Drugs in prison

Key Question 1: Who is using substances in prisons

1.What is the proportion of substance using prisoners?

It is very difficult for the respondents to give a proper estimation on the frequency of substance use among prisoners, especially in case of infrequent use or abstinence. Both prisoners and officers are uncertain about the proportion of prisoners who don’t use substances. They mention percentages between 1 and 80%, with an emphasis on 15-50 percent. We asked all the participants in the focus group to find consensus on the proportion of the prisoners who didn’t use substances. After a long discussion in the focus groups, the officers agreed that 60% of all prisoners didn’t use substances. The prisoners settled on 25%. The prisoners said that they stated a lower proportion because cannabis was included, and many of their inmates used cannabis whenever they could. Most prisoners, although, cannot afford cannabis frequently, it is possible only occasionally. Therefore, the prisoners also estimated that substances were used occasionally (up to once or twice a month) on 60% of the cases while officers estimated this proportion to be 30%. Both the prisoners and the officers gave more precise answers when they were asked for the proportions of more frequent use. Between 10 -15 percent use drugs once or twice a week. Less than 10 percent use drugs three to five times a week. The officers and the prisoners disagree on the proportion of daily drug use. Most respondents claimed in the interviews that less then 5% used drugs daily. In the focus groups, the officers settled on 2%, and the prisoners on 6%. Several respondents said that nobody among the prisoners used drugs daily, simply because they couldn’t afford that. There are some focus group members, both from among the prisoners and the officers, who say that nobody uses drugs daily. According to them, the reason why nobody uses drugs daily is that the prisoners simply don’t have enough money to be able to use drugs daily; drug availability has less to do with it. This is also the reason why the officers estimate daily drug use to be 2%. Prisoners claim that there is an alternative trading system in prison. When the prisoners get or buy goods for the money, they, for example, have received from their families and relatives, they try to sell the goods, or trade them for substances. Thus, the prisoners see more financial capacity among their inmates, and estimate the daily drug use to be 6%.


2. Which age group is most affected?

Looking at the age of substance using prisoners, it appears that the largest group of drug users in prison comprises of prisoners of 22-30 years of age, followed by 18-21 year olds, and then 31-40 years olds. The number of substance users in the age group of over 40 years is the smallest.
Certainly, it should be kept in mind that the majority of the prisoners of Murru Prison are in the age of 22-30. The number of the prisoners in the age of 18-21 in Murru Prison is much smaller. The percentage of the population of Murru Prison is the following:
10.7% - in the age of 18-21
38.4% - in the age of 22-29
26.5% - in the age of 30-39
19.2 % - in the age of over 40

3. What features of substance using prisoners have to be taken into account in developing/offering meaningful assistance to them?

It is not possible to form concrete and most vulnerable groups which we should pay more attention to. Although, there are features of substance using prisoners that have to be taken into account in developing/offering meaningful assistance to them. Most mentioned features are: low level of education; from Ida-Viru County; Russian speaking prisoners; nervous and unpredictable behaviour; lack of social guarantees; health problems; unemployed; from Tallinn.

4. What is the proportion of substance using prisoners who started using substances in prison (first time use):

All the respondents agreed that ten percent or less of the substance using prisoners started to use drugs in prison. Half of the respondents estimated it was less then 5%.

5. What factors play a role in starting to use substances (first time use) in prison?

The two most important factors influencing starting drug use in prison are ‘influence of the group’ and ‘lack of activities’. Regarding the items ‘curiosity’ and ‘wish to escape from reality’, the officers tend to claim that they are important reasons for starting using drugs in prison while the prisoners tend to say that they are not. In addition, they mention several other factors that are related to both starting drug use in prison, and continuing drug use in prison. In that context, they mention factors like ‘tension’, ‘stress’, ‘social recognition and identity’, ‘wish to escape from reality’. Group pressure also influences both starting and continuing drug use in prison. ‘’If you are the only one in a group of prisoners who doesn’t use drugs, you will be suspected to be a snitch, and you will be cast out if you don’t join. Another prisoner says that everybody wants to belong somewhere, and if one ends up in the company of drug addicts, he or she probably starts to use too.’’

 Key question 2: What kind of substances are being used in prison

6. What substances are used in prisons?

Cannabis and amphetamines are the most used substances in prison, followed by heroin and fentanyl, an analgesic also known as the White Chinese. Some respondents mention also cocaine but they say that it is used very rarely.


7. Are any substances of those you just mentioned used by certain groups in the prison community?

Drug users differ very much from each other, and it is impossible to compile uniform profiles. Amphetamine and cannabis are the most widely used narcotics, thus the concrete drug specific user profiles have not developed, yet. Heroin user is mostly a Russian speaking prisoner who is materially better off.

