Chapter 2
All countries

The Pompidou Group’s human rights approach to developing comprehensive drug treatment systems in prisons

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A patient taking a methadone dose in a drug treatment centre

Interview with Robert Teltzrow, Principal Project Consultant at the Council of Europe Pompidou Group

In this interview filmed on 26 March 2021, Robert Teltzrow presents the Council of Europe Pompidou Group’s approach to further human rights and public health in the highly stigmatized and vulnerable key population of incarcerated people who use drugs. From the perspective of effective drug treatment in prison, he argues that prison health care systems are to respond to three main prison healthcare principles : the principle of equivalence of care, the integration of prison health in the general health care system and the independence of prison medical staff.

“One of the most important, certainly, principle for the effectiveness of drug treatment interventions in prisons is that of independence of the medical profession. So, prison doctor should not be the doctor of the prison, but it should be the prisoners’ doctor”

Interview with Denis Huber, Executive Secretary of the Pompidou Group

Interview given in April 2021

What is the Pompidou Group and what does it stand for?

The Pompidou Group is the Council of Europe’s cooperation platform on drug policy, working to reduce drug supply and drug use as well as drug-related harms.

The Group was created in 1971 at the initiative of the French President Georges Pompidou. In the early 1980s, it was integrated into the Council of Europe. Today, the Pompidou Group is composed of 41 member states, mainly from Europe but also from the Americas, North Africa and Middle East. It supports the governments in the delivery of cost-effective and humane responses to drug-related challenges.

We strive to ensure a human rights approach to drug policies. In the context of prison health, this translates into categorical opposition to the death penalty for drug-related offences in respect of the right to life. It also refers to the opposition to inhuman or degrading treatment or punishment of people who use drugs, for example through ensuring access to basic health care and treatment in prisons to avoid human suffering.

Our approach also applies to the promotion of good democratic governance principles indrug policy and includes efforts to reduce the stigma of people who use drugs in line with the principle of non-discrimination.

How does the Pompidou Group cooperate with civil society?

The Pompidou Group considers civil society a major actor in the field of drug policy. Civil society’s involvement in policy planning, decision making and delivery is one of the pillars of a democratic society, as it brings relevant expertise, added value and practical applicability. Therefore, the Pompidou Group promotes the important role of civil society in the development and implementation of drug policies.

In its 2015 policy paper on the interaction between government and civil society organisations, the Pompidou Group provides guidance and tools for decision-makers and policy managers in developing practical and meaningful ways for cooperation in the field of drug policy.

Most recently, in March 2021, the Pompidou Group released a publication on COVID-19 and people who uses drugs. One of the aims of this document is of course to give voice to people who use drugs in the difficult times of the pandemic. It also highlights the daily fight of the numerous social workers who deliver harm reduction and treatment services for them under the current crisis conditions, in full respect of their right to a healthy life.

What are the objectives of the Pompidou Group’s Criminal and Justice Prison Programme?

The Programme addresses the rights of detainees in the context of substance use and promotes access of people who use drugs to specialised care in prisons. The same way (as much as possible) as these are available in the community. It started in 2012 and it covers Eastern and South-East European countries. The overall aim is to improve public health care and reduce drug dependence and drug-related harm in prison through improving service delivery.

These goals are achieved, on one hand, through enhancing the skills of health professionals, social workers and correctional staff working with drug-using detainees. On the other hand, we work with prison authorities to develop policies and programmes for social reintegration after release and alternatives to imprisonment. More generally, the programme is expected to contribute to reducing recidivism and overcrowding in prisons, improving the well-being of people and reducing the transmission of blood-borne diseases among the prison population, the spread of which poses a serious challenge in Eastern

Among the concrete results we have achieved, I would mention the introduction of the first in-prison therapeutic community in the Republic of Moldova. I believe this programme is a great example of the meaningful involvement of civil society organisations and former beneficiaries of the programme in service delivery. In Ukraine, the Programme introduced drug treatment and prevention tools such as the family conferencing method in juvenile prisons, as well as opioid agonist treatment in prisons. In Georgia, we supported efforts in elaborating policy measures for alternatives to imprisonment for drug use.

This Programme includes the establishment of comprehensive drug treatment systems. Can you tell us more about this?

Through the Criminal Justice and Prison Programme, we indeed advocate for the development of comprehensive drug treatment systems in prison. Such comprehensive approach should encompass drug-free treatment such as therapeutic communities, medication-assisted treatment and harm reduction measures (like the opioid agonist treatment, needle and syringe programmes and naloxone for preventing overdose) and lastly the option of psycho-social assistance such as counselling, family conferencing methodology or cognitive behavioural therapy.

Such a system must be based on adequate provision of information and screening. This includes providing information on the range of services that are available in the prison and the local community for testing, treatment, safe use and overdose prevention, and information about ways of ensuring the confidentiality of personal information. An initial assessment for substance use disorders and related risks should also be available upon entry to prison.

When we talk about a human rights-based approach to treatment, it also means that it is the needs and choice of the individual, the patient, who should be at the centre of interventions.

Finally, can you draw us some perspectives for the future?

We have been involved in the development of comprehensive drug treatment systems in prisons in Eastern and Southeastern Europe for the last 10 years and we will continue on this path.

This year we increased our attention to building cooperation and capabilities at the regional level in South-East Europe. We are working together on three main angles: introducing and improving treatment structures for drug-dependent inmates in the region; enhancing knowledge and skills of correctional staff on substance use through training; and improving continuity of care upon entry to and release from prison.

As part of this work, we are planning to take a closer look at the implementation of international standards on drug treatment in prisons. Several international guidance documents on prison health principles and standards on drug treatment already exist. Our discussions at the regional level will focus on practical ways of making these standards operational, and making them work in practice. This also entails identifying the essential elements and requirements of a comprehensive drug treatment system,
as well as prioritising the implementation of these when the resources and supporting structures we have at hand are limited.

We are also living an exciting year concerning the future of the Pompidou Group. In 2021 the Group celebrates its 50th anniversary and we are using this momentum to finalise the revision of its founding status. We operate in a fast-evolving environment that is the drugs field and our goal is to make the Pompidou Group fit for the current and future challenges of drug policy. One major point of this process is the extension of the Group’s mandate to encompass addictive behaviours which are related to licit substances (such as alcohol or tobacco) and new forms of addictions (such as Internet gambling and gaming). We also intend to make the respect and promotion of human rights in designing, adopting and implementing drug policies a statutory mission of the Group, while reinforcing cooperation with Council of Europe entities and civil society organisations.