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Behavioural change amongst drug injectors in Scottish prisons
Pergamon
0277-9536(94)EOW-V
RESEARCH BEHAVIOURAL
See. Sci. Med. Vol. 39, No. II, pp. 1585-1586,1994 Copyright 0 1994 ElsevierScienceLtd Printed in Great Britain. All rights reserved 027%9536194 57.00+ 0.00
NOTE
CHANGE AMONGST DRUG IN SCOTTISH PRISONS
INJECTORS
D. SHEWAN,* M. GEMMELLt and J. B. DAVIES Addiction Research Group, University of Strathclyde, Glasgow Gl lXQ, Scotland Abstract-A study of injecting behaviour amongst a purposive sample of drug-users in Scottish prisons found that 32% reported injecting prior to current sentence. The percentage of these who were injecting during their current prison sentence (i.e. inside the prison) had fallen to 11%. Of those who were injecting prior to imprisonment, 24% reported sharing injecting equipment at that time. Of those who were still injecting in prison, however, 76% reported sharing equipment. Overall, therefore, there were fewer injectors in prison, but a higher proportion of these shared needles. Factors most closely identified with current sharing of injecting equipment in prison were: (a) having injected a wider range of drugs in prison (during both current and previous sentences); (b) frequency of Temgesic use; and (c) being prescribed methadone in the community, then having that prescription discontinued on entry to prison. Key words-drug,
injecting,
prison,
risk, HIV
INTRODUCTION Prison is an environment which has the potential to modify drug using behaviour [l-3]. It is unclear, however, what the predictors of behavioural change are. A recent study in four Scottish adult male prisons focused on the nature of drug using behaviour in Scottish prisons, and particularly sharing of injecting equipment. METHODS Semi-structured interviews were carried out with 234 prisoners. Sampling was purposive, and results should not therefore be seen as estimates of overall prevalence; prevalence was assessed in a separate study [3]. Purposive sampling selects a particular target group of interest (in this instance, drug users in prisons) with a view to exploring the dynamics of a particular phenomenon (drug use) within that target group. A recruitment rate of 91% was achieved. Two different reliability studies were carried out, and one statistically significant difference was found from amongst eighty drug use variables. RESULTS In this sample, drug injecting in prison was less likely than was prior injecting in the community. *Present address: Department of Psychology, Glasgow Caledonian University, Glasgow G4 OBA, Scotland. TPresent address: Central Research Unit, Prisons’ Branch, Scottish Office Home and Health Department, Celton House, 5 Redheughs Rigg, Edinburgh EH12 9HW, Scotland.
Prior to current sentence, 32% had injected regularly in the community, compared to 11% who were injecting during their current sentence. The data suggest that prison is not a major factor in introducing people to drug injecting; only two people in the sample reported developing a regular injecting habit while in prison. while one other first injected drugs while in approved school. However, the general reduction in drug injecting amongst prisoners has to be seen in the context of the nature of the drug injecting which still occurs in Scottish Prisons. Of those who had been injecting prior to their current sentence, the proportion who were sharing equipment at time of arrest was 24%. By contrast, of those who reported injecting in prison, 76% were still sharing equipment in prison. Whilst no significant difference emerges between rates of previous sharing of injecting equipment in the community and in prison, when comparing current rates of sharing of injecting equipment there is a much greater likelihood that current injectors will be sharing in prison than in the community. In general terms, therefore, drug users appear less likely to inject in prison than in the community; but those who do are more likely to share equipment. Those who were currently sharing injecting equipment in prison were characterized by having injected a wider range of drugs within prison-both during current and previous sentences-suggesting a willingness to take chances within the prison system, allied to a knowledge of who to find a way around security. This also applies to their obtaining and using injecting equipment in prison. The most common drug injected was Temgesic, and current sharers were 1585
