**5. Drug services in prisons**

Services of prevention, therapy and aftercare for drug users started to develop in the Czech Republic in 1990. At the end of 1990s, there was a relatively comprehensive system of preventive programs. Communication with prison managements started to develop and first projects started to emerge, focusing exclusively on working with clients in prisons. There are 36 prisons in the Czech Republic, including detention facilities. Nine of these places offer methadone therapy to prison inmates. A few years ago, 15 non-profit organizations provided their services in 30 prisons and detention facilities. Their work consisted in health-oriented interventions, including addiction counseling and drug addiction therapy, and also in the preparation of prison inmates for their release, and in arranging for aftercare upon release. General Directorate of the CR Prison Service has an "action plan in drug policy" in place, which in one of its parts focuses particularly also on the area of harm reduction. There are drug-prevention centers in prisons, drug-free zones are available and drug users get therapy including detox and substitution therapy. They are provided by the Prison Service (hereinafter PS) and many of the services are also provided by non-profit organizations. Measures taken by PS are divided into 3 areas. In the area of drug supply reduction, beside drug addiction monitoring, creation of drug-free zones and preventive medical examinations, stress is put mainly on the analysis of medical records, performance of initial medical examinations in order to find clues of drug application and on making the indication and

administration of addictive medications more restrictive. As far as primary prevention is concerned, there are antidrug programs, initial training courses for new prison staff and regular in-service training for healthcare staff. As far as secondary and tertiary prevention is concerned, the prison service staff takes upgrade training courses and drug prevention centers are established. The important fact is that prison inmates have the same right to healthcare access as the rest of the population, including assistance and therapy provided to drug users. From the medical, therapeutic and educational point of view, there are 4 groups of prison inmates based on treatment in prisons:


Other groups may include drug dealers, who do not use drugs, and people who were ordered compulsory treatment. Of course the drug availability in prisons is not comparable with the availability out of prisons. Different types of treatment do not exclude each other but can complement each other and meet different needs of clients. In order to provide differentiated approach to serving a sentence, the prison team implements several types of antidrug measures and programs. These include the following:


*Illegal Addictive Substances among Prison Inmates in the Czech Republic DOI: http://dx.doi.org/10.5772/intechopen.97160*

Upon request of the prison service, the services in prison are currently focused on abstinence. For the time being, the harm reduction approach is applied mainly in the form of information. Drug services in prisons are provided by non-profit organizations. This practice is based on legislative capabilities of interest groups to operate in prison [8].

#### **6. Screening**

The accused and the convicted are tested for the presence of addictive substances in the body. One of the reasons is to check compliance with the drug prohibition. This information may indicate therapy or other antidrug intervention and last but not least it indicates whether the rules of therapy are followed. Two basic types of tests are performed, one for reference using a set to detect addictive substances or their metabolites in urine, and a confirmation analysis performed by an accredited toxicology laboratory mostly using a chromatographic method. Possibility of detecting some of the addictive substances in urine:


Initial medical examinations of inmates at the start of detention and inmates at the start of imprisonment that exceeds 4 months include the test. This is used to monitor a probable proportion of drug users in prison population. This testing is also used to verify the anamnestic information given by the inmates at the initial medical examination and becomes part of the person's medical records. Another category of testing includes randomly systematic testing and so-called targeted testing [9].

#### **7. Detoxification units**

Detoxification units are designated for handling withdrawal symptoms and intoxication with addictive substances that do not require intensive care in another facility, e.g. in an intensive care unit. Detoxification units are most often separate units within hospitals or parts of facilities for medium-term or long-term treatment. Clients in substitution programs are detoxified most often as outpatients. The target group includes namely clients who need to reduce their drug tolerance because of their health or social situation but they are not motivated to abstain or to start other therapy, then clients who are dangerous to themselves or to their surroundings because of intoxication or withdrawal symptoms, or possibly clients for whom it is necessary to distinguish between intoxication and mental illness. The detoxification units should provide pharmacologic treatment of states of acute intoxication, withdrawal syndrome and somatic complications. Detoxification includes overall assessment of client's condition, and laboratory testing, pharmacotherapy,

#### *Criminology and Post-Mortem Studies - Analyzing Criminal Behaviour and Making Medical…*

psychotherapy, social work and structured program are used. Withdrawal symptoms when opiates and opioids are withdrawn often look dramatic. As the opioid withdrawal symptoms make the patient crave the drug, the patient often overacts the signs and symptoms in order to get higher doses of medications. Clinical symptoms are often compared to those of flu as far as appearance and severity are concerned. Opiates and opioids with longer biological half-life cause longer and milder withdrawal state, while opioids with shorter half-life cause short withdrawal state but with more severe symptoms. The withdrawal state upon withdrawal of heroin and morphine usually starts 6–8 hours after the last dose, it peaks on the second and third day and lasts approximately 7–10 days. The withdrawal state upon methadone withdrawal starts 1–3 days after the last dose and lasts one to three weeks. The most standard detoxification methods:

