House of Commons - Drugs: Breaking the Cycle

Drugs: Breaking the Cycle - Home Affairs Committee Contents

6 Drugs in prisons

Drug use in prisons

184. Drug use is a major problem in the prison system:

70% of offenders report drug misuse prior to prison;
51% report drug dependency;
35% admit injecting behaviour;
36% report heavy drinking; and
16% are alcohol dependant.[224]

A survey by the Prison Reform Trust has found that 19% of prisoners who had ever used heroin reported first using it in prison.[225]

185. The Ministry of Justice's overall measure of success in tackling prison drug-use is the proportion of prisoners testing positive under the random mandatory drug testing programme. This figure has fallen significantly, from 24.4% in 1996-7 to 7.1% in 2010-11, representing a 71% decline in the proportion of prisoners testing positive.[226] However, despite this overall reduction in measured drug use, it continues to be a serious problem in certain prisons. A recent Report on HMP Durham by Her Majesty's Inspector of Prisons found that as many as one in three prisoners tested positive in random tests, and 13% told inspectors that they had developed a drug problem while in prison.[227]

186. Boredom and a lack of structured activity are often cited as reasons for drug use among prisoners.[228] HM Chief Inspector of Prisons has said that the main issue facing prisons is not "how many prisoners could be squeezed into the available cells", but "whether there were the resources available to hold all detainees safely and securely and do anything useful with them when they were there".[229] In Durham, the inspectors found that education was operating at only two-thirds capacity, and prisoners spent between 16 and 20 hours locked in their cells each day.[230]

Availability of drugs in prisons

187. In the annual report 2011-2012 of Her Majesty's Chief Inspector of Prisons, information taken from surveys carried out during the previous year found that 24% of prisoners reported that it was easy or very easy to get drugs in their prison.[231] Officials from the National Offender Managing Service told us that drugs enter prisons by a variety of means: they are brought in by corrupt staff, smuggled in by visitors, newly-arriving prisoners or in the post, or quite commonly thrown over the wall from outside.[232] Prison inspectors recently found that there had been 54 "throw-over" packages detected at HMP Birmingham over a three-month period. Prisons use a range of strategies to prevent drugs and other contraband getting in, including the physical searching of prisoners and visitors, drug detection dogs, intelligence sharing with the police and mandatory drug testing.[233] There are also plans to increase intelligence sharing between prisons under "Project Mercury" a secure IT based intelligence system, which is intended to improve NOMS' ability to assess the threat to prison security locally, regionally and nationally, including drugs.[234] This is due to be rolled out over the course of the next year.

188. We accept that prisons cannot be hermetically sealed and that it will never be possible to eradicate completely the availability of drugs within prisons. However, the fact that almost a quarter of prisoners surveyed found it easy to get drugs in prison is deeply disturbing. The methods of reducing supply are only effective if they are implemented as intended. We recommend that the National Offender Management Service ensure that measures such as the installation of netting to stop 'throw-over' packages, regular cell searches and regular drug tests based on suspicion are put into operation.

Drugs addiction treatment in prisons

189. Almost half of the prison population have an addiction to drugs. A majority of addicts in prison will be there because of crimes committed related to their addiction, whether it be acquisitive crime, violent crime, supplying or possessing drugs.[235] Prison is an opportunity to help them recover and so break the cycle of drug use and re-offending. However, this outcome is not easy to achieve—partly because offenders do not always want to change their behaviour and partly because there is a lack of support for those who do wish to change. The Prison Reform Trust found that 47% of adults released from prison re-offended within a year. The figure was 57% for those serving sentences of less than 12 months.[236] A 2008 study found that rates of using heroin, cocaine or crack were higher (44% to 35%) for prisoners sentenced to less than one year than for those serving longer terms,[237] suggesting that drug dependent offenders might be more likely to re-offend.

