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Education And Debate

Prison rights: mandatory drugs tests and performance indicators for prisons

BMJ 1996; 312 doi: (Published 01 June 1996) Cite this as: BMJ 1996;312:1411
  1. Sheila M Gore, senior statisticiana,
  2. A Graham Bird, consultant immunologistb,
  3. Amanda J Ross, statisticianc
  1. a MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR
  2. b Immunology Department, Churchill Hospital, Oxford OX3 7LJ
  3. c MRC-BIAS, Centre for HIV Research, Edinburgh EH9 3JN
  1. Correspondence to: Dr Gore.
  • Accepted 10 May 1996

Mandatory drugs testing of prisoners applies throughout England and Wales. Data from the 1995 pilot study in eight prisons show that the proportion testing positive for opiates or benzodi-azepines rose from 4.1% to 7.4% between the first and second phase of random testing and that there was a 20% increase over 1993-4 in the provisional total of assaults for 1995. Interpretation of these data is difficult, but this is no excuse for prevarication over the danger that this policy may induce inmates to switch from cannabis (which has a negligible public health risk) to injectable class A drugs (a serious public health risk) in prison. The performance indicators for misuse of drugs that are based on the random mandatory drugs testing programme lack relevant covariate information about the individuals tested and are not reliable or timely for individual prisons.

Introduced in February 1995, mandatory drugs testing of prisoners1 now applies to all prisons in England and Wales, but information from the mandatory drugs testing pilot study in seven men's prisons and Holloway women's prison2 has not had independent scrutiny. Random mandatory drugs testing has been promoted in England and Wales as “a means of gathering information.”1 In Scotland, where the use of injected drugs and prevalence of HIV infection in prisons has been carefully researched,3 random mandatory drugs testing has been seen as a punitive response4 when urgent public health action was needed.5

The performance indicators that the prison service proposes to introduce for drugs misuse are based on its random mandatory drugs testing programme: every establishment will be required to test a minimum number of prisoners each month and the percentage of inmates testing positive for each type of drug will be monitored. Methodological issues6 bedevil comparisons between and within institutions. Even …

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