Drugs

Drugs

1. why tackle drugs

   • mass availability of drugs (drug use in prison)
     • drugs are more easily available than soap... Chamber 2010 - the availability of drugs within prison undermines treatment programmes and leaves them unprepared for release and therefore primed to re-offend
     • highest drug use is for white, women and young... between a third and a quarter of prisoners are injecting... some studies suggest 56-76% of prisoners are using drugs... Hucklesby and Wilkinson found 70% f prisoners had used drug in some point of their sentence.... Edgar and O'Donnell found 76% had used drugs.... Ramsay 2003 = found 23% had used drugs and 38% had drug problem.
     • cannabis the most widely used then heroin then tranquilisers... Chamber 2010 = found 85% of prisoners said they could get hold of drugs should they want to and 5% said they were easily available
     • Blakey 2008 = drugs get into prison a number of ways including visitors, over the wall, post, prisoners and corrupt staff... Chamber 2010 - found that the majority of drug dealing within p is highly organised and involves collusion with around 1000 members of corrupt staff (around 7 per prison).... 23% of prisoners said staff were the main route
   • health and safety concerns
     • injecting and sharing of needles due to the lack of needles within prison - increases risk of diseases as well as the risk of serious harm to other prisoners if used as a weapon
     • Seaman et al 98 = increased mortality rates linked to overdose as a result of lower level of tolerance... as well as the likelihood of binging upon release with drugs of higher consentrate
     • Singleton et al = investigated drug related mortality in sample of 12,500 of newly release prisoners and found 79 of 137 were drug related... p were 40x more likely to due a week immediately following release than general pop
   • general increase in drug use in society (pre prison drug use)
     • larger number of dug users entering P... Blakley 2008 = p taken from world where the use of illicit drugs is endemic - maj have drug prob or drugs is the reason they are in P... 1 in 6 p are in for drug related offences
     • around 70% of p use drugs before entering p (higher for w)... Ramsay 2003 = 72% of a sample of female p had used prohibited drugs in the last year at liberty (heroin and crack higher for w)... McGrowhill = 60-85% of prisoners reported some drug misuse prior to imprisonment, 66% within 1 month and 55% report severe drug problem
   • Link between drug use and crime
     • meta-analysis confirmed strong link between substance misuse and criminal behaviour across life course of offenders (Serin et al 2013)... Ramsay 2003 = serial or repeat offenders are often prolific drug users suggesting p and d are mutually reinforcing... Powden and Brown 2002 = a predictive rela betw d and criminal recidivism
     • uk drug policy commission = at least 1 in 8 arrests est to be problem heroin/crack users (compared to 1% of general pop)... also found that 81% of arrestees who used heroin and/or crack least 1 a week said they committed on acquisitive c in past 12 months.. drug related c costs £13.5 billion
     • Bramley Brief 2015 = increased level of drug taking among prolific offenders... 64% admit to using drugs in past 4 weeks before custody.. 14% of m and w in are serving sentences for drug offences... 66% of w and 38% of m in p admit to committing offences to get £ to buying drugs
   • Drug dependence causes problem in p
     • creates hierarchy, affects behaviour, increases bullying and assaults (due to having to pay for the drugs) = Blakey 2008
     • McGrow-hill = causes conflict, leads to transgression of prison code, also feeds a black market leading to corruption, tension and violence.... d are a de-stabilising influence creates conflict

2. modes of drug use

   • self-medication model = reduce boredom, aid sleep deprivation, stress relief = sedation and relief
   • Time management model = pass-time out of structured life of p
   • Social networking model = p can connect with wider groups
   • status model = controlling supply means they hold positions of power - author - rebellious against p staff
   • economic model = fuels the cashless p economy

3. History of Drug policy

   • prison service originally pursued a twin track strategy of tackling supply and demand through an abstinence based approach
   • McGraw-Hill = in early 80s was p policy was solely focused on abstinence due to HO advocation... then in the late 80s the harm of drugs was apparent
   • Ramsay = but treatment programmes were limited.. not really viewed as a problem until 90's when first policy on d was intro
   • 1st. drug misuse in p 1995 - aims to reduce supply, reduce demands and rehab misusers... mainly focused on abstinence
   • 2nd. 1998 dug strategy (similar to first)
   • 3rd. 2005 first NOMS drug strategy... aims to reduce supply, reduce demands and reduce harms - recognised that total abstinence is not feesible
   • 4th. 2008 2nd NOMS drug strategy.. introduced through care and stressed the importance of integration and end-end management
   • 5th. 2012 Health and Social Care Act = placed NHS at forefront of a recovery focused system in community and prison

4. Supply side measures

   • Blakley 2008 = found drugs get in 5 ways (over the wall, post, prisoners, staff and visitors) - each route needs to be dealt with in order to overcome the issue.. can do this by increasing the number of searches (including the use of dogs), better legislation (tougher), disrupting mobiles, use of the chair and greater partnership working.... removing of prisoners found to be dealing
     • Under the 2007 offender management act people who smuggle phones or drugs into prison can be sentenced up to 10 years
   • SOCA 2009 report = need to implement a major anti-corruption programme to reduce the risk of serious criminals conditioning members of staff
     • current a lack of sanctions on those members of staff who are found bring drugs into p - no requirement to even notify NOMs when a member of staff is accused of misconduct... dealt with at local level.. info therefore not available on corrupt staff
   • focus on supply reduction could cause P to take more risk in covert strategy... Malloch 2000 = methods of disruption and detection are ineffective at reducing drugs in p

