ABSTRACT
Introduction:
In February and March 2022, the Government Delegation for the National Plan on Drugs completed the fourth edition of the survey on the prison population (men and women over 18 years of age) in 78 Spanish prisons.
Objectives:
The aim of this survey was to obtain data on socio-demographic characteristics, health, drug use, high-risk practices and treatment for drug use in the prison population in Spain, the aim being to gather useful information to develop and evaluate programs and interventions aimed at preventing and reducing drug use and associated problems in this population.
Material and method:
A face-to-face personal interview was carried out using a digitalized, anonymous and pre-coded questionnaire (available in Spanish and Arabic) with 5,512 inmates.
Results:
The study reveals that the prevalence of drug use when entering prison decreases for all drugs; this decrease is most striking in alcohol and cocaine use. A downward trend in the prevalence of use in prison was observed for most illegal drugs. Cannabis, which is the most widely used illegal drug, shows a clear downward trend, with its use falling to one third of what it was in 2006.
Discussion:
The study leads us to conclude that preventive and treatment measures are optimal tools that should continue to be oriented towards the characteristics and profile of this population, which requires a multidisciplinary approach and coordination by the agents and institutions involved. A prison sentence is an opportunity to improve the health of the prison population and to carry out prevention and treatment programs. Work should continue to be done to reduce drug use and the associated risks and problems.
Keywords: health surveys, prisoners, public health, drug users, addiction treatment
RESUMEN
Introducción:
Durante los meses de febrero y marzo de 2022, la Delegación del Gobierno para el Plan Nacional sobre Drogas (DGPNSD) realizo la cuarta edición de la encuesta en población penitenciaria privada de libertad (hombres y mujeres de mas de 18 anos) en 78 centros penitenciarios en España.
Objetivos:
El objetivo de esta encuesta fue obtener datos sobre características sociodemográficas, salud, consumo de drogas, prácticas de riesgo y tratamiento por uso de drogas en población penitenciaria en España, con el fin de disponer de información útil para desarrollar y evaluar, sobre la base del conocimiento, programas e intervenciones dirigidas a prevenir y reducir el consumo de drogas y los problemas asociados en esta población.
Material y método:
Se realizo una entrevista personal cara a cara a través de un cuestionario digitalizado, anónimo y precodificado (disponible en español y árabe) a 5.512 internos.
Resultados:
El estudio revela como al ingresar en prisión disminuye la prevalencia de consumo de todas las drogas, descenso que es mas llamativo en el consumo de alcohol y cocaína. A lo largo de los anos, se observa una tendencia descendente en la prevalencia de consumo en prisión para la mayoría de las drogas ilegales. El cannabis, que es la droga ilegal mas consumida, muestra una clara tendencia descendente, reduciéndose su consumo a un tercio de lo que se consumia en 2006.
Discusión:
El estudio permite concluir que las medidas preventivas y de tratamiento son herramientas óptimas que deben seguir orientándose a las características y perfil de esta población de riesgo, que requiere un abordaje multidisciplinar y la coordinación de las diferentes instituciones y agentes implicados. La estancia en prisión es una oportunidad para mejorar la salud de la población penitenciaria y llevar a cabo programas de prevención y de tratamiento. Se debe continuar trabajando para reducir el consumo de drogas, los riesgos y problemas asociados.
Palabras clave: encuesta epidemiológica, prisioneros, salud publica, consumidores de drogas, medicina de las adicciones
INTRODUCTION
Greater knowledge about drug use amongst the prison population is essential, given the privileged position that the prison system occupies as a source of information about drug-related issues, since drug use tends to be more common amongst the prison population (released) than amongst the general public1.
The fact that offenders are sent to prison offers an opportunity to improve the prison population’s health and carry out prevention and treatment programs2. Having constant, up to date information is of great help in budgeting, developing and evaluating healthcare interventions geared towards benefitting the prison population, their families and the general public.
The use of psychoactive substances in prisons, the associated problems and the possibilities for intervention in the prison setting are priority working areas for the European Union (EU) and the United Nations Organisation (UNO)3. For this reason, there are a growing number of studies on this subject, and Spain is one of the countries with the most information available on the issue.
