[The drug addict in prison: Medical response and its limitations]

Over the past twenty years, the proportion of drug dependent inmates has risen dramatically in the prisons of Western Europe. In the Geneva romand prison, where about 30% of entries present problems of opiate abuse and dependence, treatment of withdrawal symptoms with decreasing doses of methadone over a period of 5-10 days has been available since 1974. The rational of this treatment policy is to limit immediately disabling symptoms during the stressful period following imprisonment, when the prisoner has to make important decisions concerning the criminal proceedings in which he is involved. On the other hand, methadone maintenance treatment is not provided within the prison, even for patients on methadone maintenance programs prior to imprisonment. This paper traces the evolution of withdrawal treatments with methadone over the period 1974-1987 in relation to the total number of entries, the age and sex distribution. During the three year period 1985-1987, we found that 6% of prisoners had received at least one course of withdrawal treatment. Many drug dependent individuals have repeated arrests: we found that 27% of those receiving withdrawal treatment in a three year period had more than one treatment. The frequency of suicidal gestures (including wrist slashing) and suicide was not greater during the withdrawal phase than at other times. A number of therapeutic approaches to opiate withdrawal now exist. No method seems clearly to be the treatment of choice within the prison environment. Arrest and imprisonment imply enforced withdrawal in a context of conflict and stress without the possibility of close medical supervision or psychological support.(ABSTRACT TRUNCATED AT 250 WORDS)