5. Reduce demand

   • CARRATS (counselling, assessment, referral advice and throughcare)
     • intro in 1999 to offer drug treatment in every P across E&W as a low level intervention that provides a gateway to support services in and out of custody via assessment referrals.... provides specialist advice and support to reduce harm and secure assess to treatment
     • refers problematic drug users to short duration or intensive drug rehab programme as well as medication (as alternative to drugs)
     • made up of multi-discipline teams = mix of uniformed prison officers and external organisations -- creates plans and one to one or group work inervention
     • refer p to other services and establishes through care by linking with resettlement teams... Ramsay 2003 = half of all p who received assessment agreed with care plan if agree more likely to follow though
     • :( demand outstrips supply... too many p serving short sentences and going through whole sentence without help/assessment.... services also vary from p with many failing on the through care aspect... too much focus on quantity rather than on quality
   • IDTS (integrated drug treatment schemes
     • intro in 2007 designed to be a joint venture between MOJ and department of health to improve treatment by offering a broad range of clinical responses to substance misuse including clinical management and psychological services... also aimed to increase the volume and quality of programmes/services.. mainly substitute treatments
     • key objective = to ensure integration between clinical and CARAT services and provide end to end care
     • :) provides gateway to substitute treatment - there has been a dramatic increase in the numbers of prisoners receiving forms of opiate substitutions - numb has ballooned (Chambers 2010).... now almost 20,000 p receiving maintenance treatment every year... rise of 57% from 1988-2007.. also provides path to community substitute treatment - continual treatment reduces harm outside
     • :( prescribing maintenance treatment too readily... 16.5% of p using... just replacing addiction to illegal drugs onto drug substitutes - not a detox just maintenance prescribing... also evidence to suggest that those p who had gone under detox schemes were given methadone prior to release "to protect against overdose".... has caused another trade
   • RAPt (rehab for addicted prisoners trust
     • founded in 1992 as the 2st drug treatment facility in UK p based on a 12 step-programme with the aim of managing rather than curing addiction through abstinence
     • provide high quality drug and alcohol services to over 20,000 people every year within the CJS and in com using through care plans... provide counselling, assessment, referral and advice in through care services to 25 prisons
     • prog last an average of 16 weeks and involves group work, counselling, complementary therapies and community activities as well as prog in drug free wings
     • SDTP - rolling abstinence based treatment prog lasting betw 16-22 weeks based on same 12 step prog - designed specifically for p addressing dual dynamic risk factors of substance misuse in p as ppt receive intensive treatment with support from models who guide and support them
     • supplementary assignments are tailored to specific needs of individual p to support learning and embed recovery attitudes and behaviour
     • :) :) graduates have lower rates of offending... :) eval shows good quality after care... :) works for m and w but better for those under 35
   • DIP (Drug intervention programme)
     • launched in 2003 as a 3 year initiative that forms part of govs commitment to reduce the effects of drug related crime in com and p... at its heart is partnership work to ensure the sharing of intel between agencies - work together with CARAT.. providing short and long treatment... short duration is available in 41 estab
     • Brings together a range of agencies including police, courts, prison and probation service, private/charity treatment providers, gov departments and drug action teams - work together to provide tailored treatment - aim is to reduce cycle of drugs and crime by providing end to end support in order to motivate and encourage prisoners to engage in treatment
     • take a holistic approach = each stake holder in treatment process forms a key role
     • :) pulled CJ together for the first time therefore offering beginning to end support system for drug misusing offenders.... through care and after care at centre of this system - due to the belief that this prevents offender failing through gaps and offers them support during times when they are at risk (leaving p) - ensures that on release there is a platform for consolidating work carried out during sentence
     • :) programme is evidence based - know that treatment in p results in the individual having a greater chance of developing alternate to criminal lifestyle and move away from drugs... nationally acquisitive crie has dropped 20% since its intro... also successful at reaching hard to reach groups
     • cost effective = for every pound spent on treatment at least £9.50 is saved in c and health costs = prog is expectd to save at least $4.4 billion for the tax payer over 8 years
     • :) everybody wins - drug misusers receive treatment and ongoing support, CJS spend less money on crime and less time on offenders and the tax payers saves money on prisons

