PRISON DRUG PROBLEM MAY BE DRIVING HEPATITIS EPIDEMIC

SCOTTISH prisons may be fuelling the country's hepatitis epidemic, a drugs
expert has warned.

Dr Laurence Gruer, addictions co-ordinator at Greater Glasgow Health Board,
says Glenochil prison - where 19 inmates contracted HIV and 15 were
infected with hepatitis B in 1993 - and other jails could be accelerating
the spread of hepatitis strains across Scotland.

Dr Gruer was commenting on a new survey which shows continued dangerous
levels of needle-sharing among drug injectors in Scottish jails.

The Scottish Prison Service was not doing enough to tackle the very high
number of inmates who continue or even start to take drugs behind bars, he
said.

"Prisons certainly could act as a driver for new hepatitis B epidemics.
Hepatitis B can more readily be transmitted sexually, and also from mother
to baby.

"So there is more risk of prisons acting as a driver for its spread in the
wider community. It is also fair to say that prisons would certainly be
contributing to the spread of hepatitis C.

"I am sure that the SPS isn't doing enough to provide education and drugs
services. It isn't because of lack of recognition of the problem, it's just
not seen as an urgent priority."

But the SPS denied that it was being complacent, and announced it was about
to start a pilot project at Greenock prison offering all new inmates
vaccination against hepatitis B.

Michael Mulford, a prisons service spokesman, said: "The proposition that
using dirty needles in prison is fuelling a hepatitis outbreak in jails and
beyond has no hard scientific evidence to back it."

Dr Gruer spoke after the publication of the 'Third Scottish Prison Survey',
for which 4,780 inmates were questioned. The survey shows that more than
650 prisoners admit to taking heroin behind bars in the last six months,
with 237 injecting the drug.

Nearly 200 shared needles and syringes making it almost inevitable that
they will infect each other with hepatitis C, a virus shared by an
estimated 70-80 per cent of Scottish drug injectors. Injectors are also at
high risk of contracting the less lethal hepatitis B - a disease that they
may sexually transmit to their partners in the wider community.

The risk of contracting HIV is lower, as prisons now provide needle
sterilisation tablets. Hepatitis is ten times more infectious than HIV.

At Glenochil, Inverness and Low Moss prisons and the National Induction
Centre at Shotts, all drug injectors are sharing needles.

"It is, I think, concerning that in Glenochil 100 per cent of injectors ate
sharing works [needles and syringes], as Glenochil was the place where in
1993 there was the first fully documented HIV epidemic in a prison anywhere
in the world," Dr Gruer said.

"The problem with prison is that there is evidence that some people will
start injecting in prison, with nothing better to do.

"The chances of contracting hepatitis C in prison if you have never
injected before are very, very high indeed.

"Works are likely to be shared with lots of people anyway, and there is no
adequate way of cleaning syringes that get pretty ancient and rusty.
Viruses can hang around in the nooks and crannies of these old needles."

Dave Liddell, the director of the Scottish Drugs Forum, said the prison
survey figures on needle-sharing were a big cause for concern.

"What we saw in Glenochil before was the very rapid spread of HIV among a
group that shared injecting equipment. Hep C is much more virulent than HIV
and the risks are very much greater.

"It may be that given the level of sharing in prison, prison plays quite a
strong part in the level of infection in Scotland."

The inmates most anxious to inject heroin were those who were suffering
serious withdrawal symptoms - particularly from NHS methadone.

Both Dr Gruer and Mr Liddell said the survey results made it urgent for
more prison doctors to consider continuing methadone prescriptions to drug
addicts who have been receiving it in the community.

Glenochil does prescribe methadone, but most inmates serving short
sentences are offered little or no help, a fact that has contributed to a
number of suicides.

"The absence of methadone prescribing is another major, major gap in the
prison approach to drugs, which they are very slowly coming around to
recognising," said Dr Gruer.

The one policy that would prevent the spread of hepatitis - providing
sterile needles and syringes in exchange for dirty ones - has been ruled
out because of the risk of infected needles and syringes being used as
weapons.

The prison survey showed that the drug users admitting to taking heroin
behind bars has risen from 9 per cent in 1994 to 31 per cent this year.

Checked-by: Mike Gogulski