The Survey on Health and Drug Use amongst Prison Inmates (ESDIP) has been conducted on a five-yearly basis since 2006. It is included in the National Statistics Plan of the Spanish National Institute of Statistics (INE) and is framed within the lines of work established by Spanish and European strategies on drugs and addictions4,5.
It provides information that enables trends to be explored that are references at national and international levels. There are currently relatively little data at European level about the prevalence of drug use amongst inmates in prisons, and comparisons between countries are still scarce despite the progress made in recent years1.
The prison population in Spain has undergone profound changes in recent years, and these can be seen in the survey. The number of inmates has dropped by 25%, especially younger offenders. The changes made to the penal code, and alternative measures to prison for drug-related crimes have had a major impact. A range of interventions have also been set in motion for drug use and addictions in prisons from a public health perspective, covering prevention, harm reduction and treatment. Opioid substitution programs with a broad scope were introduced decades ago, and needle exchange projects were later provided to reduce the risk of infection amongst intravenous drug users6,7.
Programs such as these have been introduced in other countries, although Spain is something of a leader in the field of harm reduction in prisons8.
The aim of this article is to present information about health and drug use in the prison population taken from the 2022 survey, to provide useful information that can act as a basis for developing and evaluating programs and interventions designed to prevent and reduce drug use and the associated problems in this population.
MATERIALS AND METHODS
The ESDIP survey forms part of the National Statistics Plan, and has been carried out every five years since 2006. It consists of personal interviews with prison inmates throughout Spain. The body responsible for coordinating the survey is the Spanish Observatory on Drugs and Addictions (OEDA), which forms part of the Government Office for the National Plan on Drugs of the National Ministry of Health.
The Sub-Directorate of Prison Health, which answers to the General Secretary of Prisons (SGIIPP) of the Ministry of Home Affairs, the General Directorate of Penitentiary Affair (DGAP) of the Regional Government of Catalonia and the Directorate of Justice of the Regional Ministry for Equality, Justice and Social Affairs of the Basque Government, are key organisations in making the survey possible, thanks to their Program of Analysis and Inspection of Prisons.
The survey includes data about the characteristics of the prison population (age, sex, nationality, education, status of legal proceedings, etc.), information about health (perceived state of health, mental health, infection by HIV or hepatitis, tuberculosis), drug use (consumption, type of drug, route of administration), high-risk practices (intravenous drug use, unprotected sex, tattoos), awareness of high-risk practices, and treatment for drug use.
The survey was carried out throughout Spain and the results are representative for the prison population. Information was gathered from 1 February to 19 March 2022. The sample was made up of 78 prisons. Participants consisted of men and women over 18 years of age with sufficient knowledge of Spanish or Arabic to answer the questionnaire. According to their criminal classification, the inmates included were on remand, convicted of second-degree offences, under pre-trial detention or unclassified.
The sample was conducted through a table of random numbers and was proportional to the number of inmates in each prison and their nationality, and to gender, with women being over-represented (weighted by sex to make the sample proportional once again). The final sample was 5,512 inmates (4,706 men and 806 women) with a sampling error of 1.24% (confidence level of 95% for p = 0.5%) and a response rate of 86.4%.
Personal face-to-face interviews were carried out, using a questionnaire in Spanish and in Arabic depending on the inmate’s choice. The questionnaire was digitalised, anonymous and pre-codified, and was completed by the interviewer. Every person selected was informed about the objectives of the study. He/she was also told that participation was voluntary and that the answers were confidential.
Once the survey was completed, the interviewers verbally requested informed consent or willingness to participate, which was noted down in each questionnaire. If at any moment during the survey the interviewee decided to no longer continue, he/she was immediately replaced.
The questionnaire was translated into Arabic, as approximately 10% of the prison population speak it and have difficulties in understanding Spanish (very few other non-Spanish speaking nationalities were represented in the sample). 545 questionnaires in Arabic (537 for men and 8 for women) were completed, along with 3,508 questionnaires in Spanish (4,169 for men and 798 for women).
