharmacotherapy with buprenorphine andpsychosocial intervention.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Intervention
OST (Buprenorphine)
• Intiate daily dispensing in prison
• Continue post release in community at• NDDTC, Ghaziabad, AIIMS• Community clinic, Trilokpuri,
AIIMS• Mobile clinic, Sundarnagari,
AIIMS• Psychiatry OPD, AIIMS
Psychosocial intervention
• Administered in group sessions and individual sessions
• By trained NGO’s operating at Tihar prison regarding• Goals of maintenance
treatment• Treatment compliance• Relapse prevention• Coping and problem solving
skills• High risk behavior• Motivation enhancement• Lifestyle changes• Rehabilitation
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Methodology
Design • Pre-post design with assessments (on predetermined
parameters) at• Baseline• 3 months• 6 months• 9 months and• 12 months
Post release • On release, patients assigned a designated follow up centre
(closest to their residence) to continue OSTPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Inclusion criteria Age > 18 years Likely to stay in prison for one year ICD-10 diagnosis for Opioid dependence (as per self
report) at the time of incarceration (Preference would be given to those IDU’s who are HIV/ hepatitis B/
hepatitis C +ve) History of opioid dependence for ≥ 5 years Staying near or willing to follow up in a community centre Willing to participate voluntarily and provide informed
consent Priority given to patients already receiving OST in the
community upon imprisonment
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Source: International Centre for Prison Studies, London, 2005
Countries Remand prisoners and/or pre-trial detainees as % of all prisoners
India 70
Bangladesh 60
Sri Lanka 48
Nepal 60
Maldives NAPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Daily Dispensing
Buprenorphine was given as daily Directly Observed Treatment(DOT) sublingually.
The medication was dispensed early in the morning tominimize disruption of their daily activities of the prisonersincluding legal visits and allotted work.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Baseline
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Socio-Demographic Profile Age: 83% in 18-35 years age group 40% in 18-25 years 43% in 26-35 years Mean age of the sample 29.2 ± 8.1 yrs
Marital status: 71% were single 56.4% unmarried 14.3 % were either divorced or separated due to drug use
Sizeable number were illiterate (47.4%) followed by thosewho were literate / educated up to only the middle level (33%)
65%: either presently unemployed or never employed 38%: either living alone or with friends
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Crime record
96%: pretrial remandees 93%: repeat offenders Mean no. of times arrested before this crime was (6±4)
Mean age at first imprisonment 20±6 years Majority (81%) NOT arrested under NDPS act 98%: committed offences to support their drug use
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Drug use profile Mean age of initiation of primary drug is 18 +5 yrs In 37%, age of onset, before 15 years
The mean duration of regular use 10+7 yrs
70.5% were currently (1month prior to imprisonment) IDUs Sharing of syringe/needle: 85% Sharing of paraphrenalia: 67%
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
0
20
40
60
80
100
Ever usePrior to imprisonment
Drug use among prisoners
Most were poly drug users with heroin being the primary drug in 97%
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
At follow-up
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Treatment outcome at time of release Median duration of stay in the prison: 81 days (minimum=2,
maximum=715, s.d. =152)
95.5% retention rate in prison 100 % compliance among those retained in prison
3 months 6 months 9 months 12 months
Mean dose of Buprenorphine(in mg)
5.1± 2.4 4.8± 2.1 3.8 ±1.1 3.3± 1.4
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Drug use 3 prisoners reported IDU at follow up Majority reported not using any illicit drugs on follow up 4% reported heroin use 5% reported Cannabis use
Objectively confirmed by urine screening 47% continued use of tobacco within prison setting although
not on a daily basis
Marked decline in drug use
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Lab parameters: urine screening
•6% of sample tested positive at 3 months•None tested positive at 6, 9 and 12 months follow-up
N=133Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
7.7
1.30.8 0.9
0.00123456789
at Beginning 3 months 6 months 9 months 12 months
A significant decrease (F=39.94,df=4,p<.001) in severity of dependence of drug use was reported over time
Mean score of severity of dependence of the inmates over time
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Withdrawal symptoms
Mean Subjective Opioid Withdrawal Scale score (SOWS)
Mean Objective Opioid Withdrawal Scale score(OOWS)
38.3
8.53.1 0.3 1.4
05
1015202530354045
A highly significant decrease(F=182.19, df=4, p<.001) was observed over time 5.0
2.2
0.61.2
0.00
1
2
3
4
5
6
Baseline 3months
6months
9months
12months
A highly significant decrease(F=22.97, df=4, p<.001) was observed over time
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
7.5
0.80.6
0.0 0.00.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
Baseline 3 months 6 months 9 months 12 months
A highly significant decrease (F=121.73, df=4, p<.001) was observed over time.
