Prisons are one of the most important settings to provide interventions aimed at drug users, both in terms of treatment and harm reduction.

What works?

  • Opioid substitution treatment has a very strong protective factor against death in prison for opioid-dependent prisoners. It is also very important that there is continuity of treatment in the community when drug users are released from prison
  • Substitution treatment is also particularly important in prison as it reduces injecting risk behaviours
  • Psychosocial treatments reduce the re-incarceration rates in female drug-using offenders
  • For drug-using offenders the use of naltrexone seems to help to reduce their re-incarceration rates
  • Education and training interventions with take-home naloxone provision help to decrease overdose-related deaths after release from prison
  • Therapeutic communities in prison may help to reduce re-incarceration rates of drug-using offenders with co-occurring mental illness

What's unclear?

  • It is unclear if pharmacological treatment in prison can help drug-using offenders to reduce use and criminal activity on release. This also appears the case for the specific sub-group of female drug-using offenders, yet caution is needed since the number of studies is small.
  • Moreover, it is unclear if the provision of needles and syringes in prison help prevent infections and reduce risky behaviours

What doesn't work?

  • So far, we are not aware of interventions which proved to cause harm

Explore all resources in the Best practice portal

Collaborations and partnerships in best practice

logo of the cochrane collaboration  grade logo   grade logo  Health Evidence Network, WHO Europe