The questionnaires were completed in the prisons themselves, in a separate room, ensuring complete confidentiality and anonymity for the inmates and their answers. The duration of the interview varied between 30 and 45 minutes.
The results were integrated into a database and analysed with the IBM Statistical Package for the Social Sciences (SPSS) for Windows, version 28.0 (Armonk, NY: IBM Corp). Descriptive tables of the sociodemographic variables, perceived state of health, diagnosed psychiatric pathology, suicidal ideation, attempted suicide and prevalence of use of psychoactive substances were presented, stratified according to sex (other variables shall be considered in other publications). Substance use was compared with the EDADES 2022 survey9, completed in the same year at the domiciles of members of the general public of 15-64 years of age. The prevalence of substance use in prison in this survey was compared to the previous ESDIP surveys in 2006, 2011 and 2016 for inclusion in the results.
RESULTS
Sociodemographic characteristics
Table 1 shows that the sociodemographic profile of inmates is that of a Spanish male of 40 years of age who stopped his studies after secondary school or beforehand. In the 12 months prior to sentencing, he was working and lived in a stable setting with his own family (9% lived in unstable environments). As regards their legal status, 18.3% had previously been in youth detention centres and more than half had served prison sentences. The vast majority were serving sentences and had been in prison for an average of three years. The most common offences were criminal offences against property or against persons.
Table 1. Sociodemographic and legal characteristics of prison population according to gender (%) (Spain, 2022).
| Sociodemographic characteristics | Men | Women | |
|---|---|---|---|
| Sex | Men | 100 | - |
| Women | - | 100 | |
| Age | Mean (years) ± SD | 40.0 ± 11.6 | 41.0 ± 10.5 |
| Standard error of the mean | 0.2 | 0.6 | |
| ≤34 | 34.4 | 29.9 | |
| ≥35 | 65.6 | 70.1 | |
| ≤24 | 8.0 | 4.3 | |
| 25-34 | 26.4 | 25.6 | |
| 35-44 | 31.2 | 35.7 | |
| 45-54 | 23.0 | 23.9 | |
| 55-64 | 8.9 | 8.7 | |
| ≥65 | 2.5 | 1.7 | |
| Nationality | Spanish | 73.4 | 77.5 |
| Other country | 26.7 | 22.5 | |
| Moroccan | 10.5 | 2.5 | |
| Romanian | 1.4 | 1.9 | |
| Colombian | 2.6 | 3.1 | |
| Ecuadorian | 1.1 | 0.5 | |
| Algerian | 2.3 | 0.0 | |
| Others with lower values | 8.8 | 14.5 | |
| Educational level | Illiterate, no education or uncompleted primary school | 11.6 | 12.9 |
| Primary studies completed | 40.6 | 39.2 | |
| Secondary school completed | 41.6 | 38.3 | |
| Higher education | 6.2 | 9.6 | |
| Job situation | Working (fixed contract or temporary) | 56.1 | 45.1 |
| Unemployed and seeking work | 16.2 | 15.4 | |
| Inactive * | 27.7 | 39.5 | |
| Type of residence† | Stable residence (house, flat or apartment) | 89.5 | 84.0 |
| Unstable residence‡ | 9.0 | 15.3 | |
| Other type of accommodation | 1.5 | 0.7 | |
| Cohabitation† | Partner | 38.9 | 40.4 |
| Children | 24.5 | 43.3 | |
| Family of origin (parents/siblings) | 34.6 | 24.9 | |
| Living alone | 18.1 | 13.4 | |
| With friends | 6.9 | 6.3 | |
| Status of legal proceedings† | Sentenced | 83.2 | 82.2 |
| Pre-trial | 16.8 | 17.8 | |
| Previous admissions | Youth centre | 18.7 | 12.0 |
| Prison | 51.3 | 40.1 | |
| Age at time of first imprisonment | Mean (years) ± SD | 30.1 ± 11.5 | 33.3 ± 11.2 |
| Standard error of the mean | 0.2 | 0.6 | |
| Average time in prison | In this sentence (years) | 3.1 | 2.5 |
| Throughout lifetime (year) | 6.2 | 4.2 | |
| Crime committed for current sentence (against...)§ | Property | 37.1 | 37.3 |
| Traffic safety | 4.7 | 2.5 | |
| Persons | 28.6 | 25.6 | |
| Sexual offence | 5.8 | 1.7 | |
| Public health | 21.0 | 28.7 | |
| Gender violence | 13.3 | 3.8 | |
| Violence against infants and adolescents | 1.5 | 0.5 | |
| Others | 4.5 | 6.3 |
Note. *In prison for a year, unemployed without seeking work, student, retired, housework and not seeking employment). †Status of legal proceedings, type of residence and cohabitation refers to the 12 months prior to imprisonment. ‡Inadequate housing, pensions, hostels, hotels, homeless shelters…§The prison population may have entered prison for one or more offences and lived in one or more categories. The total of these sections is over 100%. SD: standard deviation. Source: Spanish Observatory on Drugs and Addictions (OEDA). Survey on health and drug use amongst prison inmates. ESDIP 2022.