Mean visual analog (VAS) score for craving
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Side effects
OST with buprenorphine demonstrated to be safe No major adverse events reported during implementation
Buprenorphine well tolerated Minor side effects like headaches, light headedness,
drowsiness and weakness reported at 3 months and wereminimal at 6 months followup
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Diversion
Diversion noted at the initial stages of the project No diversion reported in the past year
To prevent diversion Medications dispensed in small batches of 3-5 prisoners Supervision by doctors, nurse with one staff from the jail
administration Tablets were crushed before dispensing
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Safe keeping of Buprenorphine
Safe keeping of Buprenorphine was ensured and bulk stock ofmedication was stored in the head office of the prison and astock of few days medication was maintained at the site ofdispensing.
Mechanisms were put in place to ensure that the supply chainof buprenorphine is well maintained.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Monitoring of provision
Intensive mentoring inputs were provided from the technicalexperts from NDDTC during this period who made weekly sitevisits to hand hold the provision of OST and monitor thedifficulties encountered/solve operational problems during thefirst 6-8 months.
Once mechanisms of delivery were established, these visitswere made fortnightly and later monthly.
Further, telephonic contact with technical agency was alwaysmade available
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Pre-release planning
It is well known that the continuity of treatment for prisoners as they re-enter the community is of critical importance to prevent death by overdose and reduce relapse to heroin use,
community linkages were secured at the start of the study.
On release the prisoner was provided with referral slips for follow up to the appropriate community centre indicating that the date of commencement of opioid substitution therapy and current dose of Buprenorphine.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Pre-release planning
Midway through the project, it was realized that a two daystake away dose of the buprenorphine naloxone combinationon release from prison may be provided to the prisoners upontheir release to offset the risk of relapse.
This allowed the released prisoner some time to locate hisfollow up center in the community and also provided cover forholidays.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Qualitative data- Staff
Initial 3 months of the program were very difficult due to coordination problems both the staff and patient.
Perceived increased workload was causing difficulties.
It took an initial 3months for all of them to comfortable with each other and all procedures to fall in place
Duties of staff adjusted to accommodate increased responsibility
Rapport with patients is much better, they respect the staff members and listen to what they have to say.
“Insaan ban gaye”Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Changes noted in patients behaviour Marked improvement in personal hygiene
Take a bath, shave ,wash clothes
Marked improvement in irritability and disciplinary problems
Are amenable to counselling
More responsible Do the work alloted to them
Look after new OST prisoners
Listen to what the staff members are saying
EAT!A positive change in behavior reported by jail authorities.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Patients
Subjective report of patients being relieved, comfortable reporting no craving, withdrawl or irritability.
They can finally focus on other issues.
First ray of hope that treatment is possible.
Satisfied with treatment and attitude of staff
Were satisfied with the dosage of drug provided.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Issues and challenges
A major challenge in the implementation of this project wasthe unpredictable duration of stay (mostly short) andunplanned release of these inmates as overwhelming majoritywas pretrial remand prisoners and not convicts.
The available time for therapeutic intervention was oftenshort.
Therefore the designated follow up community center wascommunicated to the inmate at the time at the time ofinduction itself and a referral slip to the community center wasprovided on discharge.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Refresher trainings It was also realized that maintaining a trained workforce in
prison may require continuous effort as rotation of staff was a norm.
Provision of periodic refresher trainings were required which besides training new personnel, incorporated a review of internal coordinating mechanisms between health personnel, counselors and prison administration staff to ensure smooth delivery of OST intervention.
Provision of these trainings also helped to maintain momentum of OST intervention program and helped to keep the team motivated.
Periodic refresher trainings were found to be an important component of the overall programme.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Post release A further observation of the project was that despite having
successful in prison outcomes, there was high rate of attrition post release even though community linkages were secured.
This may imply that to prevent relapse into crime and drug use people additionally need adequate support with overall social integration(Mourino,1994)..
