Substance use and psychological states in imprisoned population in Greece—Key findings from a recent nationwide survey

Background: Assessing the needs of people who are imprisoned and have a current or past drug-use history is key in improving quality of life in prison. In 2022-2023, the first nationwide prison drug cross-sectional survey was conducted in Greece, in the framework of the PRS20, an EC co-funded European research project with the aim to assess the situation and identify needs. 

Methods: Following standardised data collection procedures, anonymous self-explanatory surveys were group-administered in prisons by trained external research assistants. Available in 11 languages, the survey was a shortened version of EMCDDA’s “European Questionnaire on Drug use among people in Prison-EQDP” and included measures on illicit substance use (excluding alcohol, but including cannabis and misuse of benzodiazepines) -both prior and during current imprisonment- and higher risk drug use (injecting, sharing and overdose), as well as victimisation and psychological state. Participation was voluntary. 

Results: 26 out of the 30 eligible prisons agreed to participate in the study (87%, prison-level participation rate), allowing the return of a total of 2,470 surveys (24% of total prison population). Analyses were based on 2,131 cases (97.2% males, 58.6% aged above 34, and 49.9% Greeks). Overall, 70.7% reported ever use of an illicit substance  and 49.0% ever use in prison. About 6.5% initiated use while in prison. Cannabis (35.9%) and benzodiazepines (misuse of, 31.1%) were the drugs most commonly used in prison, followed by heroin or other opiates (20.5%) and cocaine (20.0%). Among those reporting drug use in prison (n=1003), one sixth (17.0%) reported ever injection and one fifth (20.0%) ever overdose in prison Among those reporting ever injection in prison (n=156), about four fifths (73.1%) reported ever sharing used needles in prison. Additionally, 41.7% had been victims of robbery and/or theft and 27.3% of physical and/or sexual violence while in prison. In the past 2 weeks, 39.0% had depressive feelings, 35.5% anxiety and 16.0% sleep problems. Finally, 54.2% felt loneliness and 34.0% had thought of self-harming themselves while in prison. In all cases, prevalence of victimisation and adverse psychological states was significantly higher among those reporting drug use in prison. 

Conclusions: Greek prisons host a large proportion of people with current and/or past drug-use history. Use of illicit substances in prison is undisputable. Besides cannabis, misuse of prescription benzodiazepines accounts for most of drug use in prison. Drug use is associated with adverse psychological states and victimisation. The prison system should ensure that addiction and mental health services and interventions for related risk behaviours and problems are both and accessible for inmates with drug-related needs.

* EQDP/EMCDDA group
* European drug monitoring in prison