The sociodemographic profile of female inmates was that of a Spanish woman of 41 years of age, who had left the education system after secondary school or before. In the 12 months before sentencing, she was unemployed and seeking work or was inactive. The majority live in a stable setting with children, but one noteworthy figure is that 15.3% lived in unstable environments. The figures for their legal situation showed that 12.0% had been in youth detention centres and 60% were serving their first prison sentence. The vast majority had been convicted and the most common offences were against property or against public health.
State of health
Table 2 shows that 61.5% of the prison population had a good or very good perception of their state of health. A higher percentage of men considered their state of health to be good or very good than women (62.0% men and 53.0% women). On the other hand, positive health perceptions were higher amongst the younger population and went down with increasing age.
Table 2. Perceived state of health of prison population according to gender (%) (Spain, 2022).
| Total | Men | Women | ||
|---|---|---|---|---|
| Current perceived state of health in prison | Very good or good | 61.5 | 62.0 | 53.0 |
| Average | 24.4 | 24.2 | 28.0 | |
| Bad or very bad | 14.1 | 13.8 | 19.0 | |
| Perceived current state of health in prison compared to same before imprisonment | Better than outside prison | 20.7 | 20.6 | 21.4 |
| Same as outside prison | 13.0 | 13.1 | 11.2 | |
| Worse than outside prison | 66.3 | 66.2 | 67.3 |
Note. Source: Spanish Observatory on Drugs and Addictions (OEDA). Survey on health and drug use amongst prison inmates. ESDIP 2022. Government Office for the National Plan on Drugs, Ministry of Health; 2022.
Comparisons of their current state of health with what they felt they had before imprisonment showed that 66.3% of the prison population considered that their state of health had worsened after entering prison, but 20.7% felt that it had improved. The highest scores for this improvement appeared most frequently amongst women and younger members of the population.
34.8% of the prison population mentioned having been diagnosed with a mental or emotional disorder at some point in their life. There was a higher prevalence in this regard amongst women (42.3%) than amongst men (34.3%), and greater amongst inmates over 34 years of age in both sexes than amongst younger inmates. The average time of treatment mentioned by persons diagnosed with a mental disorder is 8.7 years; with 9.6 years for women and 8.7 for men.
Figure 1 shows the type of mental disorder 1, and the variations according to sex. Men are more often diagnosed with schizophrenia and drug-induced psychosis, while women are more commonly diagnosed with depression and personality disorder. There are statistically significant differences between men and women in diagnoses for depression and for schizophrenia (Pearson’s chi-squared test, p <0.05). The prevalence of psychosis and bipolar disorder are similar in both sexes.
Figure 1. Percentage of inmates who have been diagnosed with one or more of the following psychiatric pathologies (Spain, 2022).
An important element in mental health is the concept of suicidal ideation. Table 3 shows that 32.2% of the prison population had ideas of suicide at some time in their lives (38.7% women 31.8% men). These figures are higher inside prison than outside for both sexes.
