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This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March –June 2020).

The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies.

The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care.

Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored.

The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic.

Problematic drug use in prison remains a pervasive and increasing concern throughout the European Union (EU) in terms of costs to the individual, community and the state. Drug‐related problems in prison seem to be more prominent among female prisoners, as a high proportion of them are problematic drug users whose use continues in prison. Assuming that women’s drug use is an indication of need for treatment and health care, it becomes increasingly interesting how the European penal institutions differ in their response to this need. For this reason, a survey of the prison drug services for adult female drug users has been carried out among the Ministries of Justice of all 25 EU member states. The main purpose of the survey was to gain comprehensive and systematic information on the prevalence of female problematic drug users in European prisons and the availability of treatment and healthcare services. Altogether, 27 European countries and autonomous regions completed the questionnaire developed for this survey. The results of the data analyses indicate that there is poor availability and quality of data relating to the extent of problematic drug use in women’s prisons and, where it is available, it seems to underestimate the proportion of female problematic drug users in prisons. However, most of the European countries provide a range of different harm‐reduction and drug treatment services to respond to the reported health and rehabilitation problems of female problematic drug users. At the same time, however, it is evident that there is a need for further action in some countries, due to their low provision of prison drug treatment and healthcare services for this group. This article is based upon the European research project ‘Female drug users in European prisons’, which was conducted between 2003 and 2004 and funded by the AGIS Programme, Directorate General Justice and Home Affairs, of the European Commission.

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non‐binding or so‐called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.

This chapter reconstructs and critically examines the recent history of strip searches in Belgium. About 10 years ago the Belgian parliament adopted its first law on prisoners’ rights. A major part of the Prison Act of 12 January 2005 deals with disciplinary and control measures. Article 108, in particular, has provoked quite some controversy. It introduced a clear distinction between the (more superficial) search of an inmates’ clothes on the one hand, and the (substantially more intrusive) measure of strip searching on the other hand. The main difference between these two measures is that the latter involves forcing prisoners to strip naked. Because of their intrinsic intrusiveness, such strip searches were meant to be exceptional measures: they should only take place following an individual assessment and decision by the prison governor. In practice, however, the prison administration tended to interpret Article 108 somewhat differently and the line between searching an inmate’s clothes on the one hand and strip searching on the other became blurred.

I first discuss the problem of order in prisons and explore how strip searches have been regulated in Europe. I then reconstruct the recent history of the regulation of strip searches in Belgium. In order to make sense of this history, I mobilize some of the ideas of Stanley Cohen’s sociology of denial, in particular, his distinction between literal, implicatory and interpretive denial, and apply these to the history of strip searches in Belgium.

A consistent finding from this chapter is that the Belgian prison administration has – through creative manoeuvres of interpretive denial – been able to circumvent the new barriers that were erected by the Prison Act of 12 January 2005 and, in doing so, it has been able to continue stripping detainees naked without an individualized decision from the prison governor. The approach that I develop throughout this chapter helps us better appreciate the limits of legal reform and top-down (European) regulation of strip searches.

The chapter demonstrates that Stanley Cohen’s work on denial is not only useful for scholars who do research on gross human rights violations but also for interpreting more down-to-earth aspects of criminal justice systems across the globe.

Objective. The objective of this study was to examine practices and policies in place for the provision of targeted prevention and treatment of cocaine and Amphetamine Type Stimulant (ATS) users in prison in nine European countries. Methodology. Across nine European member states (Belgium, the Netherlands, Czech Republic, Lithuania, Slovenia, Sweden, Malta, Ireland and Portugal), interviews were conducted with ministerial representatives and professionals (i.e. service providers and security officials) working in prisons and a total of 16 focus groups with a total of 125 prisoners. Results. The use of stimulants in prison is associated with aggression and violence, financial problems, and psychological and physical problems in prisoners (depression, anxiety and psychological craving). Both security and healthcare staff in prison often feel ill‐equipped to deal with stimulant‐related problems, leading to a lack of equivalence of care for stimulant users in prison, therefore the variety and quality of drug services outside is not reflected sufficiently inside prison. There is a need for more specific product information and harm reduction material on stimulants, for clear guidelines for the management of acute stimulant intoxication and stimulant withdrawal, for structural adjustments to improve potential diagnosis of personality and psychiatric disorders, for more non‐pharmacological treatment strategies and more opportunities for prisoners to engage in purposeful activities.

