22. CORE MODULE
Session 3 Harm reduction (110 minutes)
x Activity: How does HIV spread in prison? How can we reduce harm from risk behaviours? (Part II)? – 30 minutes
x Lecture on harm reduction – 50 minutes
x Activity: Common concerns about harm reduction – 30 minutes
Conclusion (questions and comments) (10 minutes)
Evaluation (10 minutes)
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Resources:
Introduction to core module
UNODC (2009). Drug Dependence Treatment: Interventions for Drug Users in Prison. Treatnet Publi-cation. Retrieved September 9, 2009, from
http://www.unodc.org/docs/treatment/111_PRISON.pdf
WHO, UNODC & UNAIDS (2004). Substitution maintenance therapy in the management of opioid dependence and HIV/ AIDS prevention. Geneva. Retrieved September 11, 2009, from
http://www.unodc.org/docs/treatment/Brochure_E.pdf
Session 1
EMCDDA (2002). Annual report on the state of the drugs problem in the European Union and Norway.
Chapter 3 on polydrug use. Retrieved October 16, 2009, from http://www.emcdda.europa.eu/html.cfm/index37266EN.html
Hulse, G., White, J. & Cape, G. (2002). Management of Alcohol and Drug Problems. South Mel-bourne: Oxford University Press.
Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, B. J., Judd, L. L., & Godwin, F. K. (1990).
Comorbidity of mental health disorders with alcohol and other drug abuse. Journal of the American Medical Association, 264, 2511-2518.
United Nations Economic and Social Commission for Asia and the Pacific (2003). Life Skills Training Guide for Young People: HIV/AIDS and Substance Use Prevention. Retrieved October 15, 2009, from http://www.unodc.org/pdf/youthnet/action/message/escap_peers_00.pdf
WHO (1993). Expert Committee on Drug Dependence. Twenty-eighth Report. WHO Technical Report Series. Geneva: WHO. Retrieved from September 15, 2009, from
http://whqlibdoc.who.int/trs/WHO_TRS_836.pdf
WHO (2000). International guide for monitoring alcohol consumption and related harm. Retrieved Sep-tember 28, 2009, from
http://whqlibdoc.who.int/HQ/2000/WHO_MSD_MSB_00.4.pdf
WHO (2007). ICD-10. Version 2007. International statistical classification of diseases and related health problems. 10th revision. Retrieved October 29, 2009, from
http://apps.who.int/classifications/apps/icd/icd10online/
Session 2
EMCDDA (2008).The state of the drugs problem in Europe. Annual Report 2008. Lisbon: EMCDDA.
Retrieved October 15, 2009, from
http://www.emcdda.europa.eu/publications/annual-report/2008
Farrell, M., & Marsden, J. (2008). Acute risk of drug related death among newly released prisoners in England and Wales. Addiction 103, 251-255.
Hunt, N. (2003). A review of the evidence-base for harm reduction approaches to drug use. London:
Forward Thinking on Drugs. Retrieved October 15, 2009, from http://www.antidrug.health.am/eng/lib_eng/HR_Hunt.pdf
UNAIDS (2008). Report on the global AIDS epidemic. Geneva. Retrieved October 8, 2009, from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research. Geneva. Retrieved October, 21, 2009, from
http://www.who.int/classifications/icd/en/GRNBOOK.pdf
WHO (2007). ICD-10. Version 2007. International statistical classification of diseases and related health problems. 10th revision. Retrieved October 29, 2009, from
http://apps.who.int/classifications/apps/icd/icd10online/
WHO (2007). Orientation on Harm Reduction. Training Course: Trainer Manual. Retrieved October 16, 2009, from
http://www.wpro.who.int/NR/rdonlyres/699B2B2B-381D-43E1-914B-FE997E116C24/0/TrainerManual2.pdf
WHO (2010). Prevention of acute drug related mortality in prison populations during the immediate post-release period. Retrieved June 10, 2010, from
http://www.euro.who.int/__data/assets/pdf_file/0020/114914/E93993.pdf
Session 3
CCSA (1996). Harm Reduction: Concepts and Practice: A Policy Discussion Paper.. Retrieved Octo-ber 13, 2009, from
http://www.ccsa.ca/2005%20CCSA%20Documents/ccsa-003900-2005.pdf
Newcombe, R. (1992). The reduction of drug related harm: a conceptual framework for theory, prac-tice and research. In: O'Hare et al (Eds.). The reduction of drug related harm. London: Routledge.