6. Mandatory Drug testing

   • existed since 1996 and continued on until today - aims to measure the extent of use in P, to act as a deterrent and as a rehab effort by referring into treatment.
   • tests are random but can also be made based on suspicion... on average around 6-7% of tests are positive
   • Blakey - running in p for 1- years with 5-10% of p having their urine tested at random (for maj of drugs)... whilst numbers of those testing positive has lowered figures still indicate that around 8.8% (6,800) of p are taking drugs when tested
   • :( Chambers 2010 = not always effective... MDT is badly flawed - with the number of p using drugs being highly underestimated... whilst MDT would suggest that 8.8% use drugs in p.. but in reality others say 35% use drugs and 18% have used d once a week
   • :( minimal threshold for detection is quite high- still need drugs in system.... Ramsay 2003 = 2 out of 3 felt that MDT encourages use of heroin (a drug only detectable for short periods of time)... other drugs are completely undetectable or not tested in MDT - illicit production of tramadol a popular synthetic opioid is reportable on the rise across Europe and not tested in MDT.. use of opiate substitutes cover up illicit drug use = illegal drugs are obscured by prescribed drugs
   • :( predictable testing regime ... p just hold off.. but also performance management targets obscure who gets tested -- testing manipulated so not actually random
   • :( discourages disclosure :( disproportionately done on BME = SPF ae more likely to get caught if tested more
   • :) ID problem drug users and provides route to treatment
   • :( its failure has resulted in talks f replacements... Scotland replaced with addiction testing (aim of reducing supply and assisting p to rehab

7. overall evaluation

   • drug prog in prisons are little more than 4 years old but it is looking quite effective - still need a few improvements
   • :) p a good place to deliver drug treatment which can also help reduce crime.... p are a captive group with just minor access to outside work.... :( but others say the very process of the p estab operates directly against abstinence and treatment initiative due to pure availability of drugs and boredom... p estate fundamentally flawed... community is thought to be more effective to rehab in p (Malloch)
   • :) whilst the maj (23%) of newly arrived male p had used one or more prohibited drugs (+38% admitting drug prob) p generally welcomed treatment... 4 out of 10 expressed interest in treatment (Ramsay 2003)... but need more efforts to motivate and involve young p in as young p less interested
   • :) Ramsay 2003 = whilst only 2 treatment programmes in this country p have been eval in terms of outcomes international literature suggests treatment in P can be effective at reducing drug use and re-offending... McGraw-Hill 10 = prog have been successful across Europe
   • :( lack on continuity and consistency = quantity has taken over quality... all p are different so cant have one size fits all approach... Ramsay 2003 - treatment should be matched to individuals of ground and all have different needs... Black p more likely to use crack/herion and w more likely to recourse to most damaging drugs... suggests gender and ethnicity need to be taken in planning and delivery of programmes... but also need some form of uniformity across p and prisoner (which is lacking)
   • :( Lack of resources and availability... Ramsay 2003 = those using drgs daily tend to be in p for short sentences so treatment not always available.... not easy to involve prolific offenders due to the lack of short programmes.... PWC = Across the penal estate there is wide spread variation in the volume and type of services as well as the lack of uniformity in availability... Ramsay 2003 = while the majority (61%) of p with pre-p drug use do receive some form of held the vast maj are through CARAT ass and detox... thought that less than 1 in 10 p with pre-p drug use receive rehab
   • mainly short term effects -- 12 step programmes had little or no long term impact on drug taking and criminal behaviour (Keene 97)... p with bad drug problem will need prog with long term effects, prg involving full blown therapeutic interventions which are not available --- only 11% on intensive prog in p
   • treatment is used as a scapegoat - those who carry on taking drugs or who don't comply are seen as responsible and as dangerous.... may provide a cloak of legitimacy for penal practice but in reality it fails to solve the real problem behind drug misuse (structural inequalities) - don't deal with broad background causes/issues
   • reluctant to implement 3rd strategy of harm reduction - needle exchange and arg over violence and needles - sends wrong message
   • harsher penalties for drug taking results in greater concealment than encouraging sharing - this inhibits program to p (McDrmott)
   • Ramsay 2003 = whilst there are variation in treatment available fewer p leave p with drug prob than enter = successful
   • Chambers 2010 = psy treatment and case management teams are charac by bureaucracy box ticking and targets... also states that the distribution of prog is illogical and that too much time is spent on low intensity progam which is unlikely to make much different
   • MOJ = drug use is reducing... 24.4 in 1996 to 8.8% in 2006.... testing in 2007 showed 38 prisons were clear of positive opiate tests.... NOM - doing better, better monitory, better access to treatment and improving link post release

8. Harm reduction - detox

   • most widespread treatment with 25% of p in UK eceiving some form of detox at any time (Farrall and Marsden 2005)
   • Ramsay 2003 = detox is vital starting point... nearly 1/4 of tise interview and who had used drugs when last at liberty in 2001 had been detoxed and nearly all had completed it successfully - nearly half of all p using opiates, tranquilisers or alcohol on a daly basis before prison benefitted from detox.. but other heavy users did not - so balance effectiveness
   • Blakey 08 = number on detox increased over last few years.. yet still high availability of drugs in p.... this has the potential to undermine treatment - supply needs to be dealt with first
   • Gossop 06 = detox on its own or coerced is not effective - needs to be used with psychosocial interventions... but not really offered
   • Detox often confused with maintenance prescribing - 45,000 p who are undergoing detox are actually undergoing either gradual reduction prescriptions (which last 12 weeks) or are on maintenance prescribing - detox boundaries are becoming blurred... categories of treatment need to be defined better