'My first 48 hours out': continuity of health and psychosocial care for drug users after release from prison in four European countries
Background: The immediate period after prison release is a critical time for drug users for overdose prevention and linkage with appropriate services in the community (Merrall et al., 2010). The “My first 48 hours out”-project is a European study focusing on drug use and risk behaviour and continuity of medical and psycho-social support during and after detention in four countries (Belgium, France, Germany, and Portugal). Since prisoners are entitled to equal health and social services in prison as in the community and to continuity of care (e.g. substitution treatment) (Michel et al., 2015), we studied (2016-2018) the actual implementation of these principles in a number of prisons in these countries.
Methods: Based on interviews with prisoners (n=63), former prisoners (n=40) and professionals working inside and outside prison settings (n=70), we assessed the availability of health, social and drug services in prisons and its continuity after release. Semi-structured interviews were used for data-collection in the 4 countries and data ware analysed using thematic analysis.
Results: According to the respondents, medical and psycho-social support in prisons is limited and, in particular, systematic support and preparation for release is missing in all countries. Although crucial for their social reintegration, throughcare and continuity of care after release are generally not available. Ex-prisoner report that they develop specific coping strategies to avoid relapse and overdose. Positive release experiences are usually associated with the availability of a social network or a professional/case manager supporting them. Despite its efficiency for overdose prevention, naloxone is not provided in the selected countries to drug users leaving prison.
Conclusions: These findings illustrate the overall discontinuity of health and psychosocial services in European prisons after release, largely depending on personal resources and initiatives, rather than being the result of structural and systematic measures. It is recommended to provide naloxone upon prison release to drug users and to educate them on how to use naloxone in emergency situations (e.g. through comics).