190. The Patel Report,[238] published in September 2010, highlighted some of the recent improvements in the field of treatment for drug addiction within prisons. In particular, it identified an apparent link between spending on drug treatment in prison, reduction in drug use and reduction in reoffending rates:

Funding for prison drug treatment was in 2010 over 15 times greater than in 1997 - with record numbers engaging in treatment.

During the same period, drug use in prisons, as measured by random mandatory drug tests, decreased by 68%.

This was accompanied by a significant decline in adult re-offending since 2000, with a fall of 13% between 2005 and 2006.

Since the establishment of the Drug Interventions Programme (DIP) in 2002, to provide a route out of crime and into treatment, recorded acquisitive crime—of which drug-related crime constitutes a large proportion—has fallen by almost a third.[239]

This sense of improvement is repeated in a more recent report on prisoner rehabilitation by the Prison Reform Trust, which quotes one prisoner as saying:

Well, I have drug issues, and the substance misuse team here have been brilliant, they've been really good, really focused, really helpful and always there as and when you need them, now if that's a negative side of something I bring to prison, then they've been very positive and pro-active where they've been concerned.[240]

191. However Her Majesty's Inspectorate of Prisons has found significant variance in standards of drug treatment across the prison service.

First night treatment was inadequate at Belmarsh, Brixton and Wandsworth, yet at Chelmsford, a GP was available on the designated drug treatment unit until 9pm to provide first night prescribing, treatment was flexible and needs-led, and prisoners were offered an impressive range of activities and support services. At Wormwood Scrubs, we found a much improved service and prompt access to clinical support and, at Pentonville, it was evident that prisoners were fully involved in their treatment plan and a new substance misuse unit provided a much improved environment.[241]

192. As well as clinical management of drug addiction (through detoxification or maintenance prescribing programmes), there are also psychosocial interventions within the prison service. CARAT (Counselling, Assessment, Referral, Advice, Throughcare) services have been available in all adult and young offender prisons in England and Wales since 1999. These services assess the nature and extent of a user's problematic drug use before providing, or referring to, a range of psychosocial interventions. It is designed to address the needs of low, moderate and severe drug users and to act as a gateway or link to other services within prisons and the community.[242] Some prisons also run accredited drug treatment programmes such as cognitive behaviour therapy, 12-step programmes and structured therapeutic communities which offenders can be referred to by the CARAT team.[243]

193. There are a number of issues with accessing the CARAT services for prisoners. Some prisoners report that security issues limit their access.

The Screws are so understaffed, when the CARAT team come on the wing and the Screws are like, 'No we're not unlocking anybody because we haven't got the staff to supervise you'. You can see the CARAT team arguing with them saying, 'We have to see these people to give them some support and help them for when they get out'. But the Screws are saying, 'We haven't got the staff to unlock them and supervise you doing this work'. I only saw them once and that was on my second day there, then I didn't see them after that in the whole six months I was there.[244]

There is a particular problem with prisoners who are serving shorter sentences, who are less likely to receive assistance with rehabilitation, partly due to waiting lists.[245]

DRUG RECOVERY WINGS AND SUPPORT ON RELEASE

194. One of the newest innovations is the piloting of a number of drug recovery and drug-free wings in some prisons. We visited the drug recovery wing in Brixton Prison and were highly impressed by what we saw. We spoke with offenders based on the wing and received very positive accounts. The Drug recovery wing is gated and has 69 beds. It is an incentives-based therapeutic community aimed at prisoners with a minimum sentence of 3 months and a maximum sentence of 2 years. It has rooms available for therapeutic groups such as Alcoholics Anonymous and Narcotics Anonymous. These groups have 5 or 6 meetings a week in Brixton. We were concerned to find however, that there was an issue with the lack of funding for voluntary drug testing. The prison has had all funding for voluntary drug testing cut and although they have managed to use some of the PCT budget to sustain it, this will run out in March 2013. Both staff and prisoners are adamant that the voluntary drug testing regime is a key strand of the drug recovery wing and that the recovery of prisoners is less likely without it.

