Side Event: Efficiency of Treatment and Rehabilitation Interventions for Drug Dependents in Prison

Organized by the Government of Georgia, and the European Union##

Drug Dependents in prison 

 

Ms Sarajishvilli, MInistry of Justice, Georgia:

Head of the international law department and secretary of the interagency council for combating drug abuse in Georgia – this platform designs the country’s policy against drugs. 

The penitentiary system was not part of the justice system for almost 10 years. Before it had been a separate ministry, but now penitentiary and probation is under the Ministry of Justice. 

 

 

Thomas Carter, Project Leader (UN):

We value the close cooperation with Georgia. One of the major accomplishments is the drafting and implementation of the first programme in prisons. Treatment of drug addicts within prisons has been a global issue. This programme is focused on harm reduction, social reintegration and prevention of recidivism. It strives to protect the dignity and human rights of prisoners. The EU welcomes Georgian’s initiative of adopting this programme. Drug trafficking undermines institutions and threatens public health – fighting this phenomenon should not be an isolated one. 

 

Ms Inga Sarjveladze, Special Penitentiary Service, Head of the Department on Rehab-Resolution of inmates: 

There are 15 prison units and 10,000 prisoners in a country of 3.17 million. This is our model of the drug rehabilitation prison system. As soon as a drug addict enters a prison they are identified and immediately referred to medical assessment, followed by either detox,  a replacement programme, abstinence programme, and/or a rehabilitation programme. The first step of the newcomer: as soon as they arrive in prison, they receive a medical service with screening, including suicide risk and mental health screening. The next step is ‘estimation’ which includes risk and needs assessment. There are three concerns for addictive behaviour and if the risk factor is high then a psychologist immediately begins working with the prisoner. We use the Alcohol, Smoking and Substance Involvement screening test, provided by the WHO. Our rehabilitation programme: firstly we offer a 12-steps programme over a 6 month period. In 2018 we decided to establish an alternative programme based on CBT over a 6 month period. This was supported by the EU Act and Spanish experts. This was initially piloted in four prisons in 2018. In the criminal law of Georgia, rehabilitation services are divided into different types of programmes, including labour/employment, main rehabilitation programmes and supportive programmes. There are also self-help groups – we agree this is a helpful factor for addicts. There is also space for family members to be involved in the rehabilitation process. It is important to help improve relationships for drug addicts with their friends and family. The ‘release’ stage of the rehabilitation process involves multifaceted elements to ensure the person does not relapse. They are provided with a release plan, transitional management and further accommodations to manage transition.

 

Ms Tatia Khocholova, Head of the National Agency for Crime Prevention, Enforcement in Georgia:

For the agency it is quite complex work. One of the main activities is for the elevation of the beneficiaries, focusing on rehabilitation and resocialization of the person. This is a complex process. There is a mutli-disciplinary group that works with one beneficiary. There is implementation of the juvenile referral process when working with young offenders. From 1 Jan 2020, a juvenile referral centre was established, where systematic complex work has begun with children under the age of 14 – the main aim is to prevent crime and to coordinate multi agency cooperation between the Ministry of Justice and the Ministries of Internal Affairs, Education, and Health. One of the main programmes is diversion. This is an alternative mechanism of prosecution. If a child commits a crime, we use an alternative to prosecutions and instead of sending them to prison we offer volunteer work, visits to psychologists, social workers. The social worker works with the young offender and the family too. Re harm risk – an individual rehabilitation plan is determined based on the harm risk and the likelihood of falling into addiction. Rehabilitation programmes- a model can be carried out both individually and within a group. The main programme for young people is promoting healthy lifestyles in adolescents with antisocial behaviour. It is worth mentioning our cooperation with local NGOs. The challenges we face include insufficient resources, complex approaches, low level of awareness, frequent cases of drug experimentation amongst adolescents.

 

 

Ms Valeria Elefterie, Chair: I am glad to hear that Georgia puts the individual at the centre, because not one size fits all. And that their programmes are founded in high quality and scientific sense as well as taking into consideration vulnerable groups. 

 

Q&A#

 

Q: What are the key challengers for a country like Georgia to improve rehabilitation approaches for drug dependent inmates. How can monitoring help to address this challenge?

 

Ms Khocholova:

Key challenges are the human resources to provide the various rehabilitation programmes. Almost every service is in the capital, and so a challenge is to provide the services in rural areas. 