Table 3. Prevalence of suicidal ideation and attempted suicide in the prison population according to gender (%) (Spain, 2022).
| Suicidal ideation amongst the total prison population | |||
|---|---|---|---|
| Total | Men | Women | |
| At some point in life | 32.2 | 31.8 | 38.7 |
| Outside prison (12 months prior to imprisonment) | 15.0 | 14.6 | 19.7 |
| Inside prison (during current sentence) | 18.3 | 18.1 | 21.3 |
| Attempted suicides amongst the total prison population | |||
| At some point in life | 19.9 | 19.5 | 25.4 |
| Outside prison (12 months prior to imprisonment) | 8.3 | 8.1 | 12.1 |
| Inside prison (during current sentence) | 8.8 | 8.7 | 11.3 |
| Attempted suicides amongst participants with suicidal ideation | |||
| At some point in life | 61.7 | 61.4 | 65.8 |
| Outside prison (12 months prior to imprisonment) | 55.7 | 55.2 | 61.4 |
| Inside prison (during current sentence) | 48.1 | 47.7 | 53.2 |
Note. Source: Spanish Observatory on Drugs and Addictions (OEDA). Survey on health and drug use amongst prison inmates. ESDIP 2022. Government Office for the National Plan on Drugs, Ministry of Health; 2022.
19.9% recognised that they had attempted suicide at some point (25.4% women and 19.5% men). The data shows that 61.7% of the prison population that declare that they have had ideas of suicide have also attempted suicide at some moment in their life. This figure is higher amongst women (65.8%) than amongst men (61.4%).
Drug use
As regards psychoactive substance use, the figures in Table 4 show that consumption in the 30 days prior to entering prison was clearly higher amongst the prison population than amongst the general public from 15 to 64 years of age, with notable differences in cannabis and cocaine. Alcohol is the only drug that shows a prevalence of use that is higher amongst the general public.
Table 4. Prevalence of psychoactive substance use amongst the prison population over 17 years of age and the general public from 15 to 64 years of age, according to gender (%) (Spain, 2022).
| Prison population (ESDIP 2022) | General public (Edades 2022) | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sometime while in the community or in prison | Last 30 days outside prison | Last 30 days in prison | Sometime in participant’s life | Last 30 days | |||||||||||
| T | M | W | T | M | W | T | M | W | T | M | W | T | M | W | |
| An illegal drug | 76.0 | 77.1 | 59.1 | 53.5 | 54.4 | 40.9 | 16.8 | 17.4 | 8.4 | 42.2 | 50.3 | 34.0 | 9.2 | 12.8 | 5.5 |
| Alcohol | 74.0 | 75.4 | 53.6 | 54.5 | 55.9 | 34.3 | 2.0 | 2.1 | 1.0 | 93.2 | 94.9 | 91.4 | 64.5 | 73.1 | 55.7 |
| Tobacco | 85.1 | 85.7 | 76.2 | 72.5 | 73.0 | 65.3 | 74.0 | 74.4 | 67.4 | 69.6 | 74.4 | 64.8 | 37.2 | 42.2 | 32.3 |
| Unprescribed tranquilisers | 28.4 | 28.8 | 22.3 | 12.1 | 12.3 | 9.4 | 7.8 | 8.0 | 3.6 | 3.6 | 3.6 | 3.6 | 0.6 | 0.5 | 0.6 |
| Cannabis | 62.3 | 63.9 | 39.6 | 37.7 | 38.6 | 24.0 | 11.2 | 11.6 | 4.7 | 40.9 | 48.8 | 32.9 | 8.6 | 12.0 | 5.2 |
| Cocaine powder | 54.0 | 55.3 | 34.7 | 24.9 | 25.6 | 14.1 | 1.3 | 1.3 | 1.1 | 11.7 | 17.1 | 6.3 | 1.3 | 2.0 | 0.6 |
| Freebase cocaine | 30.4 | 30.6 | 27.0 | 18.1 | 18.1 | 17.7 | 1.2 | 1.2 | 0.9 | 1.7 | 2.5 | 0.9 | 0.1 | 0.1 | 0.1 |
| Heroin | 25.4 | 28.7 | 25.4 | 11.1 | 11.1 | 10.5 | 1.4 | 1.5 | 0.5 | 0.6 | 1.1 | 0.2 | 0.0 | 0.0 | 0.0 |
| Ecstasy | 25.9 | 26.7 | 14.8 | 3.7 | 3.9 | 1.0 | 0.2 | 0.2 | 0.1 | 5.1 | 7.4 | 2.9 | 0.2 | 0.3 | 0.1 |
| Amphetamines | 20.2 | 20.8 | 11.3 | 3.8 | 3.9 | 2.1 | 0.4 | 0.5 | 0.0 | 4.6 | 6.9 | 2.3 | 0.2 | 0.3 | 0.1 |
| Hallucinogens | 21.1 | 21.7 | 12.8 | 1.7 | 1.8 | 0.9 | 0.2 | 0.2 | 0.0 | 5.4 | 7.7 | 3.1 | 0.2 | 0.2 | 0.1 |
