Drug treatment in prisons: Drug treatment in prisons: recent evidencerecent evidence

Jessica Harris, RDS NOMS, Home OfficeJessica Harris, RDS NOMS, Home Office

Malcolm Ramsay, DSPD Programme, Home Office.Malcolm Ramsay, DSPD Programme, Home Office.

Structure of the presentation:Structure of the presentation:

The need for treatment – prisoners’ drug The need for treatment – prisoners’ drug use pre-prison, in prison and after prisonuse pre-prison, in prison and after prison

What’s available and what works?What’s available and what works?

Current issues and evaluation plans.Current issues and evaluation plans.

Prisoners’ drug use pre-prisonPrisoners’ drug use pre-prison

69% tested positive for one or more illicit 69% tested positive for one or more illicit drug;drug; 36% tested positive for two or more;36% tested positive for two or more; 31% tested positive for opiates;31% tested positive for opiates; 22% tested positive for cocaine;22% tested positive for cocaine; 38% tested positive for either or both;38% tested positive for either or both;

High probability of testing positive for:High probability of testing positive for:females, 20-29 year olds, white arrestees, females, 20-29 year olds, white arrestees, property offences.property offences.

[NEW–ADAM programme, 2004[NEW–ADAM programme, 2004 ] ]

At least 93% prisoners had used drugs in At least 93% prisoners had used drugs in the 30 days before custody;the 30 days before custody;

62% heroin, 49% crack and 42% cannabis62% heroin, 49% crack and 42% cannabis 74% took two or more different drugs74% took two or more different drugs Heroin: 46% white prisoners, 16% black;Heroin: 46% white prisoners, 16% black; Crack: 8% white prisoners, 30% black;Crack: 8% white prisoners, 30% black; Average spend of £600 a week on drugs.Average spend of £600 a week on drugs.

[CARATs assessment, 2004/05][CARATs assessment, 2004/05]

OffendingOffending

Criminality Survey 2000: money to buy drugs most Criminality Survey 2000: money to buy drugs most commonly cited reason for offending;commonly cited reason for offending;

(55%) reported that they had committed offences (55%) reported that they had committed offences connected to their drug taking;connected to their drug taking;

CARATs: theft and handling (24%), burglary (17%), CARATs: theft and handling (24%), burglary (17%), drug offence (11%); drug offence (11%);

NEW-ADAM: 75% of arrestees committing one or more NEW-ADAM: 75% of arrestees committing one or more acquisitive crime in the last 12 months had used acquisitive crime in the last 12 months had used heroin and/or cocaine and/or crack. heroin and/or cocaine and/or crack.

Prisoners’ drug use in prisonPrisoners’ drug use in prison MDT SurveyMDT Survey: About 16% prisoners reported : About 16% prisoners reported

using drugs in week before interview; using drugs in week before interview; Cannabis and opiates (usually heroin) most Cannabis and opiates (usually heroin) most

commonly used; commonly used; 0.7% prisoners had initiated/resumed heroin use, 0.7% prisoners had initiated/resumed heroin use,

having used no illicit drugs in the year prior to having used no illicit drugs in the year prior to custody;custody;

Criminality SurveyCriminality Survey: Only half of pre-prison drug : Only half of pre-prison drug users reported continuing to use drugs in users reported continuing to use drugs in prison. prison.

Use of stimulants (cocaine/crack) relatively Use of stimulants (cocaine/crack) relatively uncommon in prison. uncommon in prison.

Levels of re-offending post-release were Levels of re-offending post-release were significantly higher for drug users (62%) than for significantly higher for drug users (62%) than for abstainers (36%).abstainers (36%).

Heroin is the white offender’s drug of choice?Heroin is the white offender’s drug of choice? Crack is the black offender’s drug of choice?Crack is the black offender’s drug of choice?

Drug use was particularly widespread among: Drug use was particularly widespread among: short-term prisoners;short-term prisoners; property offenders; property offenders; white prisoners. white prisoners.

[Source: ‘Tackling Prison Drug Markets: An exploratory Qualitative Study’ [Source: ‘Tackling Prison Drug Markets: An exploratory Qualitative Study’ 2005]2005]

Prisoners’ drug use after prisonPrisoners’ drug use after prison

In the week following release, prisoners were In the week following release, prisoners were about 40 times more likely to die than a about 40 times more likely to die than a member of the general population;member of the general population;

male prisoners were about 29 times and female male prisoners were about 29 times and female prisoners 69 times more likely to die;prisoners 69 times more likely to die;

immediately post-release, over 90% of deaths immediately post-release, over 90% of deaths were associated with drug related causes;were associated with drug related causes;

deaths from drug use post-release reflect deaths from drug use post-release reflect lowered levels of tolerance.lowered levels of tolerance.

[Source: ‘Drug-related mortality among newly released offenders’ [Source: ‘Drug-related mortality among newly released offenders’ 2003]2003]

Opiates were involved in almost all (97%) drug Opiates were involved in almost all (97%) drug related deaths; related deaths;

just over half of deaths were recorded as just over half of deaths were recorded as involving only one drug; involving only one drug;

mortality rates for women were generally higher mortality rates for women were generally higher than those for men; than those for men;

Prisoners aged 25 to 39 at the time of release Prisoners aged 25 to 39 at the time of release were most at risk; were most at risk;

odds of drug-related deaths higher for ‘white’ odds of drug-related deaths higher for ‘white’ prisoners than for those in other ethnic groups.prisoners than for those in other ethnic groups.

Risk factors for drug mortality include:Risk factors for drug mortality include:

separated, divorced or widowed;separated, divorced or widowed;

had used drugs in the month before entry into had used drugs in the month before entry into prison;prison;

had not used drugs in prison. had not used drugs in prison.

[Source: Office of National Statistics,1997][Source: Office of National Statistics,1997]

What treatment is there and what What treatment is there and what works?works?

DetoxificationDetoxification

CARATsCARATs

Intensive treatment programmesIntensive treatment programmes– (Cognitive behaviour, therapeutic (Cognitive behaviour, therapeutic

communities,’12-step’ programmes and communities,’12-step’ programmes and methadone provision).methadone provision).

White women: White women: higher dependency rates than black women (60%) higher dependency rates than black women (60%) more likely dependent on heroin more likely dependent on heroin (a ‘depressant’) (a ‘depressant’)

Black/ mixed race women:Black/ mixed race women: Lower dependency rates (29%) than white womenLower dependency rates (29%) than white women More likely dependent on crack More likely dependent on crack (a ‘stimulant’) (a ‘stimulant’)

[Source: The ‘treatment needs of white and black/mixed-race female [Source: The ‘treatment needs of white and black/mixed-race female prisoners’ 2003]prisoners’ 2003]

Some obvious needs…Some obvious needs…

to continue to develop the prison drug strategy to continue to develop the prison drug strategy in a way that brings together treatment and in a way that brings together treatment and security; security;

to increase provision for crack and poly-drug to increase provision for crack and poly-drug users; users;

to make further efforts to reach short-term to make further efforts to reach short-term prisoners.prisoners.

What now? Current issues and What now? Current issues and evaluation plansevaluation plans

Data - much is out–of–date;Data - much is out–of–date; Continuity of care – currently difficult to link Continuity of care – currently difficult to link

prison data to community data; prison data to community data; More research needed on the impact of More research needed on the impact of

interventions in reducing reoffending;interventions in reducing reoffending; Effectiveness of methadone versus Effectiveness of methadone versus

detoxification;detoxification; Evaluation of IDTS – enhanced CARATs.Evaluation of IDTS – enhanced CARATs.