**13. Substitution therapy**

The principle of the substitution (replacement) therapy is to replace illegally gained addictive substances with a substance (medication) that has a longer effect, similar properties and effects, with known concentration like the drug used, without toxic ingredients and it is applied orally. This type of substance is called agonist. This treatment was originally about administering the substance that was used, e.g. heroin. The preparations are currently prescribed by a doctor; methadone – a synthetic opiate in the form of tincture, and buprenorphine in the form of tablets are used most frequently as opiate agonists [18]. Substitution therapy of opioid addiction was introduced in the Czech Republic Prison Service in 2006 when a pilot project in two prisons started, one in the Detention Facility Prague Pankrác and the other in Příbram Prison. After successful completion of this pilot project, the substitution therapy was gradually extended to eight other prisons where substitution therapy centers were established. The whole project of substitution therapy introduction was designed from the very beginning to enable implementation under common conditions of our prisons, i.e. under the conditions of standard sentence or detention. So no special wards were established where all patients undergoing substitution therapy would be jointly placed. Substitution therapy in the Czech Republic Prison Service is usually implemented in the form of outpatient treatment. The criterion for including an inmate in substitution therapy is addiction to substances from the opioid group where the therapy by abstinence is impossible or where it was repeatedly unsuccessful. Another criterion is that only a prison inmate who is or was undergoing substitution therapy in a healthcare facility out of prison may be included in the substitution therapy. So the substitution therapy is not initiated in prison. Methadone is usually the medication used for substitution therapy. Substitution therapy is provided in a total of ten prisons where substitution therapy centers are established. The prevalence of infectious diseases and namely viral hepatitis B and C is higher in prison population than in normal population. Injection drug users are certainly a high-risk group as far as spreading of infectious diseases is concerned. The biggest non-governmental service provider

for problematic drug users and drug addicts in the Czech Republic is SANANIM, which runs not only CADAS but also for example two therapeutic communities, a low-threshold center, daycare center, aftercare center or a program of prison services and others. The effectiveness or success of therapy does not depend only on a given substitution substance but also on the related context and accompanying components of the therapy. Psychosocial interventions can contribute significantly to the success of the substitution therapy [19].

## **14. Harm reduction (risk minimization)**

The term harm reduction was originally used only in connection with measures and programs focused on mitigating the adverse health effects of narcotics and psychotropic substances. However, this term is currently used in connection with the strategies that contribute to the mitigation of potential health and social risks and harm caused by using all types of drugs, including interventions in drug supply and demand. The target group is represented by problem or injection drug users who are the biggest threat to public health. The basic characteristic of the harm reduction model is pragmatism. Instead of trying for absolute elimination of drugs and their use, it tries to work with them in a way to minimize the negative consequences of such behavior. This approach originated as a response to emerging HIV/AIDS, which started to spread among injection drug users. That is why under these programs the drug users get the used needles and syringes changed for clean ones, they are informed about the principles of less risky drug use, safe sex, etc. Introduction of harm reduction into the prison environment is a controversial topic. Nevertheless, as proven by the foreign research results, harm reduction in the prison environment may significantly contribute to limiting the spread of contagious diseases like HIV/AIDS or hepatitis C (hereinafter VHC). Viral hepatitis C infection is widespread among injection drug users. One of the main effects of the "war against drugs" is a high number of imprisoned drug users. At the same time, injecting drugs remains a widespread phenomenon in prisons. Introduction of the needle change program turned out to be an effective measure for harm reduction - minimized needle sharing and subsequently the transmission of HIV and VHC among the injection users and their sexual partners. A number of countries introduced these programs into selected prisons [20].

#### **15. Release from prison and conclusion**

The client usually encounters increased stress and challenging period on 2nd or 3rd day upon release from prison. The foreign experience and also the Czech experience show that the highest-risk period for criminal recidivism and drug relapse is the first 48 hours. These people were used to dealing with all the euphoria, stress and problems by taking drugs and it is therefore necessary to help them stabilize. It turns out that the plans created in the prison environment have to be adjusted most of the time depending on specific conditions of the client upon release from prison that were not known at the planning stage. Also, clients' resolutions, motivation and ideas often change and it is necessary to work with it flexibly. It is therefore important to take advantage of the trust that formed between the clients and the project staff and help the clients manage the highest-risk period of 48 hours after the release mentioned above and then at least another 1–2 months with the goal of providing effective direct medical and post-penal care. Moreover, these clients are double stigmatized. Both by their drug history and by their criminal past, which

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

makes their social inclusion upon release from prison more difficult and deepens their social exclusion. It is necessary to realize that hardly any group of people is forced to communicate with so many institutions like drug users in conflict with the law – police, courts, prison service, medical and contact facilities, probation officers, etc., whereas each of the institutions has different demands and view of the particular person. Antidrug policy of the Prison Service and overall practice of the antidrug services for imprisoned drug users have to be perceived as part of a wider framework of professional treatment of prison inmates. The fact that a sentenced person is addicted to substances or is a drug user may be perceived in penal practice from a few aspects. Drug use and related behavior is a serious health risk, i.e. it is a behavior that potentially compromises the health of the person but also the person's surroundings. Drug use also represents a serious safety risk as it can be expected that the person addicted to substances out of prison will try to get the drug also in prison and use it there. One of the main goals of prison systems in developed countries is to reduce the criminogenic risk of imprisoned people, specifically to reduce the probability that the particular individual, when released from prison, will commit the same or even more serious crimes than before the imprisonment. The Czech Republic Prison Service thus contributes significantly to the society protection by monitoring the situation with imprisoned drug users and mainly by offering professional intervention in the area of drug prevention to people at risk, i.e. it provides so-called antidrug services to them [21].
