SUMMARY OF THE STORY:

A new report from the Australian National Council on Drugs (ANCD) has highlighted that the operation of Australia’s prisons need far greater levels of accountability and transparency, as well as a much stronger commitment to providing effective programs and treatment for people with drug and alcohol problems issues if we are to see any real reductions in reoffending rates.

The new ANCD commissioned report shows how Australia’s prisons currently have a major focus on reducing the supply of drugs with programs that are rarely evaluated and in the end fail to stop the availability or use of drugs in prisons.

The report - which was prepared by the National Drug and Alcohol Research Centre and reveals Australia’s prison population has leapt by 30% since 2002 - provides the most recent snapshot of drug and alcohol strategies and programs currently available across Australian prisons.

Further investigation undertaken by the ANCD has also discovered that total government expenditure on prisons and correction services has climbed dramatically from $1.5 billion (2004) to $2.8 billion in just 4 years (2008).

The ANCD was deeply concerned with the difficulties the authors faced in getting details on prison based drug and alcohol programs for its report. It is almost hard to envisage any other large taxpayer funded system, which so directly affects the lives of so many people and families, would be so difficult to access and assess information on how well its substantial funding is spent.

As a result, the ANCD is calling for the introduction of regular, transparent and independent reviews of every prison to determine the breadth and level of services available to address drug and alcohol problems and reduce reoffending. Such reports also need to provide information on outcomes, performance, effectiveness and the impact of the programs being implemented.

The ANCD report also highlights that despite years of growing evidence of needle sharing in prisons, and the continued effectiveness of community based needle and syringe programs in the community, that not one prison in Australia has as yet introduced or even trialled a prison based needle and syringe program. The ANCD does however acknowledge and welcome the important recent announcement by the ACT Government to introduce a limited ‘one-for-one’ medically based clean injecting equipment model into its prison.

A new report commissioned by the Australian National Council on Drugs (ANCD) and prepared by the National Drug & Alcohol Research Centre (NDARC) at the University of NSW looks at the supply, demand and harm reduction strategies in Australian prisons.

The report highlights that the vast majority of current prison system efforts on drug and alcohol programs are being directed at reducing the supply of drugs in prisons and that effective programs operating in the community to treat drug and alcohol use are either restricted or unavailable for prisoners.

The report also reveals that Australia’s prison population has grown from 22,492 in 2002 to 29,300 in 2009. An increase of 30%.

The ANCD was particularly concerned with the extraordinary difficulties the authors faced in obtaining information from some prison systems. Some jurisdictions elected not to provide information whilst others declined to provide any further information than already publicly available – even after all ethical approvals had been met.

As a result, the ANCD is calling for the introduction of regular, transparent and independent reviews of every prison to determine the breadth and level of services available to address drug and alcohol problems and reduce reoffending. Such reports also need to provide information on outcomes, performance, effectiveness and the impact of the programs being implemented.

(Specific state and territory information that may assist is to be found at the foot of this document.)

The report will be formally launched in Sydney on Tuesday August 28^th and will highlight: 

• Most of the prison system efforts on drug and alcohol problems are directed at supply reduction with limited evidence available for their effectiveness.
• There is a significant imbalance between the implementation of supply reduction programs such as drug detection dogs and urine testing, compared to programs that reduce the demand for drugs, such as treatment, and programs to reduce harms from drug use.
• The report reveals most prisons have not evaluated the programs they implement and if they do the results are often not publicly available.
• There is a severe lack of comparability between prison and community based drug and alcohol programs, with extremely poor availability of clearly proven treatments such as pharmacotherapy programs in some prisons.
• That despite years of advocacy, a growing evidence base and high rates of hepatitis C transmission in the prison system, not one prison has a needle and syringe program operating (although the ANCD acknowledges and welcomes the important recent announcement by the ACT Government to introduce a limited ‘one-for-one’ medically based clean injecting equipment model into its prison)
• That women prisoners and Indigenous prisoners in particular face an increased risk of death upon release.
• That significant work needs to be done to strengthen post-release programs and integration with community based services given the high level of relapse, re-offending and mortality.

