This paper explores European and national trends in specialised drug treatment entry for cannabis-related problems. The analysis is based on data for the years 2003-2014 from 22 European countries. Between 2003 and 2014, the overall number and proportion of primary cannabis-related first-time entrants increased significantly. A joinpoint regression analysis indicates that the overall increase of cannabis treatment entries is continuous, although country-related differences are observed. Possible explanations for the increase and different time trends are discussed including an increase in cannabis prevalence and cannabis-related problems, changes in risk perception, increases in cannabis potency, changes in referral practices and increased availability and accessibility of treatment services.

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This chapter provides an overview of drug use in prison. It is centered on illicit drug use in Europe, where the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting aggregated data from various sources for 15 years. It also reviews, based on published literature, data from the four other global regions. A total of 59 studies from 31 countries in the five world regions were included for analysis. Results show that the prevalence of drug use varies greatly between studies. Lifetime prevalence of any illicit drug use in prison ranges between 2% to 76% worldwide with, in most cases, cannabis being the most frequently reported substance. More recent (past-month) illicit drug use is reported by <1% to 65% of inmates, while <1% to 39% report injecting illicit drugs during their stay in prison. Alcohol use in prison is reported in a few studies only, varying between 2% to 77% while the prevalence of current tobacco smoking ranges between 4% to 90%. In general, available data are scarce and patchy, especially outside Europe, with large variations in methodology relating to sampling strategy and measurement. This heterogeneity hampers comparison and may, in part, account for the wide range of prevalence estimates. Comparable methods and measures of drug use and its consequences in prison populations are needed to facilitate international comparisons and provide the sound information needed for development and implementation of drug interventions in various prison settings across the globe.

Purpose This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March –June 2020). Design/methodology/approach The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies. Findings The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care. Practical implications Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored. Originality/value The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic.

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