Harm Reduction in the Criminal Justice System

1. Harm Reduction in the Criminal Justice System Using CJS resources to promote safer drug and alcohol consumption and reducing harm to individuals, communities and peer groups in South Wales

2. Pathways into the Criminal Justice System in South Wales for adults {18+} • What do we understand as involvement with the criminal justice system for substance dependant individuals ? There are some obvious examples : • Police custody on arrest • Prison and YOI{age 18-22} on sentence • Community penalties/Probation

3. Pathways into the ‘Criminal Justice System’ in South Wales for ‘adults’ {18+} • There are some less well known pathways : - Testing on arrest for ‘class A’ drugs • Drug and alcohol arrest referral in custody • Mental Health Act • Drug Interventions Programme / IOIs • Detained Foreign Nationals • Sex workers { section 17}

4. A Changing Landscape • Traditionally the CJS has been about punishment and restriction of an individuals freedom to reduce harms associated with that individuals offending behaviour. • The role of drug and or alcohol use was acknowledged as a driver for offending behaviour but it was not until the development of Drug Testing and Treatment Orders {DTTOs} ,arrest referral schemes and the Drug Interventions Programme { DIP} that the CJS started to structurally address the need to engage people in treatment.

5. A Changed Landscape It is now accepted that ‘offenders’ with drug and/or alcohol problems will continue to offend unless they can access treatment and support quickly. This is a major change in strategic and operational thinking in a relatively short space of time. In South Wales this has led to the commissioning of an Integrated Offender Interventions Service from 1/4/2012.

6. Integrated Offender Interventions South Wales – What is it? Statutory CJS Treatment DRR/AAR/ATR Voluntary CJS Treatment Drug Interventions Programme Integrated Offender Interventions Service - South Wales

7. Integrated CJS Interventions – A Key Milestone An Integrated approach for all CJS treatment interventions for adults { 18+} will allow partners to widen their scope : the reduction of harm to self, communities and peers is no longer incompatible with the reduction in offending behaviour. How Could CJS agencies need to work to promote harm reduction in CJS settings?

8. Provision of harm reduction in CJS settings? Individuals become embroiled with the CJS in many ways – the vast majority of them will at some point find themselves in a police custody suite. This commonality of situation gives an ideal opportunity to potentially provide practical harm reduction interventions on a voluntary basis.

9. ‘Needle Exchange’ in Police Custody Many drug using individuals will try to discard evidence of drug use, including injecting equipment, pipes, foil etc, as well as the drugs. Custody staff will remove works that have not been discarded The majority will be released without charge or bailed. Currently arrest referral workers will offer brief interventions and they may well be drug tested if arrested and assessed for referral into treatment with DIP/IOIs. However, once released, these individuals may well want to ‘score’ and may well not have access to clean, safe methods of ingestion.

10. ‘Needle Exchange’ in Police Custody How can we ensure individuals leaving police custody have access to clean works and reduce harms to individuals? Many traditional NX sites in pharmacies or drug services are open for limited hours – many individuals are released outside of these hours with no access to clean equipment. How do we facilitate these individuals in a manner that complements existing NX provisions but does not criminalise or compromise them? The answer may well be to ensure NX vending machines are available in custody suites?

11. NX vending machines are available in South Wales custody suites Josie Smith { Public Health Wales} and Gareth Hopkins { DIP/IOIs Regional Manager South Wales} are working with South Wales Police to explore the possible provision of NX vending machines in custody suites. Individuals who ask for access to NX packs post release would be given a token and access to a wall mounted vending machine in the custody suite. The packs would include information of nearby NX services, drug services and harm reduction / safe use advice. The individual drug user will be in control of the process.

12. NX in Custody – a contradiction? A social justice response, rather than a criminal “justice” response, to drug use from within the core of the CJS?

13. Reality – ‘Harm Reduction’ already functions in custody suites • Brief interventions for drug and alcohol by DIP/IOIs drug and alcohol arrest referral workers • Provision of Mental Health support { EG : GOFAL} • Drug Testing on Arrest for ‘Class A’ drugs and a required assessment for treatment suitability in the community.

14. Strange Bedfellows? Harm Reduction and the CJS. Harm Reduction is a continuum, all the way from chaotic use to abstinence. It recognizes that abstinence may not be achievable by everyone. Understands that using/not using cycle is “normal” Meets people “where they’re at” by: • Encouraging safer use • Offering alternatives A harm reduction approach provides for people’s needs regardless of use and is compatible with a duty of care within the wider Criminal Justice System.

15. A future CJS mindset ? • An understanding that drug use is widespread and complex • A recognition that some people use drugs – usually for a reason • An acceptance that some people will always use drugs • The aspiration that no one should be denied service or access to service merely because they are using a drug, licit or illicit, or conversely, because they are in a criminal justice setting and not a ‘traditional’ health setting. • Seeks practical ways to reduce harm without necessarily eliminating use. • An acknowledgement of ‘offenders’ as people deserving of dignity and respect

16. Finally – some sobering statistics In Cardiff and Swansea police custody suites April-March 2011/12 c.6,500 individuals were drug tested on arrest and c.35%/2,275 returned a positive test for opiates, cocaine or both. More than 50% of these individuals were not in contact with or receiving any form of treatment or advice through local agencies on safer injecting or snorting/smoking/ingesting It would seem sensible these individuals, and thousands like them across the whole of Wales, have access to basic NX services and harm reduction advice at point of crisis? And, it is an aspiration of the wider CJS community and partnerships to explore how we can get the right interventions to the right people at the appropriate time to reduce harm and facilitate recovery, from within the wider Criminal Justice System.

17. Diolch Yn Fawr Thank You