The ANCD expressed its strong disappointment with all the delays and difficulties in putting the report together by posing the question “Could anyone seriously contemplate a situation where a fully government funded system could simply avoid proper scrutiny of how well it uses its billions of dollars of tax payer funding each year?”

As a result, the ANCD is calling for the introduction of regular, transparent and independent reviews of every prison to determine the breadth and level of services available to address drug and alcohol problems and reduce reoffending. Such reports also need to provide information on outcomes, performance, effectiveness and the impact of the programs being implemented.

Prof Margaret Hamilton of the ANCD said, “This report indicates that although supply, demand and harm reduction strategies are being offered, there is a clear over reliance on supply reduction measures which we know are unlikely to be successful. In contrast demand and harm reduction strategies, which we know are far more likely to be effective, are significantly underused. Even when implemented, there are usually limits on the number of actual prisoners who can take part in these programs. In some cases, supply reduction strategies are actually being expanded without evaluation while evidence based treatment and other programs remain restricted”

As an example, the ANCD questioned the expense incurred and effectiveness of conducting thousands of urine collections and tests for drug use when the majority of samples test negative and those that do test positive are most commonly for cannabis.

A recent related report by the same authors on a ten year follow up study of NSW inmates in methadone treatment found a 20 per cent reduction in re-incarceration and a decrease in mortality for those who left prison on methadone and remained on it after release.

ANCD Executive Director, Mr Gino Vumbaca added “Prisons should only ever be the last resort. They are violent and expensive places that cannot be expected to address the health and social problems associated with drugs, alcohol, mental health and homelessness problems. There needs to be a far greater effort into diverting people to services in the community so we can address the underlying causes of the criminal activity rather than simply over investing in the expensive construction and operational costs of prisons. Imagine the benefits to the community if the investment in drug and alcohol services increased by billions of dollars rather than the prison system”

The new study collated data on the prevalence of alcohol, tobacco and/or illicit drug use problems among adult prisoners in full time custody. It also assessed the availability, access and use of supply, demand and harm reduction strategies for the year 2009.

The report includes a section on Indigenous prisoners and released prisoners. Describing the availability of re-entry programs and mortality rates among recently released prisoners.

The new report is based on information obtained from Australian prison departments (including their websites) and from a questionnaire that was created in consultation with prison departments, although some prisons were unable or unwilling to participate in the process which delayed and limited the information available.

The “Supply, demand and harm reduction strategies in Australian prisons: an update” report was prepared by Ana Rodas, Adam Bode and Kate Dolan and undertaken by National Drug and Alcohol Research Centre, University of New South Wales. The report was prepared for the Australian National Council on Drugs.

The report will be launched at the National Drug and Alcohol Research Centre Annual Symposium at the University of New South Wales, John Niland Scientia Building. 

Media enquiries to Ross Woodward or Homira Samadi on 03 9769 6488. 

Where:            The National Drug and Alcohol Research Centre Annual Symposium at the University of New South Wales, John Niland Scientia Building 

When:             Tuesday 28^th August at 2.00 p.m. 

What:              The launch of “Supply, demand and harm reduction strategies in Australian prisons: an update” produced by National Drug and Alcohol Research Centre, University of New South Wales for the Australian National Council on Drugs. 

SOME OF THE REPORT’S KEY FINDINGS 

Supply reduction strategies

• Drug detection dogs and urinalysis are utilized in all jurisdictions
• Thousands of urine samples test negative and those that do test positive are most commonly for cannabis
• Supply reduction strategies were not evaluated or, if evaluated, the report was not available for release

 Demand reduction strategies

• Counselling programs were extensive, although there was little or no evaluation
• The provision of methadone and other pharmacotherapy programs was patchy with some jurisdictions having good access while others had very limited access
• Five out of eight jurisdictions operated drug free wings or units for prisoners. Evidence suggests that these help prisoners to remain drug free but usually the capacity of these services is very limited. 
• The range in provision of opiate substitution treatment can be seen in the table below with three jurisdictions having 13% or more in treatment (NSW, Vic, SA and ACT) while the rest had very limited program capacity (Queensland, WA, Tasmania and NT).

