Drug misuse and sharing of needles in Scottish prisons

More than a half of the people in Scotland with known HIV infection are drug injectors. Two studies have suggested that injecting with a consequent risk of HIV transmission is prevalent among drug misusers in prison. There is also concern over the lack of treatment for drug misuse in prison. Drug misusers attending needle exchange centres seem able to maintain a low level of risk behaviour, although their attendance may be interrupted by imprisonment.’ Little is known about their drug taking, injecting, and sharing of needles in prison. Subjects, methods, and results
A questionnaire was administered to 81 drug injectors at two Glasgow needle exchanges in January 1990. Semistructured indepth interviews were conducted
with another 19 injectors at the same exchanges in June 1990.

Of the 81 injecting drug misusers (61 men and 20 women), 56 (69%) had served at least one term in custody (median 5 terms, range 1-40), of whom 39 (31 men and 8 women, mean age 23 7 years) had served their most recent sentence during 1989. Of the 56 former prisoners, 55 were aware that other inmates had misused drugs and 36 said that they themselves had misused drugs in prison. Only four (11%) of those misusing drugs in prison had taken cannabis alone. Other drugs taken were buprenorphine, temazepam, heroin, cocaine, and valium. Forty nine had seen other inmates injecting drugs, and 14 men said that they themselves had injected drugs in prison. Forty five had seen others sharing needles in prison, and six said that they themselves had shared needles in
prison. This means that 43% (six of the 14) of those admitting to injecting also shared needles. Fifty one subjects said that they had not been offered treatment for drug problems while in custody, although 46 stated that the prison authorities knew that they were drug misusers. Four of the eight women had been
offered some form of treatment for withdrawal symptoms, but 47 of the 48 men said that they had not been offered any treatment.

All 81 subjects were asked whether they might inject and share needles in prison in the future. Sixty seven thought that they would misuse drugs and 55 that thev
would inject them; 20 thought that they would share injecting equipment. These figures are higher than those reported for actual misuse, injecting, and sharing

This study shows that most drug injectors attending Glasgow needle exchanges have been in prison. Six subjects (11%) admitted to sharing needles in prison.
The true extent of sharing may be greater as the other eight who reported injecting drugs in prison were unlikely to have had exclusive access to their own
equipment. Respondents in the semistructured interviews emphasised this fact-“When you hide your needle, someone else might find it and it gets used in
their circle, so you can’t say how many get to use it.” Estimates of the number of people sharing one needle varied between five and 100. It therefore seems highly
probable that when a drug misuser shares needles inside prison, this may occur more frequently and among a wider group of people than it would outside
prison. Little treatment seems to be offered for drug problems in Scottish prisons. Fifty one (910%) respondents said they had received no treatment at all. This contrasts with a recent study that found that only 40% of a group of 50 drug misusers in London had not received treatment while in custody. This apparent
lack of treatment offered in Scottish prisons, together with the prevalence of reported injecting drug misuse and sharing of needles are matters of serious concern.
This study was funded by the Nuffield Foundation,

Source: www.bmj.com Vol.302. Number 6791

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