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Eastern Europe and Central Asia (EECA) is home to 21% of the world’s population of people who inject drugs and it is the region with the fastest-growing HIV epidemic. HIV prevalence among women who inject drugs is significantly higher than among men in EECA. Even in places with high coverage of needle syringe programmes and HIV testing and treatment, women’s access to opioid substitution treatment is lower than men, and women’s sexual and reproductive health needs remain unaddressed. EECA has a unique system of drug registries that store the personal data of people who use drugs. Registration lowers the chances of employment and access to education and for women and increases the risk of losing custody of their children. The system of drug registries contributes to drug-related stigma. Breaches of confidentiality of drug registry data lead to the further marginalisation of women who use drugs. Criminalisation, past experience of police violence and poverty contribute to healthcare access barriers for women. There is a need for legislative changes to improve personal data protection, decriminalise drug use and reduce police violence. The positive effects of these changes would only be seen in the long term. In the interim, women need special access programmes that are designed specifically to address their needs, that provide free-of-charge services and that ensure the safety and confidentiality of personal data.

Parallel with trends in the wider East Africa region, there has been an increase in the number of women involved in drug use, trafficking and drug-related crime in Kenya (Beckerleg, Telfer, & Hundt, 2005 ). Vulnerable populations, such as domestic labourers, ethnic minorities, those living in slums, bar attendants, sex workers and refugees, are recruited into criminal organisations and assigned roles that expose them to negative health outcomes, human rights violations and incarceration (NACADA, 2016 ). In cases where women do not directly participate in drug use or the drug trade, they often are responsible for mitigating the risks arising from drug use by family members and the community. This reflects their triple burden of care and support when family and social life deteriorates (Mburu, Limmer, & Holland 2019).

The Kenya Narcotic Drugs and Psychotropic Substances Control Act of 1994, criminalises possession and trafficking of illicit drugs. The enforcement of this legislation has led to an increase in the number of women incarcerated in Kenya for drug, but also (and mainly) alcohol offences. This goes against the recommendation of the UN Commission on Narcotic Drugs in 2005 that States should adopt innovative measures and policies that prioritise treatment and rehabilitation as opposed to incarceration. In Kenya, prisons have adopted the Mandela and Bangkok Rules, enabling a paradigm shift in the provision of correctional services for women offenders, including remote parenting, family open days and linkages to aftercare services. However, these policies need to be anchored in the legal framework, with adequate resources to hasten the realisation of goals for the care and treatment of female drug and criminal offenders.

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

The purpose of this paper is to discuss how a “holistic approach” is enacted in two interventions accommodating the same target group, young adults with offending behaviour and drug use experiences, but offered in very different contexts, the Prison Service and the community. The aim is to show how enactments of a “holistic approach”, although similar on paper, differ in welfare institutional practices due especially to organisational and structural conditions.

The paper is based on qualitative semi-structured interviews and written material from and about the two interventions.

Different enactments of a “holistic approach”, due to organisational and structural conditions of the interventions, construct different possibilities for institutional identities. These insights could be useful to take into consideration when discussing prevention initiatives (in a broad sense) for young people with complex problems, including co-occurring offending behaviour and drug use experience.

Research with a focus on citizens with complex problems who do not comply with OR conform to standard welfare institutions are limited. The authors contribute to this literature by focussing on young adults with offending behaviour and drug experiences.

Over the past decade, an increase in the numbers of women prosecuted, sentenced and imprisoned for drug-related offences has prompted concern and debate amongst criminal justice practitioners and policymakers. The female prison population in Southeast Asian countries is high compared to other regions. The direction of national drug policies and law enforcement are critical determinants of this situation. This chapter discusses the trends in the illicit drug market, the different types of policy responses, and the impacts on correctional services in the region. It provides an overview of women prisoners’ profiles, their backgrounds and their involvement in drug-related crimes. Key issues relating to the treatment of women in Southeast Asian prisons are analysed and addressed through the lens of the relevant provisions of the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders.

The purpose of this paper is to analyse the association between drug consumption and unemployment. This paper also studies the differential association between these variables in both the pre- and current-crisis periods. The results are compared in an attempt to verify that the population of users is more vulnerable in terms of how likely they are to get and hold down a job in the labour market.

Matching methods and microdata from the Survey on Alcohol and Drugs in Spain, EDADES are used. The use of these methods on the estimates carried out prove to be particularly effective in reducing treatment-selection bias. The authors’ interest is also to analyse the differential association between the interest variables in both the pre- and current-crisis periods. For this purpose, the authors also use the differences-in-differences (DID) estimation method between the two periods to check if the impact of drug use on unemployment depends on the economic context. The estimations are compared in an attempt to verify that the population of users is less likely to attain and hold down a job in the labour market than non-drug users.