 Harm reduction strategies

• All jurisdictions, except Queensland provided education on harm reduction.
• All jurisdictions offered blood borne viral testing with only the ACT having evaluated its use.
• All jurisdictions offered hepatitis vaccination, with the ACT and Tasmania conducting evaluations.
• The provision of condoms occurred in six jurisdictions – with Queensland and NT not allowing access.
• Disinfectants were provided in all jurisdictions except WA, Tasmania, and NT.

Post release services

• Most prison systems provided assistance to inmates nearing release from prison.
• NSW Connections program administered by Justice Health, assisted over 1,000 inmates and an evaluation found it assisted inmates to remain in the community without re offending for a longer period than those not in the program. 

Mortality & Morbidity post release

• Prisoners, especially women and Indigenous prisoners, faced an increased risk of death on release.
• Only WA had a ongoing program linking released prisoners with a deaths register where research found in the immediate post-release period that Indigenous men were 4.8 times more likely to die and Indigenous women were 12.6 times more likely to die, than the general population.
• In 2008, the diagnosis rate for newly acquired hepatitis B infection among Indigenous inmates was between one and five times higher than that of the non-Indigenous population in NSW, NT, SA, Vic, Qld, and WA. 

Adherence to the National Corrections Drug Strategy 2006 -2009

• Across all jurisdictions, more emphasis was placed on supply reduction strategies than on demand or harm reduction strategies.
• Generally supply reduction strategies have not been evaluated, limiting any assessment of them.
• Demand and harm reduction strategies were less likely to be implemented, or if they were implemented, there were usually limits on the number of inmates who were able to participate in these programs. Evaluations of these measures were usually positive.

OTHER INFORMATION

Further investigation by the ANCD has also revealed that total government expenditure on prisons and correction centres has increased from $1.5 billion in 2004 to $2.8 billion in 2008/09. 

The average daily total cost per prisoner per day is estimated to be almost $290 whilst the cost of residential treatment programs are estimated to cost governments only $98 a day and pharmacotherapy maintenance estimated to be less than $10 per person per day.

The ANCD also noted that in 2010 universities in Australia received $12.5 billion from governments, which was estimated to equate to $30 per day per enrolled student, or just over one tenth of what is spent in keeping one adult in prison for one day. 

 Other recent reports also highlight: 

• 81% of prisoners are current smokers, and 74% smoke daily. In contrast 18% of the general population are current smokers, and 15% smoke daily.
• 52% of prison entrants report drinking at risky levels, in contrast to 21% of the general population.
• 80% of prisoners have been estimated to have used illicit drugs in their lifetime, in contrast to 39% of the general population.
• 31% of prisoners in 2010 reported having ever been diagnosed with a mental health disorder, a rate 2.5 times higher than the general population. 16% were currently on medication for such a disorder.
• Data on homelessness are difficult to collect and may under-represent real numbers. However, one South Australian review estimated that 10% of ex-prisoners were homeless after release, and a study of ex-prisoners in NSW and Victoria reported a rate of 21%. 