8. What factors play a role in using these substances (occasionally or on a regular basis) in prison?

As expected, almost all respondents agree that addiction plays an important role in drug use in prison. Next, they mention stress and tension, followed by availability, and a wish to escape from reality. The factors ‘isolation’ and ‘handling drugs enables one to take care of oneself, and earn money’ are thought to be important by the officers, but according to the prisoners, they are not important. The factor ‘using drugs is a part of the prison life style’ is not considered to be important. In the focus group, the factor ‘influence of the group’ is also mentioned as an important factor of continuing drug use in prison. According to the prisoners, it is important because everybody wants to belong to a group, and if a prisoner is part of a group that uses substances, he will be considered a snitch, and cast out of the group, if he doesn’t use.

5. Which three substances have been the easiest to get over the last 12 months?

Cannabis products have been most available in prison during the last 12 months, followed by amphetamines, and White Chinese (fentanyl). Other substances are available only occasionally. Some respondents think that amphetamines are more easily available than cannabis. Other respondents say that nothing is easily available, or that all substances are available, when needed.

6. Have there been any changes in availability of substances over the past 12 months?

Amphetamines and cannabis products seem to be available all the time, maybe less during the times of repression or extra surveillance. Availability of other substances seems to be more dependent on external market situation. Several respondents, mainly prisoners, disagree that the availability depends on the external market situation, and they state that it is possible to get all substances you want. According to others, it is, indeed, possible to get whatever one wants in prisons, but it is not very easy: one has to go to a lot of trouble for it.

Key question 3: What patterns of drug use are there in prison?

7. How are the most frequent substances used in general?

In prison, cannabis products are mostly smoked. According to most of the respondents, amphetamines are mostly being injected, although some respondents say that amphetamine is mostly swallowed or sniffed. All the respondents agree that heroin and fentanyl are mostly injected.

8. Do prisoners follow certain habits/patterns of using substances?

Most respondents agree that drugs are used in a family or a circle. Some respondents say that prisoners use drugs when they are alone.
Most respondents think that drugs are distributed at night or in the evening, when there are fewer officers around.
Most respondents agree that if there is a lack of syringes, one syringe is shared for injecting. The majority of the respondents believe that substance use stimulates subsequent risky behaviour, like unsafe sex.
A small majority thinks that HIV-positives do not inject with those who do not carry the virus. Many respondents disagreed, and mentioned different reasons.

Key question 4: What successful interventions are there?

9. What kind of available activities are substance using prisoners engaged in?

Most respondents mention that the activities substance using prisoners are engaged in are participation in support groups, lectures, and rehabilitation programs; they go in for sports, and go to school. In the structured interviews, we checked how many of the prisoners attended these activities, and what were the benefits to them. In addition to the several activities, the respondents could also give their opinion about the proportion of prisoners doing nothing at all. Most respondents agree that the minority of the prisoners attend activities. Especially prisoners say that most of their inmates tend to do nothing at all. A reasonable proportion of the prisoners attends school, or engages in sports. Only a few prisoners work, go to church, follow lectures or attend support groups.
According to half of the respondents, support groups and lectures are attended with the aim of exchanging merchandise, and meddling with others. The number of respondents saying that support groups are attended out of interest and out of boredom is the same. Sport is being engaged in out of one’s own free will, and it is beneficial to health and social contacts. School is also beneficial to meddling, communication and exchanging merchandise. Only a few respondents say that prisoners attend school in order to study. According to most respondents, church is mainly visited by religious people. Others mention that meddling, exchange merchandise, communication, and escape from boredom are the benefits of attending church. Exchanging merchandise, communication and meddling with others are stated as benefits of working. In addition, one can make money, and kill time by working.
In the focus groups, a question was asked whether activities could help in the prevention of drug use. It would be very important to offer prisoners activities that interest them, and that would prove beneficial in the future, for example, regarding material opportunities and profession (this would also motivate imprisoned persons). Everyday continuous activities are required. The prisoners concluded that the lack of activity was not a reason for drug use because several alternative possibilities did exist, but they had no long-term benefit for the prisoners. Motivation is necessary – interesting, meaningful activities which would be useful also in the long run; activities which would help to manage better in freedom later on.

10. What kind of available support / assistance for substance users do substance using prisoners preferably participate in?

Despite the good intentions in the focus groups, less than half of the respondents in the interviews agreed that prisoners preferred long-term activities. More than a half, both officers and prisoners, disagreed. They state that prisoners lack the necessary persistence and patience, they are too lazy, and they are not interested. They neither want, nor will do anything. At the same time, they came to a conclusion that the users of illicit substances actually liked long-term interventions. Today, these types of interventions chaotically take place in Murru Prison; one may get an impression of disarray. Thereafter, any kind of interest in support groups is lost. No direct benefits or point is found in the activities of support groups either.