The objective of this study was to examine practices and policies in place for the provision of substitution treatment in prison in 18 European countries. Methodology. Across the 15 European member states (prior to 1 May 2004) and Czech Republic, Poland and Slovenia, interviews with ministerial representatives, professionals (i.e. service providers and security officials) working in prisons, and a total of 33 focus groups with a total of 132 male and 52 female prisoners were conducted. Results. Although constraints of access to substitution treatment for specific target groups only (e.g. HIV‐positive opiate users) have largely vanished, substitution treatment is now offered to a broad cross‐section of prisoners. The provision of this treatment still lags behind the standards of substitution treatment in the community (regarding access and continuity). In most countries, this form of therapy is most likely to be discontinued when entering prison. A treatment gap persists between prisoners requiring substitution maintenance treatment and those receiving it. Heterogeneous and inconsistent regulations and treatment modalities appear throughout Europe, sometimes within the same country or region. The concrete provision practice of substitution treatment in prison varies from one country to the other, from one prison to the other, within a medical team, and even from one doctor to another. Although psychosocial care was seen as a valuable additional and necessary part of the treatment to support the medical part of the substitution treatment in prison, it was found that such support was rarely provided. Compared to previous research, this study illustrates that the scope of substitution treatment has extended considerably across Europe. Across the board, a consensus surrounding the need to continue substitution treatment that had already been started in the community was apparent.

The strongest international recognition of the importance of women’s health in prisons and the urgent need for radical change was highlighted of a WHO Conference held recently in Kiev, Ukraine.

The purpose of this paper is to analyse the extent of throughcare provision for prisoners with problematic drug use. Effective throughcare services have been recognised as important because they help to ensure that any progress in treatment made in prison is continued on release. Previous research demonstrates that examples of good practice in throughcare provision for prisoners with problematic drug use exist in many parts of the world. However, evidence from recent work carried out in Europe indicates that the implementation of throughcare services for this group of prisoners is limited and ineffective in some EU member states. This paper aims to explore the reasons for such failure and to identify the barriers to implementing effective throughcare for this particular group of prisoners.

This paper is drawn from research carried out as part of a European project funded by the Directorate General Justice of the European Commission. The project involved six partners from a range of different member states. The research involved a literature review, followed by in‐depth interviews and focus groups with key stakeholders. Each partner carried out the qualitative research within their own country, in order to enable the team to capture local nuances.

The findings indicate that key barriers to implementation of effective throughcare are resources which impacts on the availability of support services, attitudes and training of staff and ultimately the continuity of care.

This paper adds to the body of knowledge regarding the provision of effective throughcare to those with problematic drug use.

The article will discuss the particular needs of women prisoners, many of which are replicated in prisons throughout Europe, and are also often undetected and underestimated. The focus will be on the situation for women in Italian prisons, considering the specific health and social care needs they present, how some needs differ to those of male prisoners, and to what extent the organisation of prison health attempts to meet these needs. The key issue identified is that the organisation of prison health deals predominantly with emergency cases and is not able to provide a preventative healthcare service to women in prison. Also, women prisoners suffer a greater impact on their physical and mental well‐being as a result of poor implementation of healthcare services, as well as from the regime of prison itself.

The incarceration of transgender people is described as a “double punishment” based on lack of gender recognition and ability to gender affirm, and with their experiences and conditions in prison tantamount to torture. The purpose of this study is to illustrate the continued “double punishment” of incarcerated transgender people (in particular trans-women) and identify and describe breaches in human and gender rights and minimum standards of care.

There is limited global data on the numbers of incarcerated transgender people, an identified vulnerable prison group. There are inherent difficulties for prison authorities regarding placement, security aspects and management of transgender persons. While the concerns apply to all transgender prisoners, the current literature focusses mainly on transgender women and this commentary reflects this present bias. A socio-legal approach describes and evaluates international human rights’ conventions and human rights’ law, soft law instruments mandating non-discriminatory provisions in the prison setting and relevant European and domestic case law.

Transgender prisoners experience an amplification of trauma underpinned by lack of legal gender recognition, inability to gender-affirm, discrimination, transphobia, gender maltreatment and violence by other prisoners and prison staff. Despite obligations and recommendations in international human rights’ instruments and standard operating procedures at the prison level, very few countries are able to fully uphold the human rights of and meet the needs of transgender people in prison.

This study is important as it highlights the dearth of knowledge exploring human rights discourses and concerns related to the phenomenon of incarcerated transgender persons. It uniquely focusses on European and domestic law and illustrates the inherent tensions between human rights, sexual orientation and gender identity rights and security considerations regarding transgender issues in prisons. Rights assurances centre on the principles of equality, dignity, freedom of expression, dignified detention and the prohibition of inhumane treatment or punishment.