Treatment of substance use disorders in prison settings: statement by the UNODC‐WHO Informal Scientific Network, UN Commission on Narcotic Drugs

Since 2014, the United Nations Office on Drugs and Crime (UNODC) ‐ World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions, especially at the Commission on Narcotic Drugs (CND), the drug‐control policy‐making body of the United Nations (UN). The public health dimension of the world drug problem, including prevention and treatment of substance use disorders (SUDs), has become prominent in policy debates within the UN system ¹ .

Many people in the criminal justice system have a history of SUDs and other mental health conditions. An estimated one in three people in prison have used drugs during incarceration ² . The worldwide prison population stands at 11.2 million individuals ³ , and continues to increase. This and related prison overcrowding have profound implications for the physical and mental health of people in incarceration and the well‐being of their families and communities.

If people with SUDs engage in criminal activities, these are often minor offences driven by the need to support their substance use ⁴ . Imprisonment is not an effective response to substance use/SUDs ⁵ , and it may exacerbate pre‐existing problems. SUDs should be treated as health conditions and not as criminal behaviors. It is essential to provide accessible, evidence‐based SUD treatment in the community and establish different non‐custodial measures, including SUD treatment as an alternative to conviction or punishment for people with SUDs in contact with the criminal justice system. In case of personal‐use‐related drug offences and other minor offences by people with SUDs, countries should redirect them toward health care and social services instead of applying ineffective punitive measures.

This approach aligns with the UNODC‐WHO International Standards for the Treatment of Drug Use Disorders ⁴ and the International Drug Control Conventions, the UN Standards Minimum Rules for the Treatment of Prisoners ⁶ , the UN Standard Minimum Rules for Non‐Custodial Measures ⁷ , as well as the UN Rules for the Treatment of Women Prisoners and Non‐Custodial Measures for Women Offenders ⁸ .

When the severity of the crime precludes the consideration of treatment as an alternative to conviction or punishment, countries need to ensure access to SUD treatment within prison settings and ensure continuity of treatment in line with services provided in the community. Offering treatment and care in prison settings corresponds to the CND resolution 61/7 on “Addressing the specific needs of vulnerable members of society in response to the world drug problem” ⁹ and the 2016 UN General Assembly Special Session on Drugs Outcome Document ¹ .

To ensure that people with SUDs in prison settings receive appropriate treatment in line with international standards and guidelines, the ISN recommends the following:

• Individuals who use psychoactive substances for non‐medical purposes or have SUDs should not be criminalized for their substance use. People with SUDs, including those in prison settings, should have access to voluntary treatment no matter their legal status.

• Alternatives to conviction or punishment should be provided for people with substance use/SUDs who have committed minor offences, with the aim of reducing crime, recidivism and deaths, and improving health and well‐being while enhancing social justice.

• Clinical screening for substance use/SUDs and their comorbidities, notably suicidality prior to and in prison settings, should be provided, to arrive at the correct diagnosis needed to ensure adequate treatment and to prevent the exacerbation of substance use/SUD.

• Care for SUDs should follow ethical guidelines, uphold human rights principles, and align with international standards and norms. It should not be used for punitive purposes.

• Independent review mechanisms, which follow accepted standards, should be established to ensure quality care and ethical treatment in prison settings.

• In all justice‐related cases, people should receive treatment and care of a standard equal to that in the community, regardless of gender, age, race, religious, cultural or social status, including programs for individuals with special treatment and care needs.

• Treatment for individuals with SUDs should follow a continuum of care that includes broader health and social services to strengthen success upon return into the community and drug use prevention, especially for children and family members of incarcerated persons.

• Providing treatment for SUDs by prison health services should be clinically independent of prison administrations and yet be coordinated effectively.

• Evidence‐based pharmacological treatment should be widely available for the treatment of SUDs in prison and upon return to the community, including for comorbid conditions. Naloxone should be accessible to manage overdoses in criminal justice settings and upon release, and relevant training of professionals and prisoners should be ensured.

• Professional staff training, in health care and justice settings, should be provided to ensure quality care and sustainability.

• Adequate funding should be available to ensure quality care of SUDs before, during and after incarceration.

• Support and investment in systematic data collection should be ensured to monitor, evaluate and allocate resources.

• Recognizing that social determinants of health can be risk factors for substance use and for offending, policies should be developed to address them, as they are equally important for the rehabilitation and recovery of individuals with SUDs.

Treatment for SUDs based on evidence has been shown to be critical in reducing substance use, overdose, reoffending and reincarceration in populations with a history of involvement with the justice system. Treatment and care interventions in line with UNODC‐WHO International Standards can contribute towards supporting both the welfare of the community and the promotion of personal recovery. To ensure that all individuals with SUDs who come into contact with the criminal justice system, including those in prison, receive the same level of care, respect and dignity, the ISN is urging UN Member States to change their response to SUDs from a criminal justice to a public health strategy.