Drug treatment, harm reduction, overdose prevention in custodial settings

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By-law 3/2007 of 16 January and Order 22 144/2007 of the Ministry of Health and Justice authorized a pilot PNSP in Lisbon and Paços de Ferreira in 2008–2009. This was part of a broader strategy to decrease the incidence of HIV, HBV and HCV in prison settings by reducing risk behaviours associated with intravenous drug use, sexual activity, piercings and tattoos and injected use of steroids.

In 1994 a pilot needle and syringe programme was launched in Hindelbank women’s prison. The programme has two main components: syringe exchange via automated dispensing machines, and IEC and counselling on HIV and harm reduction to prisoners by external NGOs. Six syringe distribution machines were placed in various discreet locations accessible to all inmates. All prisoners are offered dummy syringes at the start of the programme, and new prisoners are offered dummy syringes upon entering the prison. The dummy syringe or the used syringe is inserted in the machine, which gives a new sterile syringe in exchange.

In Moldova, the first PSNP was introduced in Branesti prison in 1999, initially through medical department staff handing out needles and syringes. Despite the high prevalence of injecting drug use, uptake was low. Due to a lack of anonymity and confidentiality, many prisoners did not trust the programme, and needles were not available after health staff left in the evening.

In 1995, an NGO working in the Spanish Bilbao prison, which has 250 male prisoners, initiated an NSP.  This model was preferred to dispensing machines because the NGO was already working in the prison and offered the possibility of providing health education information. All prisoners and staff received information on the programme, which was established in two discreet locations.

The first pilot PNSP in the autonomous region of Cataluña was established in 2003, and in 2010 PNSP were implemented in all but one of the region’s prisons. The provision of needles is undertaken by prison health staff. The main features of the PNSP in Cataluña include: one-forone exchange of retractable syringes; prisoners must carry the syringe with them or keep it with their personal possessions; the syringe must be inside the sealed plastic package (before use) or with the needle retracted (once used); if a prisoner is to be searched by a prison officer, they must inform the officer that they have a syringe with them; prisoners in a methadone programme can also participate in the PNSP.