Prevalence of heroin drug use before and during imprisonment in Europe: results from a comprehensive literature review and analysis of prevalence data in six European countries

People in prison (PiP) report high rates of drug use and drug-related problems and people who use or inject drugs (PWUD) have higher rates of offending and an increased likelihood of spending part of their lives in prison. They represent a vulnerable population with high burden of diseases, socio-economic disadvantages and limited access to healthcare.

The aim of the study was to describe the life time prevalence (LTP) of heroin use among PiP in Europe before and during incarceration using the outcome of a comprehensive review of literature on drug use prevalence among PIP and the analysis of data from six countries collected with a model European Questionnaire on Drug use among people in Prison (EQDP).

A comprehensive literature review on articles published between 2008 and 2018 was conducted (Cochrane Library, Embase, MEDLINE, PsychINFO and PubMed). Individual data collection was carried out in six European countries between 2014 and 2018 with the EQDP. Risk factors analysis was carried out using multivariate logistic regression model.

In total, 12 studies from 7 different countries have been included in the literature review, that found that the LTP of heroin use before imprisonment ranged from 9 to 65%. The analysis of EQDP data found that the LTP of heroin use before imprisonment ranged from 16 to 27%. Female, recidivist offenders, individuals aged below 44 and with an history of mental health condition had a higher likelihood of being heroin user (p-value<0.05).

Despite the heterogeneity of the results, from both methods used in our study a high LTP of heroin use appeared among PiP across all different European countries.

Prisons can represent a point of access to integrated prison-community healthcare and social services for usually unserved populations. However, tailored preventive interventions should be implemented among vulnerable groups also at the community level.