| Inhalants | 6.9 | 7.0 | 4.6 | 0.3 | 0.3 | 0.1 | 0.0 | 0.0 | 0.0 | 0.9 | 1.4 | 0.4 | 0.1 | 0.2 | 0.1 |
Note. Sources: Spanish Observatory on Drugs and Addictions (OEDA). Survey on alcohol and drugs in Spain (EDADES) 1995-2022. Government Office for the National Plan on Drugs, Ministry of Health; 2022. Spanish Observatory on Drugs and Addictions (OEDA). Survey on health and drug use amongst prison inmates. ESDIP 2022. Government Office for the National Plan on Drugs, Ministry of Health; 2022. ESDIP: Survey on health and drug use amongst prison inmates; M: men; W: women; T: total.
The prevalence of legal and illegal drug use, both inside and outside prison, is higher amongst men. The biggest differences in use between men and women take place in prison because women reduce drug use to a greater extent when they are sentenced. Tobacco is the only drug whose prevalence of use increases when entering prison, and this takes place in both sexes.
One notable figure is that 75.1% of the prison population have consumed some kind of illegal drug at some point. As regards legal drug use, alcohol is the most widely consumed drug outside prison. However, once inmates are sentenced, consumption drops to values below 3%. Tobacco is the most widely consumed drug both inside and outside prison. Figures show that 53.5% have consumed some kind of illegal drug in the month before imprisonment, and 16.8% have done so in the previous month in prison. Cannabis is the most widely consumed drug, both inside and outside prison.
The prevalence of use of all drugs drops when the participants are imprisoned. The reduction is more notable in alcohol and cocaine use. Cannabis consumption it reduced to a third after imprisonment, and consumption of unprescribed tranquilisers goes down to almost half, although they are the most widely consumed drugs in the previous month.
The figures for prevalence of use by sex show that men present higher prevalences of use of all drugs inside and outside prison. The largest differences according to gender can be seen in cannabis and heroin use, which are much lower amongst women.
The prevalence of illegal drug use in the prison population follows a pattern of polysubstance use. This pattern is more common outside prison and goes down once inmates enter prison, with an increase in the proportion of the prison population who take no substances at all.
Figure 2 shows the evolution of use in prison in the four surveys. A downward trend was observed between 2006 and 2022 in the prevalence of use in prison over the last 30 days for most drugs. Cannabis, which is the most widely consumed illegal drug in prison, shows a clear downward trend, with consumption dropping by a third of what was consumed in 2006. One notable figure is the decrease in consumption of heroin and cocaine inside and outside prison. The only substance that does not follow this uniform trend is unprescribed tranquilisers, although the values in 2022 are lower than the ones observed in 2006 (the highest since official records began).
Figure 2. Prevalence of drug use amongst inmates in the last 30 days in prison (%) (Spain, 2006, 2011, 2016 and 2022).
DISCUSSION
The results show that the prison population presents a set of specific characteristics that are different from those found amongst the general public, with a greater degree of vulnerability. The population under consideration in this study is at risk with a poor perceived state of health, and a notable presence of mental disorders and a very high prevalence of drug use before entering prison.
