Discontinuation of Adequate Opioid Agonist Treatment in Prison: A Violation of Human Rights

Abstract

Several examples from Germany indicate that the provision of opioid agonist treatment (OAT) to people living in prisons is rather fragementary. As prison healthcare is in the responsability of the Ministries of Justice in the 16 ‘Länder’ (states) the health care for opioid dependent prisoners is rather heterogenous, there are countries with almost no waiting list for patients and there are Länder with hardly any provision of this kind of treatment at all, which means that people who are in treatment will not receive a continuation. The European Committee for the Prevention of Torture (CPT) clearly stated that such a state of affairs is clearly not in compliance with the principle of equivalence of care. The Court also dealt with such a case and found that the physical and mental strain that the applicant suffered as a result of his untreated or inadequately treated health condition could, in principle, amount to inhuman or degrading treatment. The Court concluded that the failure to adequately assess the applicants’s treatment needs involves a violation of the prohibition of inhuman or degrading treatment (article 3 of the European Convention of Human Rights). This article is addressing the health inequality in prisons in the German federal states. The supply of OAT inclusive psychosocial support in prison is still inadequate and falls short of the therapy standard for people outside of prison. There is still a gap between the number of people living in prison in need of opioid agonist treatment and those receiving it, although benefits such as reduced risk of death in the post-release period, reduced risk of transmission of infectious diseases, and reduced reoffending have been shown.

Annexes

Table 1 People with opioid use disorder living in prison, who receive OAT. Overview of the individual German federal states ([13–18] and “Deutsche AIDS-Hilfe”)

Fig. 1

Global availability of OAT in the community and in prisons (Source: Harm Reduction International 2020) (Harm Reduction International (2020): The Global State of Harm Reduction 2020, 7th edition; pp. 16–17; https://www.hri.global/files/2021/03/04/Global_State_HRI_2020_BOOK_FA_Web.pdf)