195. Both the Ministry of Justice and the Department of Health are currently undertaking evaluations in to the effectiveness of the drug recovery wings. If it is a success, the intention is to roll it out across the prison service as the Justice Secretary explained

The whole history of the struggle against drugs shows that an outbreak of enthusiasm occurs among politicians—everybody—for tackling it in a particular way, and it is pursued for a few years, and then you discover that it is producing rather disappointing results. So we will roll it out as resources permit, but that is not the main constraint, but we have to evaluate it carefully and get evidence to reinforce our optimism that we are going about it the right way.[246]

196. Despite these positive strides, two main gaps in provision for prisoners remain, as the Justice Secretary acknowledged: addressing the needs of those serving short sentences; and ensuring that continued support is available on release. In evidence to this inquiry, the Justice Secretary highlighted that he was aware of both of these matters.

One difficulty of course is the short term prisoners, the ones with 12 months or less, who don't stay in prison long enough to make a dramatic improvement, though we do concentrate on them. We find people who are trying to get off drugs and can be helped get on the way. We don't at the moment usually give any support to them when they leave the prison, so you have to put in place the programmes that will give them support.[247]

The need for support on release was emphasised to us by those we met on the drug recovery wing at Brixton Prison. In their experience, prison provided an opportunity for recovery which was then lost because on release there was so little support within the community. According to the prisoners, almost no one stays off drugs following release as they have so little structure in their lives.

197. The Prison Reform Trust has identified the provision of housing, employment, health and social care, and family support to be "pivotal to successful rehabilitation."[248] The point of release from prison is a particularly dangerous one for addicts. Not only is the risk of relapse high, even after they might have been drug-free for several months, but the risk of overdose is increased when an addict who has been abstinent for some period of time first relapses, taking a dose to which their body might no longer be habituated.

198. One of the ways which the Brixton drug recovery wing are addressing this problem was by organising housing and treatment within the community to start on the day of release and registering inmates on courses to provide structure to their day. This was done mainly by a peer support mentor working with a number of agencies including voluntary sector agencies including the St Giles Trust which supports prisoners on release.

199. Another prison that we visited—HMP Pentonville—has also addressed this issue, by having Islington Council fund a Prison Officer to work with the prisoners in their Integrated Offender Management[249] cohort of prisoners who lived in Islington before they were incarcerated. Release planning starts immediately and as much as possible is completed prior to release. This could be the Housing Needs Assessments that local authorities need or finding a specific support mechanism in the locality that would meet a particular need. Islington Council's monitoring of reducing re-offending rates and other targets, such as completions of licences, shows a reduction in crime. As this cohort tends to consist of prisoners convicted of acquisitive crime and those with a history of substance misuse, this has had a huge impact on the local community. Neighbouring Haringey Council has also recently joined the partnership.[250]

200. The scope for expanding this programme nationally is limited as it depends on working with a cohort of prisoners who come from the local area. For example, HMP Brixton has offenders from 33 London boroughs. A further complication is that every borough has a different Integrated Offender Management system which makes it impossible to have a standard process for the release of prisoners. HMP Brixton made the suggestion that each prison should serve a limited number of boroughs in order to make release easier to manage.

201. We commend the work taking place on the drug recovery wings and the drug free wings in certain prisons. The examples that we saw of both were inspiring. If the evaluation of the pilots shows them to be successful, we recommend that they be rolled out nationwide as a matter of priority. We also recommend that the Government ensure that they remain fully funded. The matter of the lack of funding for voluntary drug testing in HMP Brixton's drug recovery wing is worrying and we ask that the Justice Secretary reassure us that such a vital strand of the recovery programme remains funded.

202. There is some very impressive work happening in some prisons at present with innovative approaches being formulated in regards to treatment and managing the transition of release but this is not the standard and there is considerable scope to spread best practice

ABSTINENCE OR MAINTENANCE?