Key question 5: What interventions are needed?

11. What kind of support / assistance not yet available is needed for substance using prisoners?

When respondents were asked what kind of assistance or support not yet available would be needed they gave very different answers. The respondents were asked to evaluate whether the most mentioned items were useful or not. According to most of the officers, syringe exchange program is not particularly useful, because drugs are forbidden by law. On the other hand most prisoners say that syringe exchange program is useful. Almost all respondents think that drug-free units are very useful. Most prisoners state that methadone treatment is not useful; staff tends to be more positive about that. A large majority of respondents, both officers and prisoners, state that intensive psychological counselling would be useful for substance using prisoners. Daily activities, something to do, and work are also considered positive by a majority of the respondents. The officers, but especially the prisoners would like to see contacts with family and friends to be promoted better. Almost a half of the respondents would like to see more specialists from outside prison to support drug using prisoners. In any case, the offered intervention should be based on the specific needs of an individual; hence it is necessary to make the assessment of individual needs more efficient.

Key question 6: What do inmates know about the risks of drug use?

12. What health risks of substance use are substance using inmates familiar with?

In general, almost all respondents agree that prisoners have knowledge of the risks on drug related harm like HIV/AIDS, hepatitis, and physical and mental degradation.

13. In what way do substance using prisoners protect themselves against risks?

Most prisoners gave a positive answer to a question whether prisoners protected themselves against HIV. They say that syringes are washed before use, or that the users have their own syringes, and that they don’t share them. Over a quarter of the respondents say that prisoners do not protect themselves against HIV. Most of these respondents believe that prisoners don’t care about the risks.
To the question whether prisoners protect themselves against hepatitis, half of the respondents answer positively, the other half disagree. The respondents who gave a positive answer said that prisoners washed syringes before use, or they didn’t share syringes with others at all. Most respondents who disagree say that prisoners do not protect themselves against hepatitis because it does not matter, and they do not care, or that they don’t know how to protect against it, or they don’t have a possibility to do so.
One-third of the respondents think that prisoners protect themselves against physical degradation by engaging in sports. Two-thirds disagree because they think prisoners are not interested, and that they do not care, or that they don’t think that something like that might happen to them.
Most respondents say that prisoners don’t care about mental degradation, don’t think about it, or don’t believe that it couldn’t happen to them.
One-third of the respondents think that drug using prisoners protect themselves against an overdose by using a guinea pig to test the drug on, or by measuring exact doses. They also mention that the older teach the young how to protect oneself against an overdose, and that prisoners protect themselves to the extent possible in prison. Two-thirds of the respondents think that prisoners do not protect themselves against overdosing because they don’t care, they don’t know how, they believe that it can’t happen to them, due to the lack of possibilities, they don’t know the size of their dose, they don’t know what substance is brought in, or they don’t have enough money to get an overdose.
Finally, a question was asked whether and how prisoners protected themselves in general against harm related to drug use. Less than a half, most prisoners, said yes. More than a half disagreed because prisoners didn’t care, didn’t think something would happen to them, or due to the lack of possibilities to do so.

In the focus group, it was discussed why prisoners still used drugs unsafely, although they were aware of the risks. Two quotes from the prisoners make this quite clear: Everybody is aware of the possible risk if they inject with the same syringe. For example, if you have already mixed narcotic substance for several people then nobody is going to throw it away, or hand it over to the guards when the inmate watching at the door informs others that the guards are coming. In this case, all of the substance is injected to several people without disinfecting the needle and the syringe before they are used by the next injecting person. Nobody has any means of disinfection either because alcoholics tend to drink all the possible liquids to achieve intoxication similar to alcohol. Usually it is just asked whether everybody is clean, and that is all. Once, one HIV-positive person was held in two different cells for a short time, both times he was just asked whether he was clean, and he lied, as he wanted to get his dose. Later, 14 of those 16 who did tests were HIV-positive.” And: “They know about the risks. But heroin addicts, for instance, are so strongly addicted that they absolutely do not care. Usually, no precautions are taken, sometimes needles are rinsed for a few times, and that is nothing else, but deceiving oneself. There is no time nor means for proper protection. For syringes are expensive, and they are difficult to get; and a guard may come any minute.” According to the respondents, one must hurry in order to avoid getting caught, so prisoners are aware of the harm risks, but they don’t have time to clean syringes. There is also the lack of means for proper protection. Respondents also state that heroin addiction is so strong that addicts, when they are eager to use, don’t care about the risks.

Category: Rapid assessment and response (RAR)
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