D. SHEWAN et al.
1586
identified by frequency of use of this drug, rather than amount. In other words, they used more often, rather than taking higher average dosages at one time. Finally, being prescribed methadone prior to imprisonment, then having that prescription stopped on entry to prison, was associated with an increased likelihood of sharing. The data suggest that those who were being prescribed methadone prior to current sentence had made a move towards positive behavioural change in relation both to stopping or cutting down injecting and sharing of injecting equipment. This contrasts to their drug use during their current sentence, however, when high risk behaviour tended to be reinstated. DISCUSSION
The majority of drug injectors who had previously shared injecting equipment in the community reported that they no longer did so. In addition, a majority of drug injectors had stopped injecting during their current sentence. However, most of those still injecting in prison reported sharing injecting equipment. Of particular interest was the finding that having a methadone prescription stopped on admission to prison was associated with sharing of injecting equipment, particularly as these subjects reported attempts at positive behavioural change during the maintenance period. Methadone prescribing has been found to reduce criminal behaviour [4], and it may be that those who are subsequently imprisoned therefore represent an atypical group. Alternatively, these re-
sults may reflect the effect of the abrupt cessation of a methadone script. In either case, it is significant that current sharing in prison generally (not just of the methadone group) represents a reinstatement of previous high risk drug using behaviour in prison. It is concluded that service provision for drug users in prison should be continuous with service provision in the community, in the interests of reducing high risk behaviour. Acknowledgements-This research was funded
by Criminology and Law Research Group, Scottish Office Home and Health Department. The views expressed in this paper are those of the authors, and not necessarily those of SOHHD, nor of the Scottish Prison Service. We would like to thank staff and prisoners who took part in the study. Without their help the research presented here could not have taken place. Thanks are also due to Mr Ed. Wozniak, and Dr David McAllister, Central Research Unit, SOHHD, Mr George Sharkey, SACRO, and Mr Alisdair Forsyth, University of Glasgow. REFERENCES
Farrell M. and Strang J. Drugs, HIV, and prisons, Br. Med. .I. 302, 1477, 1991. Harding T. HIV infection in the prison environment: a test case for the respect of human rights. In AIDS and Drug Misuse (Edited by Strang J. and Stimson G. V.). Routledge, London, 1990. Power K., Markova A., Rowlands A., McKee K. J., Anslow P. J. and Kilfedder C. Intravenous drug use and HIV transmission amongst inmates in Scottish prisons. Br. J. Addiction 87, 35, 1992. Ward J., Mattick R. and Hall W. Key Issues in Methadone Maintenance and Treatment. New South Wales University Press, NSW, Australia, 1992.
0277-9536(94)EOW-V
RESEARCH BEHAVIOURAL
See. Sci. Med. Vol. 39, No. II, pp. 1585-1586,1994 Copyright 0 1994 ElsevierScienceLtd Printed in Great Britain. All rights reserved 027%9536194 57.00+ 0.00
NOTE
CHANGE AMONGST DRUG IN SCOTTISH PRISONS
INJECTORS
D. SHEWAN,* M. GEMMELLt and J. B. DAVIES Addiction Research Group, University of Strathclyde, Glasgow Gl lXQ, Scotland Abstract-A study of injecting behaviour amongst a purposive sample of drug-users in Scottish prisons found that 32% reported injecting prior to current sentence. The percentage of these who were injecting during their current prison sentence (i.e. inside the prison) had fallen to 11%. Of those who were injecting prior to imprisonment, 24% reported sharing injecting equipment at that time. Of those who were still injecting in prison, however, 76% reported sharing equipment. Overall, therefore, there were fewer injectors in prison, but a higher proportion of these shared needles. Factors most closely identified with current sharing of injecting equipment in prison were: (a) having injected a wider range of drugs in prison (during both current and previous sentences); (b) frequency of Temgesic use; and (c) being prescribed methadone in the community, then having that prescription discontinued on entry to prison. Key words-drug,
injecting,
prison,
risk, HIV
INTRODUCTION Prison is an environment which has the potential to modify drug using behaviour [l-3]. It is unclear, however, what the predictors of behavioural change are. A recent study in four Scottish adult male prisons focused on the nature of drug using behaviour in Scottish prisons, and particularly sharing of injecting equipment. METHODS Semi-structured interviews were carried out with 234 prisoners. Sampling was purposive, and results should not therefore be seen as estimates of overall prevalence; prevalence was assessed in a separate study [3]. Purposive sampling selects a particular target group of interest (in this instance, drug users in prisons) with a view to exploring the dynamics of a particular phenomenon (drug use) within that target group. A recruitment rate of 91% was achieved. Two different reliability studies were carried out, and one statistically significant difference was found from amongst eighty drug use variables. RESULTS In this sample, drug injecting in prison was less likely than was prior injecting in the community. *Present address: Department of Psychology, Glasgow Caledonian University, Glasgow G4 OBA, Scotland. TPresent address: Central Research Unit, Prisons’ Branch, Scottish Office Home and Health Department, Celton House, 5 Redheughs Rigg, Edinburgh EH12 9HW, Scotland.
