Psychoactive substance use in prison and associated risks

Health and prevention constitute a major public health issue in prison setting because of the characteristics of the population held there: high prevalence of use of psychoactive substances at entry, social precariousness, frequency of psychiatric disorders. Promiscuity, lack of hygiene, violence and current conditions of detention contribute to this health risk. Data on prevalence of substance use at entry are outdated in France and there are no national data on their consumption in detention. Indirect arguments, however, suggest the reality of their consumption inside prison and the associated risks. In terms of care and prevention, if the principle of equivalence with the free world recommended by the World Health Organization and UNODC, adopted in 1994 by France, is more or less respected for medical interventions (access to opioid substitution treatment, nicotine replacement therapy, anti-retrovirals treatments and now treatment for chronic hepatitis C as well as naloxone in the prevention of overdose), access to risk reduction tools remains deficient in spite of the Health Law of 2016. In addition, from a public health perspective, these interventions should be considered in a comprehensive way, including care and prevention for tobacco dependence, cannabis use, but also a combination of interventions targeting psychiatric disorders, social precariousness and, above all, the increasingly difficult conditions of detention.