New South Wales 

• A total of 11,127 prisoners (10,273 males and 854 females) were housed in New South Wales on 30 June 2009 (Australian Bureau of Statistics, 2009). Inmates were housed across 34 prisons, two of which were privately operated. Junee and Parklea prisons were managed by the GEO (Global Expertise Outsourcing) Group Australia Pty Ltd.  
• In 2008–09 the design capacity of all New South Wales prisons was 9,505 and the total rate of utilisation was 105.9 per cent, just above the national average of 102 per cent of prison design capacity in 2008–097 (Steering Committee for the Review of Government Service Provision, 2010). Each year there are over 30 000 new prison receptions and over 150,000 movements among prisoners in New South Wales (Corrective Services NSW, personal communication, 2011). 
• The 2009 Inmate Health Survey (IHS) undertaken by Justice Health used a stratified random sample of all inmates in New South Wales prisons. In 2009, 1,166 inmates were invited to participate; 996 agreed to participate, resulting in a response rate of 85 per cent (Indig, Topp et al., 2010). The majority of participants (84%) in the 2009 IHS had used illicit drugs. 
• The CSNSW Biennial Survey 2007–08 questioned a representative sample of 358 New South Wales inmates (306 male and 52 female) about to be discharged to the community in 2007–08. The results showed that a high percentage of inmates reported having had a drug problem at some stage in their lives (80% of males and 81% of females) (Kevin, 2010).  
• In 2009, assessment of self-reported levels of alcohol consumption found that 63 per cent of men and 40 per cent of women were engaged in hazardous or harmful drinking (indicated by an AUDIT score of eight or more) in the year prior to imprisonment. The highest level of hazardous or harmful drinking was found among Indigenous male prisoners, where 74 per cent reported alcohol consumption at risky levels compared to 57 per cent of non-Indigenous male prisoners. 
• In 2009 cannabis was reported as the most common drug ever used by New South Wales inmates. In 2009, more women (52%) than men (40%) reported a history of injecting drug use (Indig, Topp et al., 2010). 
• In 2009, 42 per cent of male prisoners and 54 per cent of female prisoners reported having used at least one illicit drug ‘regularly’ (defined as daily or almost daily) in the year prior to imprisonment. 
• In the year preceding incarceration, inmates were most likely to have used cannabis (26%) regularly, followed by meth/amphetamines (16%). Of the 2009 sample, 42 per cent of males and 44 per cent of females reported ever having used an illicit drug in prison. 
• Participants were most likely to report using the following drugs in prison: cannabis (31%), heroin (15%) and another person’s methadone or buprenorphine (10%). Injecting drug use in prison was reported by 17 per cent of participants in the 2009 IHS (Indig, Topp et al., 2010).

Queensland 

• A total of 5667 prisoners (5251 males and 416 females) were housed in Queensland prisons on 30 June 2009 (Australian Bureau of Statistics, 2009). Inmates were housed across 14 prisons, two of which were privately operated — Arthur Gorrie Correctional Centre managed by GEO Group Australia under contract to Queensland Corrective Services (QCS); and Borallon Correctional Centre managed and operated by Serco Australia Pty Ltd for QCS since 2008. 
• In 2008–09 the total design capacity of Queensland prisons was 6439 inmates. The rate of utilisation in Queensland prisons was 87.4 per cent. This was below the national average of 102 per cent (Steering Committee for the Review of Government Service Provision, 2010). 
• In 2006, 37 per cent of Queensland prisoners had a history of harmful alcohol use. Males (45%) were more likely than females (19%) to report a history of harmful alcohol use. 
• A longitudinal study of male and female prisoners being released from custody in Queensland found that 92 per cent of Queensland prisoners had an illicit drug use history. Cannabis was the most commonly used drug (88%), followed by amphetamines (71%) (Kinner, 2006). 
• In 2007, 57 per cent of Queensland prison receptions surveyed as part of the National Prison Entrants’ Bloodborne Virus and Risk Behaviour Survey had an injecting drug history. 
• Of those reporting injecting drug use (IDU), 31 per cent had injected daily or more in the month prior to the survey. Furthermore, in 2007 the majority of prison receptions reported using a sterile needle and syringe during all injections in the last month in the community (64%) and 20 per cent reported doing so most of the time (Butler and Papanastasiou, 2008). 
• There were just 0.6% of inmates in substitution treatment, less than 50 inmates. This was in spite of 44% of inmates (2,500) having a history of heroin use. There is a large unmet demand for drug treatment in Queensland and may be contribution to death post release from prison. 
• Despite initial approval for data to be made available no results for drug detection dogs, urinalysis programs or drug seizures within prison were provided, making it impossible to assess the extent of supply reduction measures in prison.