203. The Government's 2010 drug strategy announced that

This Government will work with people who want to take the necessary steps to tackle their dependency on drugs and alcohol, and will offer a route out of dependence by putting the goal of recovery at the heart of all that we do.[251]

In July 2012, the National Treatment Agency published a report which highlighted the importance of not allowing those addicted to heroin to remain on opioid substitution prescriptions without monitoring their progress.

It is not acceptable to leave people on [opioid substitution] without actively supporting their recovery and regularly reviewing the benefits of their treatment (as well as checking, responding to, and stimulating their readiness for change). Nor is it acceptable to impose time limits on their treatment that take no account of individual history, needs and circumstances, or the benefits of continued treatment. Treatment must be supportive and aspirational, realistic and protective.[252]

204. We were therefore concerned that representatives from the National Offender Management Service seemed to dismiss the possibility of abstinence-based programmes being introduced in prisons. Asked whether NOMS had adjusted drugs treatment strategies in prisons away from maintenance towards abstinence-based programmes, Richard Bradshaw, Director of Offender Health, replied:

Well, the simple answer is no because we have NICE-approved guidelines around the treatment with methadone, which has been established since 2006. So the integrated drug treatment system, which combines clinical with psychosocial, is the same as we have been applying since 2006. It is evidence-based in terms of being able to treat the addictions, and also in reducing reoffending. We have not moved away from that, but, with the advent of the idea of drug recovery wings, we have really placed that on a journey towards recovery.[253]

However the Justice Secretary later clarified that the policy was to "move towards a drug treatment system based on recovery, which does not maintain heroin users in prisons indefinitely on prescription alternatives, such as methadone, unless absolutely necessary."[254]

205. Treatment in prisons, just like treatment outside prisons, should be tailored to the individual. Some people will be able to enter abstinence programs, and should be encouraged to do so. For others, such as those who are already being maintained on methadone, prescription alternatives may be the best option, and should be made available.

Breaking the cycle

206. In 2010, the Ministry of Justice published a consultation paper entitled 'Breaking the Cycle. It stated that

The criminal justice system cannot remain an expensive way of giving the public a break from offenders, before they return to commit more crimes.[255]

Nowhere is that more true than in the area of drugs policy. A 2003 estimate placed the cost of drug-related offending at £13.9 billion a year, with £4 billion of that incurred by the criminal justice system.[256] There are also the social costs of the low level crime associated with drug dependence, for the victims of crime and their communities. Drug-related re-offending is a cycle which must be broken, and we believe that it can be broken. There are several points where a drug-dependent offender can be helped.

Education and prevention: drug-dependent offenders are not created in a vacuum, there are circumstances which contribute to their offending behaviour. We believe that one of the critical intervention points is before that offending starts. By using preventative methods to reduce drug use, we can reduce the prevalence of drug-related offending.

Non-custodial treatment referrals: The Government response to the white paper stated that it "will explore options for intensive drug and alcohol treatment based accommodation."[257] Many drug-dependent offenders are likely to be on short sentences which reduces their treatment options within prisons. If the criminal justice system can divert such offenders in to treatment successfully, the reduction in future offending and prison costs could be substantial.

Treatment and training in prison: we discussed the impact of treatment and training within prisons earlier in this chapter. Prison is a prime opportunity to get offenders off drugs.

Treatment, housing, training and employment support: The 2010 Drug Strategy highlighted goal of developing a holistic, joined-up recovery system that goes beyond drug treatment and addresses the wider needs of those with dependence on drugs. Drug-dependent offenders will need support within the community if they are to avoid the circumstances which may lead to them re-offending.

