Nordic Expert Seminar on how Nordic Prisons deal with prisoners use and abuse of Alcohol and Drugs H

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Nordic Expert Seminaron how Nordic Prisons deal
with prisoners use and abuse of Alcohol and
DrugsHelsinki, 22 November 2007

• Brenda van den Bergh
• World Health Organization
• Regional Office for Europe

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Overview

• WHO
• WHO-Europe
• Health in Prisons Project
• Alcohol and Drugs use in prisons in Europe
• Prison Health Database

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World Health Organization

• WHO was established in 1948 by 61
• governments to promote health of all people
• The WHO Constitution was ratified on 7 April
• 1948
• ? World Health Day
• WHO is a specialized agency of the United
• Nations
• Today there are 192 Member States

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WHOs mission is global and permanent

• The mission of WHO is the attainment by all
  people of the highest possible level of health

WHOs Constitution
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World Health Organization
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WHO Regional Offices
       PAHO   EURO   AFRO   EMRO  SEARO   WPRO
Americas, Europe, Africa, Eastern Mediterranean,
South East Asia, Western Pacific







































































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WHO Regional Office for Europe
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• Non-communicable diseases and lifestyle
• Alcohol and Drugs Programme
• Health in Prisons Project

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Prison health a serious problem for society

• Source for spread of communicable diseases
• Large numbers of population affected
• Great turnover in prison population
• Intensive interaction between prison and society
• Large number of drug addicted prisoners
• Addressing health and health care in prisons
• leads to improvement of public health

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The WHO Health in Prisons Project

• Launched in 1995
• Purpose to support Member States in improving
  public health by addressing health and health
  care in prisons, and to facilitate the links
  between prison health and public health systems
  both at national and international levels

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Member States Health in Prisons Project

• 35 Member States are actively involved
• 14 from West Europe
• Austria, Belgium, Finland, France, Greece,
  Iceland, Ireland,Malta, Netherlands, Norway,
  Portugal, Spain, Switzerland, United Kingdom
  (England, Wales and Scotland)
• 12 from Central Europe
• Albania, Croatia, Czech Republic, Estonia,
  Hungary, Lithuania, Latvia, Moldova, Poland,
  Romania, Slovakia, Slovenia
• 9 from East Europe
• Azerbaijan, Belarus, Georgia, Kazakhstan,
  Kyrgyzstan, Russian Federation, Tajikistan,
  Ukraine, Uzbekistan

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Strategic objectives

• Establishing integration of prison health into
  the public health system
• Encouraging prisons to work within codes of human
  rights and medical ethics
• Contributing to rehabilitation and resettlement
  and giving social support
• Reducing exposure to communicable diseases
• Reaching prison health service equivalent to
  society

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Current activities WHO Health in Prisons Project

• Annual conference and network meeting
• Publications/Status Papers
• - Prisons and Tuberculosis
• - Prisons and Mental Health
• Best Practice awards
• Prison Health Database
• Country activities
• WHO guide to the essentials in prison health

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Publications

• Prisons, Drugs and Society, 2001
• Status Paper on Prisons, Drugs and Harm
  Reduction, 2005
• Alcohol and Prisons report of a workshop held by
  WHO HIPP at the EuroCare Bridging the gap
  conference, Helsinki, November 2006

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Drug situation in European prisons key points

• Many of those who enter prison have a drug
  problem estimation 20-40
• Drug use and risk behaviour often continues
  inside prison ? high prevalence of infectious
  diseases
• Drugs services in prisons are poorly developed
• Prison can provide opportunity for interventions
• Countries start to prioritize the prison setting
  for interventions

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EMCDDA Regular use, dependence/ drug use inside
prison

• Regular drug use or dependence prior to
  imprisonment (defined in different ways in
  different surveys) ? 8-73 of inmates
• Injecting Drug Use (ever) ? 7-38 of inmates
• Majority stop or reduce drug use after
  incarceration, but some continue and others start
  using while in prison
• Ever used drugs inside ? 8-51 of inmates
• Regular drug use inside ? 10-42 of inmates
• Ever injected drugs inside ? 1-15 of inmates

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Drug users in two prisons of Kyrgyzstan

• n1004
• n977 been more than 3 months in prison
• 79 used drugs during last 3 months
• - 55 used Marihuana
• - 72 used Heroin
• - 64 used Opium
• 73 injected during last 3 months in prison
• 18 shared needles/syringes during last 3 months
  in current prison
• 37 had their first drug experience in a prison

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Drug Users in EU prisons(EMCDDA, 2002)
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WHO recommendations onprisons and harm reduction

• All prisons and prison systems are recommended
  to be able
• to accept the importance of information and
  understanding about the harmful consequences of
  inappropriate drug use as part of an approach
  based on public health and human rights
• to receive newly admitted drug-dependent
  prisoners with understanding of their needs,
  support for their immediate problems and
  knowledge of what can be provided in the prison
  for them
• to provide what is required so that prison staff
  could ensure that all prisoners are given basic
  knowledge relating to HIV/AIDS and other
  bloodborne diseases and how they spread.

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Alcohol situation in European prisons key points

• Many of those who enter prison have an alcohol
  problem
• Strong link between alcohol and violence
• ? HIPP is establishing links with other key
  networks on alcohol through the Alcohol and
  Drugs programme
• ? Next year HIPP will put more focus on
  prisons and alcohol

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Prison Health Database (PHD)

• The Prison Health Database was developed to
• Be able to compare public health with prison
  health
• ? To put focus on special health conditions in
  prison
• Increase the knowledge of prison health and
  prison health trends

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Importance of database

• The database will be used to
• Obtain an overview of the health situation in
  prisons and the organization, practice and
  quality control of assistance to prisoners in
  Europe
• Make individual country recommendations
• Compare countries
• Develop evidence-based guidance on cost-effective
  disease control and health promotion in prison

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Included in database, some question examples

• Injecting drug use
• Needle exchange programmes
• Drug free units
• Drug related treatment ? substitution treatment
• Collaboration with outside drug services
• Drug testing practice (also alcohol)
• Kind of substance use upon entry prison (also
  alcohol)
• Education (also alcohol)
• Number of alcohol psychosis

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Internet address

• http//data.euro.who.int/hip

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Next steps

• Increase network members HIPP
• Focus on increasing data availability
• Report for European Commission end 2007
• Review indicators and database 2008

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• Website
• http//www.euro.who.int/prisons
• Contact details
• Lars Møller
• lmo_at_euro.who.int
• Brenda van den Bergh
• bvb_at_euro.who.int