Drogenabhängige in Haft - Epidemiologie, Prävention und Behandlung in Totalen Institutionen

Stöver, Heino

doi:10.1055/s-0032-1311600

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…To what extent requirements and directives of the MoJ affect the initiation of treatment and health care seems to differ not only among FS but also among prisons within the FS [ 35 , 42 , 43 ]. The differences regarding treatment of diseases and OST in prisons might reflect the decentralized federal system in Germany, in which the states may pursue different approaches with respect to the management of medical care [ 5 , 6 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prevention of HIV and HCV by offering testing and counselling, providing condoms and tattooing materials as well as sterile injection equipment for people who inject drugs (PWID) also includes the initiation and continuation of opioid substitution treatment (OST) to reduce injection frequency. Furthermore, the treatment of newly diagnosed and already known infections is important not only for the person infected but also in terms of treatment as prevention [ 6 , 18 – 23 ]. Despite various challenges in providing treatment for the mentioned infectious diseases and offering OST in the prison setting, it is practicable, and crucial to reduce transmission within prisons.…”

Section: Introductionmentioning

confidence: 99%

“…Because prison health care is not part of the regular public health system in Germany, it is therefore not part of the health reporting system [ 14 ]. The extent and quality of TB, HIV, HCV and opioid dependence treatment provided to prisoners in Germany are therefore largely unknown [ 5 , 6 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

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High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

et al. 2017

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BackgroundIn Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period.MethodsSubstances unique to or typically used for the treatment of each disease were defined as marker substances with defined daily doses (DDD).For each marker substance we assessed the cumulative number of DDD, the average daily number of DDD (DDDd) and average treatment prevalence per day in percent (adTP). Accordingly, the DDDd represents one person treated per day and the adTP means the proportion of prisoners treated per day. We compared the adTP of the diseases with previously measured prevalences.ResultsWe obtained data from pharmacies supplying prisons in 11 of 16 German FS. Of the included prisons, 41% were supplied with medicines for TB, 71% for HIV and 58% for HCV and OST. Twice as many delivered marker substances for TB were indicated for the continuation phase and chemoprevention than the intensive phase. The HIV adTP ranged from 0.06% to 0.94%, HCV adTP ranged from 0.03% to 0.59% and OST adTP ranged from 0% to 7.90%. The overall adTP for the respective treatment was 0.39% for HIV, 0.12% for HCV and 2.18% for OST.ConclusionsAccording to our findings treatment rates for TB were consistent with the expected TB prevalence, at least in Berlin. HIV treatment seems to be offered to an adequate proportion of estimated infected prisoners. In contrast, the HCV treatment prevalence was low. High variation among FS in provision of all treatments, particularly of OST, point to inconsistent treatment practices, although nationwide extramural treatment guidelines for Germany exist.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

et al. 2017

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“…Additionally, the detention duration is considered a critical variable in individuals' access to OAT but is contradictorily discussed. Some authors argue that agonist treatment is more likely to be granted to individuals with short-term imprisonment (27,30,33) while other works argue that individuals with a sentence below two years are more likely to be confronted with an abstinence-oriented approach (34). More generally, language barriers seem to have an impact on individuals' access to addiction treatments outside prison (35,36); a fact that most probably also applies to the custodial setting.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study

Bernuth

Seidel²,

Krebs³

et al. 2020

Front. Psychiatry

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Background: Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT. Materials and Methods: We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention. Results: Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioiddependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%. Conclusions: The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period.

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“…According to estimates, 30% of all male prisoners and 50% of all female prisoners in Germany inject drugs [15]. Despite rigid controls, drug consumption occurs in prisons [16]. The condition of imprisonment favours risky behaviours due to concentrated at-risk populations and risk-conducive conditions such as violence or overcrowding [17].…”

Section: Introductionmentioning

confidence: 99%

Implementation of opioid maintenance treatment in prisons in North Rhine-Westphalia, Germany – a top down approach

Böhmer

Schecke

Render³

et al. 2020

Subst Abuse Treat Prev Policy

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Background: Opioid Maintenance Treatment (OMT) is a well-evaluated treatment of opioid use disorder (OUD). Especially, under the condition of imprisonment, OMT is a preventive measure regarding infectious diseases such as hepatitis C. However, only a minority of prisoners with OUD are currently in OMT in numerous countries. In 2009, the Ministry of Justice of the federal state of North Rhine-Westphalia (NRW), Germany, launched the process of implementing OMT in prisons with various elements (e.g. development of recommendations regarding the treatment of prisoners with OUD, monitoring the number of prisoners in OMT, education of prison doctors). In the recommendations OMT was defined as the gold standard of treatment of OUD. Methods: To assess the effectiveness of the implementation strategy a survey on the prevalence of OMT in prisons in NRW was carried out twice a year by the Ministry of Justice between 2008 and 2016. Participants were prisoners in NRW, Germany. The diagnosis of OUD at admission to prison and the treatment state on survey dates was measured. Results: The number of prisoners in NRW dropped from 17,301 in 2008 to 16,432 in 2016. In the same period, the number of prisoners with OUD (mainly males) dropped from 4201 persons to 3650 persons and the number of prisoners in OMT increased from 139 persons (3.3%) to 1415 (38.7%) persons. Discussion: Currently, the percentage of prisoners with OUD in OMT in NRW is almost reaching the treatment rate outside prisons in Germany (45-50%). However, after release from prison there is still a high risk for a discontinuation of OMT. Conclusions: Overall, the top-down approach of implementing OMT in prisons in the federal state of NRW was effective.

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Drogenabhängige in Haft - Epidemiologie, Prävention und Behandlung in Totalen Institutionen

Cited by 9 publications

References 8 publications

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study

Implementation of opioid maintenance treatment in prisons in North Rhine-Westphalia, Germany – a top down approach

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