Figure 3: Breaking the Cycle: Critical Intervention Points

Lack of reliable data

207. On arrival at a prison, offenders will undergo a health check, including an interview about previous and current drug use. This information is recorded in order to ascertain whether they have a problem which requires clinical management. Throughout their sentences, offenders are subject to random, mandatory drug testing. However, there are several criticisms of the mandatory testing regime. The Prison Reform Trust point towards a Home Office study which found that "mandatory drug testing results generally underestimate the level of drug misuse as reported by prisoners". In addition HM Inspectorate of Prisons reported frequently seeing MDT programme staff diverted to other duties, resulting in a lack of timely target testing and abandoned tests.[258]

208. A 2010 Policy Exchange report also highlighted flaws in the system, arguing that the fact that prisons are required to meet a target for the number of positive tests - and the fact that the overall performance of the prison is partly judged according to how low this figure is - "disincentivises staff from building up a true picture of the scale of drug misuse".[259]

209. Offenders are also subject to what is known as a "suspicion test", whereby if a member of staff suspects drug use, they can recommend a test be carried out. However, in the reports on HMP Durham and HMP Birmingham, Her Majesty's Inspectorate of Prisons criticised the lack of suspicion tests which were recommended but not carried out.[260] [261]

210. We were also surprised that drug tests were not carried out on offenders being released or follow-up on those who had been treated for drug addiction in prison once they were released. When we asked the Justice Secretary about why there was not a standard drug test on exit, he replied that

I think because it would be just vastly expensive. We get the figures, and we have people telling us what their history of drug abuse is. Obviously, some testing goes on, but the idea you introduce a regime of mandatory drug testing all the time [...] would be pointless because we know we have a problem, so we just don't need to keep testing what it is. Obviously, once you get into a drug rehabilitation wing, and so on, I am sure they look out for any indication that someone is reverting. But testing does go on now. It is used as a control technique, and we usually produce figures prison by prison, so the Inspectorate discovers what the rates are.[262]

Given that the data produced by the test would not only aid the department in building a picture of drug use prevalence across the prison system but could assist in identifying those who might benefit from information about treatment in the community, we do not agree that a test on release would be superfluous.

211. Producing an evidence base of effective interventions is one of the most vital building blocks of drugs policy. We recommend that the Ministry of Justice introduce mandatory drug-testing for all prisoners arriving at and leaving prison whether on conviction, transfer or release. Tests should be carried out for both illegal and prescription drugs. This should be in addition to the existing random testing regime, the principal purpose of which is deterrence. The information obtained from such a test would be very valuable in evaluating the effectiveness of the current systems in place and identifying those prisons which have a serious problem. Prisons are a key point in the cycle of drug addiction and if addicted offenders can be got off drugs, the monetary and societal benefits would be huge.

212. Release from prison is a critical intervention point in the cycle of addiction and re-offending. We welcome the Justice Secretary's recent announcement that prisoners will be "met at the prison gate" by mentors who can help them to settle back into the community. Successful rehabilitation is a challenging outcome to achieve, but it is worth investing the resources necessary to ensure that those leaving prison have the care and support they need in the community, including suitable and stable housing, to provide them with the best possible chance of a long-term recovery. Under the our recommended regime of universal drug testing on release, those who test positive—however long they have served—should be automatically referred to the appropriate community drug rehabilitation service. Given the importance of this point of critical intervention, we intend to return to this issue in the near future to assess whether there has been an improvement following the implementation of the Justice Secretary's policy.

224 Ev 192 Back

225 Prison Reform Trust, Out for Good: taking responsibility for resettlement (September 2012), p 47 Back

226 Ev 194 Back

227 http://www.justice.gov.uk/downloads/publications/hmipris/prison-and-yoi-inspections/durham/durham-2011.pdf Back

228 Max Daly & Steve Sampson, Narcomania: A Journey Through Britain's Drug World (William Heinemann 2012), p 42 Back

229 Her Majesty's Inspectorate of Prisons, Annual report 2011-12, p 8 Back

230 http://www.justice.gov.uk/downloads/publications/hmipris/prison-and-yoi-inspections/durham/durham-2011.pdf Back

231 Her Majesty's Inspectorate of Prisons, Annual report 2011-12, p 8 Back

232 Q387 Back

233 Ev 192 [Ministry of Justice] Back

234 Ev 192 [Ministry of Justice] Back

235 Prison Reform Trust, The Bromley Briefings (June 2012), p 59 Back