Joris Casselman

Substitution treatment in European prisons: A study of policies and practices in 18 European countries

The objective of this study was to examine practices and policies in place for the provision of substitution treatment in prison in 18 European countries. Methodology. Across the 15 European member states (prior to 1 May 2004) and Czech Republic, Poland and Slovenia, interviews with ministerial representatives, professionals (i.e. service providers and security officials) working in prisons, and a total of 33 focus groups with a total of 132 male and 52 female prisoners were conducted. Results. Although constraints of access to substitution treatment for specific target groups only (e.g. HIV‐positive opiate users) have largely vanished, substitution treatment is now offered to a broad cross‐section of prisoners. The provision of this treatment still lags behind the standards of substitution treatment in the community (regarding access and continuity). In most countries, this form of therapy is most likely to be discontinued when entering prison. A treatment gap persists between prisoners requiring substitution maintenance treatment and those receiving it. Heterogeneous and inconsistent regulations and treatment modalities appear throughout Europe, sometimes within the same country or region. The concrete provision practice of substitution treatment in prison varies from one country to the other, from one prison to the other, within a medical team, and even from one doctor to another. Although psychosocial care was seen as a valuable additional and necessary part of the treatment to support the medical part of the substitution treatment in prison, it was found that such support was rarely provided. Compared to previous research, this study illustrates that the scope of substitution treatment has extended considerably across Europe. Across the board, a consensus surrounding the need to continue substitution treatment that had already been started in the community was apparent.

Substitutiebehandeling binnen en buiten de gevangenis in België en Nederland

SamenvattingUit Europees onderzoek over substitutiebehandeling in de gevangenis in 18 Europese landen blijkt dat er een duidelijke discrepantie bestaat tussen de situatie binnen en buiten de gevangenis. Het equivalentiebeginsel op het terrein van de gezondheidszorg voor gedetineerden wordt nochtans in de landen van de Europese Unie algemeen aanvaard. Geldt deze vaststelling ook voor België en Nederland? De auteurs van deze bijdrage doen verslag van hun onderzoek onder druggebruikers in Belgische en Nederlandse gevangenissen. Alhoewel de overheid zowel in België als in Nederland dit equivalentiebeginsel voor gedetineerden benadrukt, blijkt bij nader toezien dat dit niet volledig is ingevuld.