Improving the health and wellbeing of incarcerated drug users

The work of the Social Research Evaluation Unit (SREU) has championed the use of harm reduction strategies and influenced prison policy, thus reducing the spread of drug-related illnesses in several prisons across Europe and Central Asia.

Improving the health and wellbeing of incarcerated drug users large

Research summary

A study by UNAIDS estimates between 56 and 90% of drug users will be incarcerated at some point during their lives. This addiction does not leave the prisoner while they are incarcerated and, despite best efforts to police controlled substances, prisons are often home to drug abuse.

Drug-related illness in prisons not only put lives at risk but also incur treatment costs, which only grow as infection spreads. One way to prevent drug-related illness in prisons and prevent the spread of infections, such as HIV and hepatitis C, is to introduce harm reduction strategies. These strategies include providing clean needles and syringes for drug users in the prison population, and opiate substitution therapies such as methadone to reduce the spread of HIV/AIDS.

Through a series of pivotal studies and contributions to the Dublin Declaration, Professor MacDonald and the SREU influenced policy in Asian and Central European prisons to introduce harm reduction programmes, where they were significantly lacking. This shift was essential in providing quality of care parity between prisons and the wider community, preventing infection and the spread of sexually transmitted diseases in prison communities.

Research background - prisons ill-equipped to prevent the spread of drug related illnesses

Through a series of studies evaluating drug services and strategies in Europe and beyond, the team found that harm reduction measures in many Asian and Central European prisons were failing compared to those provided elsewhere and outside of prisons. Prisoners were not being granted quality of care due to the lack of availability of items such as clean syringes, which contrasts the services available in the wider community.

The findings for these reports formed some of the key influences of SREU’s work with the Dublin Declaration (2004). MacDonald co-authored the Dublin Declaration on HIV/AIDS in Prisons in Europe and Central Asia, which has been described as “a key document that stresses the need for a consistent strategy on HIV and AIDS in prisons” and “clearly sets out a public health and human rights approach to HIV in prisons” (MacDonald 2011, 111).

As a result of the Dublin Declaration and subsequent harm reduction training provided by the SREU to criminal justice professionals, the research team has shaped international policy and debate around drug use in prisons. The team remain at the forefront of these subjects as the editors of the journal International Journal of Prisoner Health.

Outcomes and impact - Quality of care for prisoners

Due to the SREU’s work with the Dublin Declaration, “in many countries, the HIV rate among drug-using prisoners is low compared to 20 years ago” (Stöver & Hariga 2016, 109).

The team’s contributions to the Declaration has enabled the uptake of harm reduction strategies across Europe and Central Asia and their recommendations are now being used in guidance by the European Monitoring Centre for Drugs and Drug Addiction.

The impact of this work can be seen in the uptake of Opioid substitution therapy in Greece, Cyprus and Lithuania – with all of their prisons implementing the strategy in 2018, as well as other key developments.

The Unit also did significant work to provide prison management with the tools and training to introduce harm reduction methods. Specifically in Varna Prison, Bulgaria, their work was directly tied to beneficial outcomes for prisoners. The prison director, Senior Commissioner Yordan Yordanov noted that the training increased the “awareness of prison staff about the harm reduction approach” and “increased tolerance and understanding of the staff towards prisoners with problematic use of psychoactive substances”.


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Morag MacDonald

Director, SREU

Morag started her research career due to her concern about prisoners who were HIV positive in UK prisons. Becoming an academic allowed her to research the subject and provided a position from which to contribute to policy making in this area.

This has led Morag to a career in researching prisoner health internationally. Prisoner health encompasses a wide range of subject areas such as HIV, drug addiction. Alcohol problems, domestic violence and concerns about specifically vulnerable people in the prison environment like women and young prisoners.


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James Williams

Senior Research Fellow

James is a historian by background with a passionate interest in the origins and development of contemporary society and culture, both at macro and micro levels.

For James, there are two key issues: first, how global and national trends and the individual interact; and second, how we engage with our environment and how our environment shapes us. Academia has given him the opportunity to engage with fellow students of life in these issues, both in Academia and in the wider community through our various projects.


David Kane

Senior Research Fellow

David discovered his passion for research while studying for his BA at UCE and was fortunate to secure a position in a research department following graduation.

Research is a natural fit for David as he thrives on attention to detail and accuracy. Working at BCU has given him the opportunity to develop new areas of expertise as well as a chance to collaborate with colleagues across faculties on existing interests including music history and heritage. David's dream would be to establish an accessible research/history/heritage portal that celebrates Birmingham’s musical heritage with the city’s broad and diverse communities.