 

Ms Sarjveladze:

Another challenge is making the services available to all prisoners. The key challenge for us is the lack of human resources, particularly social workers and psychologists. 

 

Ms Ketevan:

We offer detox programmes in only 2 prisons, offering up to 6 months of detox. However, if we send a prisoner on this programme to another prison the are no longer able to continue it. We also unable to offer Opioid Substitution Therapy programmes for prisoners, but are hoping to implement this. OST is available to those out of the prison system, including those on the probation system, however once entering prison OST is no longer available. We are working to expand the OST programmes in all 15 prisons.  We are coming from a Soviet era and have that legacy of that, which is mainly the prison buildings themselves. We are aiming to rebuild these and they will be designed to meet the programmes’ demands and provide adequate treatment. 

 

  1. Mauritius drug enforcement: 

There are 10,000 prisoners in your prisons, what percentage of these are drug-dependent? 

 

Ms Ketevan:

We are not sure if this is available as it is difficult for us to collect this data currently. The national monitoring centre that was recently established we hope will have a key role in collecting and analysing data. For further clarification, the prison population is 9,700, however, this number not only includes those who have already been convicted but also those that are on probation. So 2000 of this number are on probation. When it comes to the segregation of those that are drug-dependent and those that have committed drug-crimes, in our country only a few of the prisoners have been convicted for their consumption of drugs alone. Our drug policies are very strict. Although this excludes the consumption of cannabis. Almost 98% of drug-related prisoners are those who have been involved in the drug supply. The challenge for Georgia is not having accurate data of the presence of drug-dependency amongst prisoners.

 

Q: I have noticed you keep using the word ‘addict’, do you not find this word very stigmatising? 

 

Mr Carter: We recognise people using drugs is an illness and it needs care. I agree there is a degree of stigmatisation and this work recognises the efforts to rehabilitate prisoners back into society. Those prisoners released from prison in their first two weeks are at the greatest risk of overdosing. The OST provision is a human right, and they should not be disadvantaged because of their situation. I had the pleasure to see the prisons in Mauritius which have similar challenges. 

 

Ms Valeria Elefterie – We recognise the issue of the name. [corrected herself in referring to those using drugs as addicts, instead acknowledges ‘drug user/drug dependent’ as appropriate and acceptable.

 

  1. Mauritius: 

How acute is the problem in Georgia?  And which type of drugs are a concern to you?

 

Ms Elefterie: The growing tendency just as everywhere else, drugs are now much easier to access, including on the darknet, it is more accessible. 

 

Ms Ketevan: The challenge for every country in the world is the means to how to get and produce the different types of drugs in prison. The decriminalisation of Cannabis: it is not a crime to consume up to 5g of Cannabis. We observe the amount of consumption is increasing. The other drugs that are popular are club drugs including MDMA and ecstasy. In terms of other drugs, we have had great seizures of heroin on the borders. But the accurate number I am not in the position to provide – ie. what is the number of the population using, how much has been seized. However, marijuana is certainly at the top of consumption, this is following the decriminalisation of cannabis in 2018 for adults up to 21 years old. 

 

Mr Carter: From the EU’s perspective: there is an increase in synthetics, and there is a small  impact of cocaine and heroin. Georgia is effectively on the heroin route between Afghanistan and Europe. But at a local level not hugely affected as a population. The world has evolved to facebook messages and whatsapp for selling drugs.

 

Q: Talking about the challengers, one of the biggest challenges is to properly address the needs of drug users with dual disorders. You mentioned in your presentation that you have a procedure to screen people in order to find out if they have mental health problems. What happens if the screening test has a positive result – what will happen to this person?

 

Ms Inga Sarjveladze:

We start interdisciplinary work with psychiatric support, including psychologists – offering one on one service. It is proper to get proper treatment with psychosis. 

 

Q: A question on the unit for children under 14- can this be considered as a special educational system?

 

Ms Khocholova:

In Georgia criminal responsibility begins from 14. For people under the age of 14 we did not have specialised programmes due to this, and so we identified that they need to create a prevention centre, working with the minister of education and health care. These are children that may not necessarily have families, and living on the streets. This is a specially adjusted educational programme for this age group. The biggest challenge is to provide the proper service once they graduate from the programme, and giving opportunity for education and vocational training. 

 

Q: Are children still using krokodil (desomorphine)?

 

Ms Ketevan:

No – but new ones have replaced it. This particular drug hasn’t been accessible since 2014 legally.

 

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