Drug treatment and prevention in Tartu prison. Maret Miljan Department of Prisons Ministry of Justice Estonia

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1 Drug treatment and prevention in Tartu prison Maret Miljan Department of Prisons Ministry of Justice Estonia

2 Prisons in Estonia 3470 prisoners ( ): 2768 convicted 702 held under custody 5 prisons: Tallinn Prison ( ) Prison Hospital (22+8) Viru Prison ( ) Tartu Prison ( ) Murru Prison (288) Harku Prison (203)

3 Specialization of Prisons (since 2008) Tartu prison Special unit for drug addicts ( places), including rehabilitation and post-rehabilitation department Psychiatric department Viru prison Drug crimes Drug-free department for adults (20 places) and minors (20 places) Harku prison Drug-free department for women (8 places) Tallinn prison Remand prisons, high number of drug addicts among the prisoners held in custody Murru prison Sex offenders and low-risk prisoners

4 Drug addicts in prisons ( )

5 Drug Treatment and Rehabilitation Estimated that over 50% of prisoners have used drugs, 28% are drug addicts ( ) National drug prevention strategy till 2012 and the action plans Drug prevention strategy for prisons (2008, 2010) Drug prevention principles and guidelines for prisons

6 Recent developments Drug situation monitoring in prisons (quarterly reports) Drug rehabilitation strategy for Tartu prison (2010) Methadone treatment (started 2009) Smoke free prisons (2010) Treatment instead of imprisonment (passed the first reading in Parliament)

7 Tartu prison Located in Tartu Founded in 2002 Maximum-security prison (with cells) Adult males and females being held in custody; convicted adult males Max. number of inmates cells in the prison, each cell 10 m employees, 243 of whom are prison officers

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9 Fight against drugs Reduction of the supply Control and inspection X-ray Checking the incoming mail Dogs Special operations Video monitoring Control over prescribed medicine Training the staff Drug testing In 2009 drugs were found in 3 cases (incoming letter, upon arrival and during the storage inspection)

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11 Drug Treatment in Tartu Prison Drug treatment: Symptomatic treatment Substitution treatment (methadone) Short term detoxification Long term detoxification Maintenance treatment MMT prior to imprisonment will be continued (break can be up 1 month) MMT can also be started

12 In 2008: Methadone Treatment in Tartu Prison: 2 cases of detoxification with methadone No MMT In 2009: 3 cases of detoxification with methadone 3 cases of MMT In 2010 I quarter: 2 cases of detoxification with methadone 4 cases of MMT

13 Problems with MMT Problems with continuation of MMT Stops in arrest houses Conservative attitude by staff Negative attitude by prisoners Previous bad experience Stigmatization Long break

14 Drug rehabilitation in Tartu prison According to the drug rehabilitation strategy for Tartu prison (2010) Still in progress Pharmacotherapy and abstinence based approach

15 Criteria for Tartu prison Diagnosed drug addiction Valid risk assessment where the drug related problems and risks are brought out At least 6 months till the end of the sentence Adult male Generally not convicted for sex offense or drug crime

16 Special unit in Tartu prison

17 The beginning 55 places Target group newcomers, prisoners under methadone treatment ( if doze gets stabile, they can move on) Activities - adaption, assessment, methadone treatment and psychosocial support for those in treatment (individual and in the group)

18 Moving on S-1 section (43 places) Target group not motivated drug addicts Activities MI, support group for HIV pos by NGO Convictus S-2 section (43 places) Target group a bit motivated drug addicts Activities MI, support group for HIV pos and drug addicts by NGO Convictus, in cell work pack nr 1 Drug, individual work

19 Rehabilitation phase S-3 section (44 places) Target group motivated drug addicts Decided by the comission: contact person, unit manager, social worker/psychologist, security officer, doctor (if necessary opinion from Convictus) First criteria is motivation to change! Filled questionnaire and in cell work pack nr1 Activities in 2 phases preparatory and main phase

20 Rehabilitation phase Preparatory stage In cell work pack nr 2 Sleep, Stress or Anger management + individual work 12 steps by NGO Convictus (once a week) Informational lessons by medical department Conversation groups and films Counseling for giving up the smoking and niccotine patches if necessary Sport programme for addicts (once a week) Art (once a week) AN (twice a month) Yoga (once a week)

21 Rehabilitation phase Main stage LIFE STYLE TRAINING FOR CONVICTED (in group 7-10 meetings or individually 8 or more meetings) Other rehabilitation programmes if needed Conversation groups and films Sport programme for addicts Art AN Yoga

22 Post-rehabilitation phase S-4 section (44 places) Target group prisoners who completed the rehabilitation phase Decided by the comission Activities: OTO programme Other rehabilitation programmes if needed Conversation groups and films In cell work pack nr 3 Relapse prevention Extra sport time Art AN School and work

23 After post-rehabilitation Open prison Probation Release Cooperation with treatment and rehabilitation centers outside

24 Other services for drug addicts HIV Prevention and Treatment 108 HIV positive ( ) Voluntary HIV testing (on arrival and after 1 year) 1865 tests done in refusals in 2009 Pre test and post test counselling ARV treatment 61 HIV positive under the treatment ( ) Various health care services

25 HIV Prevention and Treatment Support group services for HIV pos and prisoners with drug addiction 4 parallel groups NGO Convictus Estonia In Estonian and Russian For convicted and persons held in custody

26 Hepatitis B and C Voluntary testing of risk groups (IDUs, HIV pos., etc) Pre and post test counselling Voluntary Hepatitis B vaccination Convicted prisoners in the risk group Prison officers Hepatitis C treatment (usually continuation)

27 HIV Prevention and Treatment Condoms are available in medical departments, long term meeting rooms and in the prison shops No needle and syringe exchange programs in prisons

28 Future challenges Implement all parts of the strategy Further training of staff (HIV, drugs) Suggested in the report of Emilis Subata expert visit Methadone treatment According to national strategy in cases, cases Pre-release treatment? Treatment for multi-drug addicts

29 Thank you!