Prior to current sentence, 32% had injected regularly in the community, compared to 11% who were injecting during their current sentence. The data suggest that prison is not a major factor in introducing people to drug injecting; only two people in the sample reported developing a regular injecting habit while in prison. while one other first injected drugs while in approved school. However, the general reduction in drug injecting amongst prisoners has to be seen in the context of the nature of the drug injecting which still occurs in Scottish Prisons. Of those who had been injecting prior to their current sentence, the proportion who were sharing equipment at time of arrest was 24%. By contrast, of those who reported injecting in prison, 76% were still sharing equipment in prison. Whilst no significant difference emerges between rates of previous sharing of injecting equipment in the community and in prison, when comparing current rates of sharing of injecting equipment there is a much greater likelihood that current injectors will be sharing in prison than in the community. In general terms, therefore, drug users appear less likely to inject in prison than in the community; but those who do are more likely to share equipment. Those who were currently sharing injecting equipment in prison were characterized by having injected a wider range of drugs within prison-both during current and previous sentences-suggesting a willingness to take chances within the prison system, allied to a knowledge of who to find a way around security. This also applies to their obtaining and using injecting equipment in prison. The most common drug injected was Temgesic, and current sharers were 1585
D. SHEWAN et al.
1586
identified by frequency of use of this drug, rather than amount. In other words, they used more often, rather than taking higher average dosages at one time. Finally, being prescribed methadone prior to imprisonment, then having that prescription stopped on entry to prison, was associated with an increased likelihood of sharing. The data suggest that those who were being prescribed methadone prior to current sentence had made a move towards positive behavioural change in relation both to stopping or cutting down injecting and sharing of injecting equipment. This contrasts to their drug use during their current sentence, however, when high risk behaviour tended to be reinstated. DISCUSSION
The majority of drug injectors who had previously shared injecting equipment in the community reported that they no longer did so. In addition, a majority of drug injectors had stopped injecting during their current sentence. However, most of those still injecting in prison reported sharing injecting equipment. Of particular interest was the finding that having a methadone prescription stopped on admission to prison was associated with sharing of injecting equipment, particularly as these subjects reported attempts at positive behavioural change during the maintenance period. Methadone prescribing has been found to reduce criminal behaviour [4], and it may be that those who are subsequently imprisoned therefore represent an atypical group. Alternatively, these re-
sults may reflect the effect of the abrupt cessation of a methadone script. In either case, it is significant that current sharing in prison generally (not just of the methadone group) represents a reinstatement of previous high risk drug using behaviour in prison. It is concluded that service provision for drug users in prison should be continuous with service provision in the community, in the interests of reducing high risk behaviour. Acknowledgements-This research was funded
by Criminology and Law Research Group, Scottish Office Home and Health Department. The views expressed in this paper are those of the authors, and not necessarily those of SOHHD, nor of the Scottish Prison Service. We would like to thank staff and prisoners who took part in the study. Without their help the research presented here could not have taken place. Thanks are also due to Mr Ed. Wozniak, and Dr David McAllister, Central Research Unit, SOHHD, Mr George Sharkey, SACRO, and Mr Alisdair Forsyth, University of Glasgow. REFERENCES
Farrell M. and Strang J. Drugs, HIV, and prisons, Br. Med. .I. 302, 1477, 1991. Harding T. HIV infection in the prison environment: a test case for the respect of human rights. In AIDS and Drug Misuse (Edited by Strang J. and Stimson G. V.). Routledge, London, 1990. Power K., Markova A., Rowlands A., McKee K. J., Anslow P. J. and Kilfedder C. Intravenous drug use and HIV transmission amongst inmates in Scottish prisons. Br. J. Addiction 87, 35, 1992. Ward J., Mattick R. and Hall W. Key Issues in Methadone Maintenance and Treatment. New South Wales University Press, NSW, Australia, 1992.