WHO (2005). Status Paper on Prison, Drugs and Harm Reduction. Retrieved October 8, 2009, from http://www.euro.who.int/document/e85877.pdf
Other helpful resources:
EMCDDA (2010). Harm Reduction: evidence, impact and challenges. EMCDDA Monographs. Publica-tions Office of the European Union: Luxembourg.
UNODC ( 2009). World Drug Report 2009. Vienna: UNODC. Retrieved October 5, 2009, from http://www.unodc.org/unodc/en/data-and-analysis/WDR-2009.html
WHO (1993). Global Programme on AIDS. WHO guidelines on HIV infection with AIDS in prison. Ge-neva: UNAIDS. Retrieved October 6, 2009, from
http://data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf
WHO, (2007). Health in prison. A who guideline to the essentials in prison health. Copenhagen: WHO.
Retrieved October 6, 2009, from
http://www.euro.who.int/document/e90174.pdf
WHO (2010). The Madrid Recommendation: Health protection in prison as an essential part of public health. Retrieved June 10, 2010, from
http://www.euro.who.int/__data/assets/pdf_file/0012/111360/E93574.pdf
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Other helpful training manuals on harm reduction:
Bulmistre, I., Bundule, L., Brokere, I., Dudareva, S., KarnƯte, A., LƗss, I., et al. (2009). Comprehensive Action on HIV/AIDS Prevention among IDUs and Bridging Population. A Manual for Harm Reduction Service Providers. Retrieved August 21, 2010, from
http://www.lic.gov.lv/docs/268//handbook_en_2009.pdf
WHO (2004).Training Guide for HIV Prevention Outreach to Injecting Drug Users. Workshop Manual.
Retrieved September 24, 2009, from
http://www.who.int/hiv/pub/prev_care/trainingguideweb.pdf
WHO (2007). Orientation on Harm Reduction. Training Course. Retrieved September 16, 2009, from http://www.wpro.who.int/publications/PUB_9789290613077.htm
Other helpful websites:
Publications on HIV and prison settings from UNODC. Retrieved June 16, 2010, from http://www.unodc.org/unodc/en/hiv-aids/publications.html?ref=menuside#prison
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Introduction
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The following introduction to the module is meant for the trainer, giving general background information on the topic.The number of problem drug users is comparatively higher in prison than in the outside community.
Within the last years, a rise in the use of drugs is found in the outside community and subsequently in the prison setting.
WHO, UNAIDS and UNODC (2004) state that around three-quarters of prisoners have alcohol or drug related problems and around one third may be opioid dependent.
Upon release, opioid dependent prisoners have a disproportionally higher risk of fatal overdose and relapse. Rates of infectious diseases, such as HIV and hepatitis as well as mental health disorders, suicides or suicide attempts are much higher in prison than in the outside community, with drug use as one of the main contributors.
There are various explanations for drug use in prison:
x Drug dependence was developed before imprisonment x Drug problems/ dependence developed in prison
x Criminal activity took place in order to fund drug use which led to imprisonment
x Drug use itself was the reason for imprisonment (in some countries, drug use per se is an ille-gal activity)
x Drug use began after criminal activity in order to cope with the consequences (UNODC, 2009)
Although prisons are secure environments, drugs are widely available to prisoners. Drugs can be smuggled into prison in various ways and it is unlikely that it will ever be possible to curtail this.
Around Europe, imprisoned drug users are under-served in terms of treatment and help. However, there is a tendency to view prisons as being completely separate from society at large. This is untrue on two counts: prisoners come from the community and go back to it after their release and prison staff, too, are in daily contact with prisoners during their working day and return home to the commu-nity after work. Addressing the problem of drug use and infectious diseases in prison is therefore es-sential as prisoners form part of our society. Prison health problems should be taken into account and adequate treatment measures implemented.
As drug dependence poses a risk factor to offending, adequately treating dependence and related health problems are a valid measure in reducing re-offending. Mere criminal justice interventions only show limited impact on drug-using behaviour and re-offending.
This core module is in three parts.