The figures for educational levels show a higher percentage of persons without studies or with uncompleted primary school studies in the prison population (11.7%) than amongst the general public from 15 to 64 years of age in the EDADES survey of the same year (9.9%). The survey for 2016 shows how the profile of the prison population has changed in the last six years. A somewhat higher percentage of the prison population completed primary school (22.7% in 2016 against 40.5% in 2022). There is a larger percentage of persons living alone in the prison population (17.8%) than in the general public from 15 to 64 years of age included in the EDADES survey (12.5%).
The vast majority of inmates feel that their state of health has worsened after entering prison. However, there is a higher percentage of inmates who feel that their state of health has actually improved when in prison than in 2016. The World Health Organisation (WHO) has declared that mental health-related issues are up to seven times more likely to appear amongst the prison population than the general public in Western countries3.
Descriptions of the psychological effects of entering prison such as confinement and the prison system mention that the prison population consequently have high higher rates of mental disorders than they may have had if they had remained in the community10.
The results of this survey show that 4 out of every 10 women and 3 out of every 10 men have been diagnoses at some point in their lives with a mental or emotional disorder, with different diagnoses according to gender. A larger number of women suffer from depression than men and there is a higher percentage of men who suffer from schizophrenia than women. One problem related to mental health is that of suicide11,12.
The prison population is regarded as a high-risk group, with a considerably higher suicide rate than that of the general public. This survey showed that one third of the prison population mentioned suicidal ideation at some point in their life, and one fifth said that they had attempted suicide at some moment. In both cases there was a higher prevalence amongst women, and percentages increased slightly when they entered prison.
The prison population is much more likely to consume drugs, consume them regularly and experience drug-related problems than persons living in the community1,13,14.
Approximately 50% of prison inmates in Europe declared that they consumed drugs in the year prior to entering prison15, and 30% to 51% of the prison population meet the diagnostic criteria of substance use disorder16.
In 2022, about half of the Spanish prison population declared that they had consumed illegal drugs in the 30 days before entering prison. The proportion of active users amongst inmates then drops to 16.8%. The largest decrease in consumption takes place amongst women. The percentage of illegal drug users is much higher amongst the prison population (outside prison) than it is amongst the general public. Illegal drug use in the prison setting is more common amongst men and younger inmates. The most widely consumed substances in prison are tobacco (which is available to inmates), followed by cannabis and unprescribed tranquilisers.
Figures for 2006-2022 show that there was a strong downward trend in the prevalence of drug use in prisons in the last 30 days for most illegal substances. Cannabis, which is the most widely consumed illegal drug in prison (and in the community), shows a clear downward trend, with a drop to one third of the levels of use seen 16 years before. The only substance that shows an upward trend in consumption is unprescribed tranquilisers. Use of these drugs has been increasing since 2011, although the current values are lower than the ones seen when the surveys commenced in 2006.
The results of this survey allow us to define the challenges to be overcome in the work to reduce drug use and the associated risks and problems for this population. Preventive and therapeutic measures should be adapted to inmates’ unique characteristics. The figures show a high prevalence of drug use before imprisonment. The growing use of addiction therapies as an alternative measure to prison probably plays an important role in reducing the number of young inmates and preventing recidivism. Prisons also allow many inmates to start participating in treatment programs, as the figures in the survey show: 20.8% of participants declare that they have undergone treatment for substance use during their current prison sentence, mainly for heroin and cocaine. Considerable efforts have been made to implement treatment and harm reduction programs, even more so when this issue is considered from an international perspective7,8,17,18.
A multidisciplinary approach is required, along with coordinated efforts and close collaboration with the agents involved, to enable the preventive and therapeutic options to be adapted to changing realities in the illegal drug market6,7,13. At the same, there is a clear need to continue working on risk reduction approaches in drug use and in other practices18,19.
Acknowledgements
This article is the outcome of the combined efforts of many professionals from different sectors. We would like to offer our sincerest thanks to all of them, especially prison personnel, whose collaboration made this study possible, and to the prison population who were interviewed in the ESDIP. The authors would also like to thank Dr. Joan Ramon Villalbí Hereter for reviewing this article and for his many valuable contributions to our study.
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