Victoria 

• A total of 4350 prisoners (4068 males and 282 females) were housed in Victorian prisons at 30 June 2009 (Australian Bureau of Statistics, 2009). In 2008–09, Victorian prisons received 5626 prisoners. 
• The Statistical Profile of the Victorian Prison System 2004–05 to 2008–09 reported that the utilisation rate of Victorian prisons in 2009 was 92.1 per cent (Corrections Victoria, 2009). 
• In 2009, 5444 prisoners were randomly tested and 15 155 were tested as part of the targeted testing program. On average, Victorian prisoners undergo urinalysis testing nine times per year (Victorian Ombudsman, 2008). The cost of this testing would be extraordinarily high and could be spent on providing drug treatment rather than detection. Also not all the result of urine testing wer provided but 7.4% were positive for cannabis.  
• Targeted testing yielded the most positive results across the three prisons but it also accounted for the most tests undertaken at each prison. 
• Positive tests identified illicit use of the following substances: amphetamines, cocaine, benzodiazepines, cannabinoids, methadone, anti-psychotics, buprenorphine, non-opiate analgesic and anti-depressants. 
• Drug seizures within prisons Cannabis and white powder were found 106 times by SESG, prison staff and/or drug detection dogs in 2009. 

Western Australia 

• On 30 June 2009, there were 4419 full-time adult prisoners (4078 males and 341 females) in custody in Western Australia. Inmates were housed in 14 prisons, of which 13 were public and operated by the Western Australian Department of Corrective Services (WADCS).  
• In 2008–09, Western Australian prisons had a design capacity of 3433 and were operating at 116.9 per cent of the total design capacity. The optimum rate of prison utilisation is 85–95 per cent of the design capacity. This allows some flexibility to cater for prisoners with special needs (e.g. protection, hospital and varying security levels). Western Australian prisons were operated at 21.9 per cent over the optimum rate (Steering Committee for the Review of Government Service Provision, 2010). 
• A more recent study found that 45 per cent of 146 prisoners reported using drugs in prison. Of those reporting drug use while in prison, 21 (over 30%) reported that the last time they injected was in a prison setting (Kraemer, Gately and Kessell, 2009). 
• A cross-sectional audit of all medical notes for inmates at one regional prison in Western Australia found that 57 per cent of inmates had documented evidence of illicit drug use in their lifetime (Gilles et al., 2008). 
• In 2009, a total of 4807 searches were undertaken by drug detection dogs in Western Australian prisons. On 721 occasions dogs indicated illicit drugs. Drugs detected included 30 quantities of green vegetable matter, six tablets and one quantity of powder. 
• There were over 12,00 urine tests conducted and about 10% were positive and mostly for cannabis. 
• In 2009, of 7394 prison receptions in Western Australia, 947 (12%) experienced withdrawal symptoms. 

South Australia 

• A total of 1960 prisoners (1839 males and 121 females) were housed in South Australia on 30 June 2009 (Australian Bureau of Statistics, 2009). Inmates were housed across nine prisons; eight of these were publicly operated by the South Australian Department for Correctional Services (SADCS). 
• In 2007–08 the total design capacity for South Australian prisons was 1411 inmates and the rate of utilisation was 131.5 per cent 24 (Steering Committee for the Review of Government Service Provision, 2010). 
• In 2008, 25 almost three-quarters of prison entrants had a history of some form of substance abuse. The highest level of drug use was among prisoners aged 18–24 years old (76%). In 2008, 70 per cent of male and 67 per cent of female prison entrants had used illicit drugs within the past 12 months. 
• More than half of South Australian prison entrants during the 2008 census period had a history of high alcohol intake (56% of males; 78% of females), with similar levels for both Indigenous and non-Indigenous prisoners. 
• This is in contrast to national levels, which show that 65 per cent of Indigenous prisoners show high-risk alcohol use in comparison to 47 per cent of non-Indigenous prisoners reporting high-risk alcohol use. Additionally, 76 per cent of 18–24 year olds reported high-risk alcohol use (South Australian Prison Health Service, 2008). 
• Cannabis use was highly prevalent among South Australian prison entrants, with over half of inmates reporting having used cannabis within 12 months. Data on poly drug use were not available for 2009. However, in 2008 a study on the substance use patterns in newly admitted male and female South Australian prisoners found that 15 per cent of males and 16 per cent of females used two substances in the three months prior to screening; and 26 per cent of males and 18 per cent of females used three substances in the three months prior to screening (Holmwood, Marriott and Humeniuk, 2008). 

