Progress in the
Penal System (PIPS)

14: Drug and alcohol treatments

Standard 14:

People with drug and alcohol addictions are diverted from the criminal justice system to receive appropriate treatment. Where imprisonment is the only appropriate response, treatment must be made available within prison, with a continuum of care upon release.

Rationale:

Drug and alcohol use is increasingly being recognised primarily as a public health issue. [381] The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, 2018) highlights two important health intervention principles in prison (i.) equivalence of care (ii.) continuity of care between the community and prison on admission and post release. [382]

Current context:

Addiction is a prevalent characteristic across the prison population in Ireland, with 70% of the general prison population being characterised as having addiction issues, [383] and an even higher percentage for women, estimated to be 85%. [384]

The National Drugs Strategy [385] also highlights the prevalence of drug use among the prison population where lifetime prevalence of cannabis, cocaine and heroin use is far higher than the general population and where female prisoners reported higher levels of lifetime and past month use of heroin, crack and powder cocaine. Between 2009 and 2015, 5,450 cases received treatment in prison, representing more than 9 per cent of treatment cases in the country over this period. [386]

Dual diagnosis (the condition of experiencing both addiction and mental health issues) is a significant concern. Where a person experiences dual diagnosis there is a risk that the approach to treatment can be fragmented. The National Drugs Strategy recognises the issue of dual diagnosis and commits to developing a programme on “Dual Diagnosis: mental illness and co-morbid substance” which aims to develop a standardised approach to identification, assessment and treatment of co- morbid mental illness and substance misuse. [387]

Six community based organisations are funded to provide services in the prison system: Merchants Quay Ireland (MQI), Ana Liffey Drug Project, Coolmine Treatment Centre, Ballymun Youth Action Project, Fusion Community Prison Link and the Matt Talbot Community Trust. [388] During 2016, 2,624 prisoners accessed MQI addiction based counselling service. [389] MQI also contributed to the delivery of a multi-agency 8 week detox and drug treatment programme which assisted 80 prisoners detox from methadone and benzodiazepines. [390]

Recently it was reported that reduced expenditure has led to some prisons having access to addiction counsellors only on a part-time basis, while waiting times for accessing services have increased. [391] It is vital that there are adequate numbers of medical staff available to support these services across all prisons. There should be consistency in drug treatment options offered across the entire prison estate. The same key performance indicators which are used by the Health Service Executive should be applied to ensure ‘equivalence of care’ is provided, such as: whether treatment commenced within one calendar month following assessment and the number of clients in receipt of opioid substitution. [392]

The EMCDDA recommends that further studies be carried out to improve the evidence base of responses which can be of most benefit individuals with addiction. [393] So far in 2018, 1125 individuals have been referred to the Drug Treatment Court Programme, 608 of these were deemed unsuitable [394] and an additional 370 were discharged. By May 2018, 69 participants had graduated with ‘gold status’. [395] ‘Gold status’ indicates that the individual has clear drug screens and keeps appointments with counsellors and/or participates in education. [396]

According to the EMCDDA [397] , the following drug treatment response options scored highest in terms of quality of evidence:

  1. Opioid substitution treatment is protective against death in prison for opioid-dependent prisoners.
  2. Substitution treatment is also important in prison in reducing injecting risk behaviours.
  3. To prevent overdose death in the period directly following prison release, it is important that there is a continuity of treatment in the community. [398]

A study[399] which examined re-offending in a two year period following treatment showed a 21% reduction in re-offending by opiate users and 49% reduction in re-offending with alcohol only clients. Therefore the need and demand for these services should be further examined including access to residential drug treatment. There is only one mother and child residential drug treatment programme in Ireland.[400]

There is also currently no consistent tracking of outcomes for prisoners treated across the estate. [401] The same review outlined a number of gaps in provision including; the availability of drug free environments within the prison setting for prisoners who have completed detoxification and treatment programmes, the development of non-opiate based detoxification services, alcohol treatment services and access to treatment for cohorts such as sex offenders. [402]

Post-release is a particularly critical time for those with addiction issues. Research has shown that there is a raised risk of death from drug overdose in the first week of release. [403] One recommendation made by the EMCDDA suggests that training on overdose prevention should occur pre-release including the consideration of the provision of Naloxone. [404]

Indicators for Standard:

Indicators for Standard 14

Indicator S14.1: Waiting lists for addiction services in prison: There are currently 44 individuals on a waiting list for the Drug Treatment Programme (18th September 2018). The Irish Prison Service also acknowledged there are waiting lists for counselling services. [405]

Indicator S14.2: Number of places on drug treatment programmes available in prison: The national Drug Treatment Programme is based in the Medical Unit of Mountjoy Prison. This programme allows for treatment for up to 18 individuals. [406] The Programme is available to all prisoners from across the estate.

Indicator S14.3: Number of drug-free wings across the prison estate

The Irish Prison Service has acknowledged the need to provide more appropriate locations so that a prisoner can maintain his/her drug-free status. [407]

Indicator S14.4: Harm reduction options available in the prison estate: The Irish Prison Service has stated that they endorse and apply this approach where appropriate. [408]

Indicator S14.5: Availability of detoxification beds in the prison estate: The drug treatment programme is available to all prisoners from across the estate, and is run on the Mountjoy Campus. The programme is for people who have moved away from illicit drug use and is support through a biopsychosocial model of interventions. [409]

Indicator S14.6: Waiting lists for post-release addiction services: The number of recent prisoners on community waiting lists is not available. The Irish Prison Service states that all persons leaving custody who have an addiction need will be engaged with a community addiction service to meet their current level of need either through a specialist GP or a community addiction clinic.

Progressive Practice:

Diverting Offenders with Drug, Alcohol and Mental Health Problems

The Ministry of Justice in the UK has recently announced a pilot project where by the Departments of Justice and Health have signed a protocol in five areas. [410] Local panels comprising officials from both departments provide information (including psychologist- provided evidence) to the court to enable judges to determine whether the individual needs treatment and is eligible for a Community Order. [411] The Ministry of Justice has said that this has increased confidence in sentences, resulting in more Community Sentence Treatment Requirements being used. [412]

Actions required:

Action 14.1: The National Drugs Strategy, Reducing Harm, [413] Supporting Recovery 2017- 2025, should be fully implemented.
Action 14.2: As recommended by the Inspector of Prisons, [414] those who complete detox programmes should be provided with immediate follow-up supports by the appropriate services for a specific duration as determined by professionals involved in the detox programme.
Action 14.3: The Irish Prison Service and the Department of Health should have an inter-agency protocol to ensure a continuum of care both upon admission to prison and post-release to the community. There should be publication of information on lengths of time waiting to access various forms of treatment including methadone programmes, residential drug treatment and other therapeutic supports.
Action 14.4: A new strategy should be developed by the Irish Prison Service in response to the emerging and changing drug trends and patterns among the prison population, working in conjunction with the Health Research Board (HRB) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
Action 14.5: The Department of Health should increase provision of access to drug treatment residential drug treatment places available in the community including facilities that accept those who have been in prison irrespective of their category of offending behaviour.
Action 14.6: Services should be integrated to ensure better outcomes for people with dual diagnosis.

References:

IPRT Irish Penal Reform Trust

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