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Heterogenic care of addicted detainees in the various prisons in the Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled ‘Pharmacological care for detained addicts’. This article presents the content of this guideline, which mainly focuses on opioid‐dependent addicts. In the Netherlands, approximately 50% of the detainees are problematic substance abusers, while again half of this group suffers from psychiatric co‐morbidity. In addition, somatic co‐morbidity, especially infectious diseases, is also common. Due to the moderate outcome seen with voluntary drug counselling regimes in prison, there is a policy shift to extent utilization of legally enforced approaches. Continuity of care is of great importance. In case of opioid addicts this, in general, means continuation of methadone maintenance treatment. Aftercare immediately after detention and optimalization of medical information transfer is crucial. This guideline aims to realize optimal and uniform management of addiction disorders in the Dutch prison system.

This extended review of Stimson and Oppenheimer’s classic book Heroin Addiction aims to highlight its contribution to the literature and consider its contemporary relevance for research, policy and practice.

The review examines the core themes of the longitudinal study that the book presents by bringing it in to dialogue with a recent “living history” project on John Marks’ radical heroin prescribing in the 1980s and 1990s.

The three core themes explored are treatment as containment; the balance between therapy and social control; and the benefits of heroin versus methadone.

The book is a “timeless classic” that still resonates with contemporary concerns and has much to tell us about heroin addiction and its treatment.

The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.

This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50+ groups were assessed using Fisher's exact test.

Amongst the 92 in the group 50 years and above, 67 (average dose=63.25 mg) were on methadone maintenance (average dose=63.25 mg) and 19 (average dose=10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood‐borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50+ age group.

There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.

This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age‐related differences in particular related to physical health and social needs.

The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and the UK within the past 15 years.

The paper is based on literature reviews, documentary analyses and key informant interviews with a range of stakeholders involved in OST and policy in Denmark and UK. The study is part of the EU-funded project: Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project.

Denmark and the UK are amongst those few European countries that have long traditions and elaborate systems for providing OST to heroin users. The UK has a history of dominance of medical professionals in drugs treatment, although this has been recently challenged by the recovery movement. In Denmark, a social problem approach has historically dominated the field, but a recent trend towards medicalisation can be traced. As in all kinds of policy changes, multiple factors are at play when shifts occur. We examine how both countries’ developments around drugs treatment policy and practice relate to broader societal, economic and political changes, how such divergent developments emerge and how medical professionals as stakeholders enhanced their roles as experts in the field through a variety of tactics, including the production and use of “evidence”, which became a key tool to promote specific stakeholder’s perspectives in these processes.

The paper contributes to current policy and practice debates by providing comparative analyses of drug policies and examination of stakeholder influences on policy processes.

The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia.

A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix.

Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV.

The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics.

The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting.

This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

The organizational effectiveness of methadone maintenance treatment is qualitatively evaluated by analyzing levels of compliance and involvement with treatment programs for clients at three types of methadone clinics in the San Francisco Bay Area. Secondary analysis is used on longitudinal data collected from a project funded by the National Institute on Drug Abuse, “Injection Drug Users, Methadone Maintenance Treatment, and AIDS” (n = 233). This analysis rests on the theoretical model of clinics types differentiated by the clinic's style of control over clients. With a focus on the interaction between individuals and their institutional environments, the analysis compares three types of clinics: reformist, medical-model and libertarian. Reformist clinics exercise the most control over their clients and libertarians the least. Compliance with clinic rules is defined as changes in levels of drug use and involvement with clinic program is comprised of patterns of retention. While affiliation at all three clinic types reduces drug use, reasons for continued use vary substantially by clinic type. Variation is explained by a control balance approach to understanding responses to organizational type.

This paper looks at ISIS, the primary care service that was set up in the London borough of Islington to improve throughput into GP prescribing services from the drug‐using population. ISIS is a service developed from a statutory and voluntary sector initiative that was developed with a GP shared‐care model in its design. It is led by a GP and two non‐medical prescribing nurses to service a population that would not stay with the service but would be managed through the project to GP prescribing services.Over the course of the first year, however, while throughput to GP services improved, the numbers were still too low for the model to work effectively. Just under half of GPs were not offering services to this population, and there were a number of more complex patients who needed to be referred to a specialist drug agency.Results from the annual audit showed that there was a population of clients who were responding well to treatment but did not have a prescribing GP to be referred on to. This paper highlights these stable patients and argues that this population can be managed in a GP‐led service such as ISIS. Revisions to service design and commissioning objectives may be required, but should be easy to implement.

Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of HIV/Aids. The peculiarities of Italian culture and tradition led to the adoption of a ‘Latin’ model, while in northern countries the culture of pragmatism and evidence‐based practices, together with a long tradition of public health policy were determinant in promoting harm reduction. In Italy, the ‘social perspective’ on the drug problem adopted by a large part of professionals working in public services and by most non‐governmental organisations (NGOs), has prompted a synergy between ‘cure’ and ‘care’ (ie. treatment and harm reduction), leading to the ‘integration’ of harm reduction and the traditional drug‐free work on addiction. As a result, since the mid 90s, public services and therapeutic communities have been cooperating to build a complex system of low to high threshold facilities. Until the 90s, most NGOs only ran drug‐free programmes in therapeutic communities, but from then onwards many began running harm reduction programmes as well, especially street units and needle exchange programmes, secondary prevention units at rave parties, drop‐in centres, and low‐threshold detoxification centres. Similarly, there has been an increase in methadone maintenance in public services, after the ‘retention in treatment’ of clients was established as the primary objective in the effort to protect users from drug related death and HIV infection. Though harm reduction interventions are far from being fully implemented, data shows that in the past 15 years the harm reduction/treatment system has reduced health risks for drug users and has been instrumental in referring a remarkable number of injecting drug users into treatment programmes. In the mean time, drugs of choice, patterns of use and ways of drug consumption have substantially changed. Now the question is, will the Italian approach be able to address these new challenges?