Northern Territory 

• On 30 June 2009, the total number of prisoners housed in Northern Territory prisons was 1056 (1011 males and 45 females) (Australian Bureau of Statistics, 2009). There are two prisons, both managed by the Northern Territory Department of Corrective Services (NTDCS). In 2009, there were no private prisons. During 2008–09 there were 3172 receptions (2377 distinct persons) into Northern Territory prisons, a 10 per cent increase from 2007–08 (Northern Territory Department of Corrective Services, 2009). 
• In 2008–09, Northern Territory prisons had a total design capacity of 858. The total prison utilisation rate was 120 per cent above the national average of 102 per cent of prison design capacity in 2008–09 (Steering Committee for the Review of Government Service Provision, 2010). 
• In 2009, the NTDCS urinalysis program consisted of both random and targeted testing. As part of the random urinalysis testing program, 404 tests were conducted. There were 13 positive results: nine for cannabis and four for ‘other drugs’. As part of the targeted testing program, 521 inmates were tested in 2009. Of these, 49 were positive for cannabis and two for ‘other drugs’ (Northern Territory Department of Corrective Services, personal communication, 2010). 
• Northern Territory was unable to provide aggregated data on the extent of drug and alcohol use by prisoners, the use of drug detection dogs or prisoner programs. 

Tasmania  

• On 30 June 2009, 535 prisoners (492 males and 43 females) were housed across Tasmanian prisons (Australian Bureau of Statistics, 2009). 
• In 2009, the Tasmanian Prison Service (TPS) reports that there were a total of 1492 prisoner receptions (1311 male and 181 female). Inmates were housed across four prisons and two remand centres. Tasmanian prisons had a total design capacity of 643. The prisons operated at 81.1 per cent of the total design capacity in 2008–09 (Steering Committee for the Review of Government Service Provision, 2010). 
• More than 60 per cent of individuals admitted to prison in Tasmania identified alcohol and other drug use as being related to their offending (Tasmania Department of Justice, 2010). 
• In a sample of 107 consecutive receptions to Risdon Prison Clinic, alcohol was found to be associated with previous imprisonment, physical symptoms or current offending behaviours in 86 per cent of cases (Donaldson, 2010). 
• In 2007, 28 per cent of receptions reported a history of injecting drugs (Butler and Papanastasiou, 2008). A history of injecting amphetamines was reported by 73 per cent of the IDU sample, while 5 per cent reported a history of injecting heroin.

ACT 

• A total of 203 prisoners (180 males and 23 females) were housed in the Australian Capital Territory on 30 June 2009 (Australian Bureau of Statistics, 2009). 
• In 2008–09, Australian Capital Territory prisons had a design capacity of 153 inmates. With a total rate of utilisation of 76.7 per cent, this is below the national average of 102 per cent of prison design capacity in 2008–09 (Steering Committee for the Review of Government Service Provision, 2010). In 2009 the AMC received a total of 492 prison receptions (432 males and 58 females). 
• In May 2010, an Inmate Health Survey (IHS) was conducted with a sample of 135 inmates at the AMC. The majority of those surveyed (91%) reported lifetime use of illicit drugs and 52 per cent of inmates reported having been told by a doctor that they were drug-dependent (Stoové and Kirwan, 2010). 
• Stoové and Kirwan (2010) also found that alcohol consumption patterns showed that 44 per cent of inmates reported drinking more than 10 standard drinks on a typical day when alcohol was consumed. Additionally, 33 per cent of inmates surveyed reported drinking more than six standard drinks on one drinking occasion. 
• In 2010 cannabis was reported as the most common drug ever used by Australian Capital Territory inmates participating in the IHS. Illicit drug use was taking place within the AMC, with 32 per cent (24 of 72) of IDUs reporting injecting at the AMC and 27 per cent (21 of 79) reported that the last time they injected drugs was in a prison setting (Stoové and Kirwan, 2010).