Despite the fact that a large portion of the prison population is made up of people who use and inject drugs, harm reduction continues to be extremely limited in prison settings. This article begins with a review of drug-related incarceration, drug use in prisons, and HIV and hepatitis C (HCV) prevalence among prisoners globally. It presents the scientific evidence, alongside legal and economic arguments supporting the provision of harm reduction to people who use drugs, both inside and outside of prisons. The article then provides a global overview of the availability, accessibility, and quality of harm reduction services in prisons-specifically needle and syringe programs; opioid substitution therapy; provision of the opioid agonist naloxone; and diagnosis, treatment, and care for HIV, HCV, and tuberculosis.
Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that are available suggest that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; and a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life changing and life affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.
This paper reviews evidence of how drug control has been used to uphold colonial power structures in select countries. It demonstrates the racist and xenophobic impact of drug control policy and proposes a path to move beyond oppressive systems and structures. The ‘colonization of drug control’ refers to the use of drug control by states in Europe and America to advance and sustain the systematic exploitation of people, land and resources and the racialized hierarchies, which were established under colonial control and continue to dominate today. Globally, Black, Brown and Indigenous peoples are disproportionately targeted for drug law enforcement and face discrimination across the criminal system. These communities face higher arrest, prosecution and incarceration rates for drug offenses than other communities, such as majority populations, despite similar rates of drug use and selling among (and between) different races. Current drug policies have contributed to an increase in drug-related deaths, overdoses and sustained transnational criminal enterprises at the expense of the lives of people who use drugs, their families and greater society. This review provides further evidence of the need to reform the current system. It outlines a three-pillared approach to rebuilding drug policy in a way that supports health, dignity and human rights, consisting of: (1) the decriminalization of drugs and their use; (2) an end to the mass incarceration of people who use drugs; (3) the redirection of funding away from ineffective and punitive drug control and toward health and social programs.
The COVID-19 had a substantial impact on the provision of harm reduction services for people who use drugs globally. These front-line public health interventions serve a population that due to stigma, discrimination and criminalisation, faces barriers to accessing health and social services and are particularly vulnerable to public health crises. Despite this, the pandemic has seen many harm reduction services close, reduce operations or have their funding reduced. Simultaneously, around the world, harm reduction services have been forced to adapt, and in doing so have demonstrated resilience, flexibility and innovation. Governments must recognise the unique abilities of harm reduction services, particularly those led by the community, and identify them as essential health services that must be protected and strengthened in times of crisis.
Introduction Detention settings are high-risk environments for the spread of infectious diseases. Since 2020, COVID-19 has posed unprecedented challenges for governments and prison administrations. In some jurisdictions, this has catalysed early release programmes to decongest prisons to minimise the harm of COVID-19 in prison systems. Methods From March to June 2020, HRI monitored the adoption of prison decongestion measures in response to COVID-19 in Europe and worldwide. HRI tracked criteria for eligibility and implementation of the measures and distributed online expert surveys as part of the Global State of Harm Reduction 2020 that included questions on harm reduction in prisons and the response to COVID-19. Survey data was supplemented by a review of academic, governmental, and non-governmental literature. A review to update the data will be carried out by mid-2021. Results and discussion Results show prison decongestion schemes initiated in 17 countries in Europe and 109 countries worldwide. Overall, by July 2020 decongestion measures reduced the global prison population by 16% in Europe and just 6% worldwide. In a quarter of countries (including at least four in Europe), people incarcerated for drug offences were explicitly excluded, regardless of whether they suffered from health condition or belong to a vulnerable group. We found no evidence of expanded access to harm reduction programmes to address the risk of overdose after release. Issues that exacerbate overdose risk included interruptions to the provision of opioid agonist therapy (OAT) and the unavailability in most jurisdictions of naloxone on release. Conclusions People who use drugs and are in detention settings have been inadequately served during the COVID-19 pandemic. To address the unique health risks of detention settings, there is a need for greater commitment to the adoption of non-custodial measures, and diversion from criminal justice towards a health-led response to drug use.
Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that is available suggests that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe, and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include: stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life-changing and life-affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.