There was a strong expressed need for rehabilitation both in prison and on release by prisoners. Thus mechanisms of strengthening the post release arm of treatment needs to be explored and formulated.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
High Rate of attrition post release
Although facilitated entry in treatment but retention rates were low Reasons
Transportation charges/financial/unemployment Follow up centres very far Peer pressure Involvement in criminal activities Lack of family support/family wants patient to continue criminal
activities as source of income/family involved in drug peddling/ Lack of residence Trilokpuri centre near police station
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
What did we achieve in the prisons? Demonstrated that the intervention if feasible Achievements in jail
• Abstinence from illicit drugs as confirmed by periodic urine screening• Decrease in craving and withdrawl of drugs• No drug seeking behaviour• Decreased high risk behaviour• Retention in treatment in prison• Positive changes in institutional behaviour including increased
productivity• Information, education and communication on HIV and related risk
behaviours• First exposure to maintainence treatment • Counseling regarding nature of OST and relapse prevention counselingCoordination of prison health staff and administration essential
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Conclusion
This collaborative project was implemented in Tihar prisonsfrom 2008-12.
Overall, this project was a significant regional advance as itdemonstrated that it is feasible to implement OST in prisonsand support from both, prison administration and healthservices is critical to implement this programme.
This project has also helped to develop the StandardOperating Procedures to be followed for OST within prisonsettings.
The effectiveness of OST was demonstrated in prison settingsand this OST model was also “presented” (through study visits)to Government counterparts from other countries of SouthAsia.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Where do we go from here?
Scale up nationally and
regionally
SOP laid down for
implementation
Develop models of community
linkages
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Future directions• Acknowledge problem in national policies• Assess extent of the problem• Implement comprehensive and standardized screening and
assessment process• Match inmates to appropriate treatment programs based on
their individual needs and severity of substance abuse• Develop policies and procedures for providing clinical
supervision to treatment and evaluation• Develop models of community integration
Do we need to send them to Prison at all???
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Acknowledgements Mr. B.K Gupta (ex- DG prison) Mr. Neeraj kumar (DG prison) Dr. Girdhar, RMO Tihar prisons Project team at NDDTC AIIMS UNODC-ROSA
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Needle and Syringe Programmes (NSP) Opioid Substitution Therapy (OST) Voluntary HIV Counselling and Testing (VCT) Anti-Retroviral Therapy (ART) Sexually Transmitted Infections (STI) prevention Condom programming for IDUs and partners Targeted Information, Education and Communication
(IEC) for IDUs and their sexual partners Hepatitis diagnosis, treatment (Hepatitis A, B and C) and
vaccination (Hepatitis A and B) Tuberculosis (TB) prevention, diagnosis and treatment.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
THE NARCOTIC DRUGS AND PSYCHOTROPICSUBSTANCES (NDPS) ACT,1985-
Under section 64 A, any addict, who is charged with an offence punishable under section 27 or with offences involving small quantity of narcotic drugs or psychotropic substances, who voluntarily seeks to undergo medical treatment for de-addiction from a hospital or an institution maintained or recognized by the Government or a local authority and undergoes such treatment shall not be liable to prosecution under section 27 or any other section for offences involving small quantity of narcotic drugs and psychotropic substances. This immunity may be withdrawn if the addict does not undergo the complete treatment for deaddiction.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
THE NARCOTIC DRUGS AND PSYCHOTROPICSUBSTANCES (NDPS) ACT,1985-
. Section 71 of this act, empowers government to establish centers for identification, treatment, education, after care, rehabilitation, social reintegration of addicts and for supply, of any narcotic drugs and psychotropic substance (as prescribed by concerned Government) to the addicts registered with government and to others where such supply is a medical necessity
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
N A T I O N A L P O L I C Y O N NA R C O T I C D R U G S A N D P S Y C H O T R O PI C S U B S T A N C E S The primary purpose of these [drug court] programs is
to use a court's authority to reduce crime by changing defendants’ substance abuse behavior. In exchange for the possibility of dismissed charges or reduced sentences, eligible defendants who agree to participate are diverted to drug court programs in various ways and at various stages in the judicial process. These programs are typically offered to defendants as an alternative to probation or short-term incarceration." - See more at: http://www.drugwarfacts.org/cms/Drug_Courts#overview
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
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