The results obtained in the current study are consistent with the hypothesis that drug use decreases an individual’s capacity and availability when he or she is trying to enter the labour market. In both 2007 and 2013, drug users were more likely to be unemployed, regardless of the type of drug. Differences in the probability of being unemployed intensify during an economic crisis. In light of these results, it is possible to conclude that the negative effect of drug consumption on an individual’s employability is increased during periods of economic recession.

The study presented here has some limitations. Firstly, cross-sectional data were used to examine the causal relationship between consumption and employment. In this sense, the results are susceptible to bias. The unavailability of longitudinal data on the same individual made it impossible for the researchers to consider periods of abstinence, the duration of periods of consumption and how this consumption affected an individual’s productivity and his or her working situation. Another limitation is that certain relevant unemployment variables may have been omitted. Among the variables that affect an individual’s labour participation is the existence of sources of income as an alternative to market salaries. With state subsidies, income from illegal activities and money sent by family or friends, an individual may decide not to work. This problem could be mitigated if omitted variables operate in a similar way throughout both of the periods examined.

Given the results obtained in this paper, the authors believe that public policy conclusions should be mainly concerned with the importance of implementing proactive employment policies, along with family support programmes and a greater role for primary care among the people with the highest risks of exclusion. Health treatment should go jointly with measures that make it easier for individuals to enter the workforce. These steps would only be possible with an improved level of education and more complete professional profiles, to increase motivation when individuals seek employment.

This study could make various contributions to the existing body of evidence. In the authors’ knowledge, this is the first attempt to document the effect of the economic crisis on the employability of the drug-using population in contrast with the general population. Moreover, a methodology is presented that provides an alternative to those used in earlier studies, in terms of reducing treatment-selection bias. At the same time, the use of a DID estimation method between pre- and current-crisis periods allow us to check if the impact of drugs consumption on unemployment depends on the economic context.

Sex and gender are regarded as critical structural determinants of mental health and mental illness. Mental illness is a complex phenomenon, and risky behaviour and substance use commonly occur simultaneously or subsequent to one another. A gendered vulnerability in biological, environmental, and behavioural risk factors has been registered in the development and escalation of mental illness. Studies have found that women who use drugs experience greater physical and mental health repercussions than men. Women who use drugs present higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress. This chapter addresses the most common mental illnesses associated with women who use drugs: depression, anxiety, trauma-related disorders, and eating disorders.

The purpose of this paper is to explore the prevalence of potential problem gambling among Finnish prisoners; the associations between problem gambling and demographics, substance use and crime-related factors; and problem gamblers’ support preferences.

Prisoners (n=96) from two Finnish prisons were recruited between December 2017 and January 2018. The estimated response rate was 31 percent. Gambling problems were measured using the Brief Biosocial Gambling Screen. The participants were asked to report their gambling both for one year prior to their incarceration and for the past year. The independent variables were demographics (age, gender and marital status), substance use (alcohol, smoking and narcotics) and crime-related factors (crime type, prison type and previous sentence). Statistical significance (p) was determined using Fischer’s exact test.

Past-year pre-conviction problem gambling prevalence was 16.3 percent and past-year prevalence 15 percent. Age, gender, smoking, alcohol or illicit drug use were not associated with past-year problem gambling before sentencing. One-third of the prisoners (33.3 percent) who were sentenced for a property crime, financial crime or robbery were problem gamblers. One-quarter (24 percent) of all participants showed an interest in receiving support by identifying one or more support preferences. The most preferred type of support was group support in its all forms.

It is recommended that correctional institutions undertake systematic screening for potential problem gambling, and implement tailored intervention programs for inmates with gambling problems.

This study provides a deeper understanding of problem gambling in prisons. Problem gambling is associated with crime and also seems to be linked with serving a previous sentence. Early detection and tailored interventions for problem gambling may help to reduce reoffending rates.

Rabbit syndrome (RS) is an antipsychoticinduced rhythmic motion of the mouth/lips resembling the chewing movements of a rabbit. The movement consists of a vertical-only motion, at about 5 Hz, with no involvement of the tongue. Long-term exposure to typical antipsychotics has clearly been associated with RS, but little is known of the risk of RS due to exposure to newer atypical antipsychotics. There have been isolated reports of RS in patients treated with the atypical agents risperidone, aripiprazole, olanzapine, and clozapine. We present the case history of a 44-year old female patient treated for paranoid schizophrenia for 22 years and RS during her last 10-month clozapine treatment. Background information from the literature is also discussed.