Continuity of care for drug users in prisons and beyond in four European countries. Final report

For prisoners with a history of drug use, in particular opioid use, the risks related to drug use and especially overdose and death are extremely high in the immediate period after release due to high rates of relapse and lower opioid tolerance (Farrell and Marsden, 2008). Much still needs to be done in order to ensure that people with a severe history of drug use are sufficiently cared for when released from prisons. Harm-reduction measures need to be in place for ex-prisoners to be able to readjust to freedom without relapsing back into drug use and to prevent the extreme risk of fatal overdose when released.
The EU project 'My first 48h out' aims to address the gaps in continuity of care for long-term drug users in prison and upon release, by supporting life-saving interventions for the prevention of overdoses and the reduction of other risks related to drug use, and for the establishment of a treatment trajectory that is not interrupted upon release.
This report shows the results of one specific objective of the project (4). A multi-country (Belgium, France, Germany and Portugal) qualitative study, including elements of participatory research (user involvement). Two dimensions of continuity of care were evaluated in this study, since we were looking at the continuation (or discontinuation) of essential medical/drug treatment for drug users once released (in particular OST and ART) and the provision of case management, transitional care or throughcare upon release. This part aims to provide an overview of barriers as perceived by drug users and professionals working in prison and community services with drug users with a detention history, and strategies adopted in different countries to overcome these barriers.
Approximately 30 prisoners and/or drug users with prison experience, eight professionals working inside prison and eight working outside prison were targeted to be involved in the research in each of the four countries. Focus groups (prisoners) and semi-structured qualitative interviews were administered in prisons and outside.