Compared to the general population, people living in prison show a significantly higher prevalence of tobacco use. This article analyzes the causes and consequences of this phenomenon as well as existing deficits in tobacco prevention within German prisons and forensic psychiatric institutions. The high smoking rates among people in prison contrast with limited cessation services, insufficient nonsmoking protection and a lack of health support. Beyond consumption, cigarettes also serve as a social and structural element in daily prison life. International studies indicate that smoking bans in correctional settings can reduce second hand smoke exposure, although they are only sustainably effective when combined with robust cessation programs. The article highlights the need for comprehensive tobacco control strategies that integrate structural, organizational and individual level measures. It calls for tailored, gender and culturally sensitive smoking cessation and reduction programs for both inmates and staff, including education, individualized support, health-promoting infrastructures and systematic monitoring and evaluation. Ultimately, the article recommends a differentiated approach that combines health promotion with harm reduction, without uncritically adopting blanket smoking bans.

Inhaftierte weisen im Vergleich zur Allgemeinbevölkerung eine deutlich höhere Tabakkonsumprävalenz auf. Der Artikel analysiert die Ursachen und Folgen dieses Phänomens sowie bestehende Defizite im Bereich Tabakprävention in deutschen Justizvollzugsanstalten (JVA) und Maßregelvollzugseinrichtungen (MRV). Die hohe Rauchquote unter Gefangenen steht im Kontrast zu mangelnden Entwöhnungsangeboten, eingeschränktem Nichtraucherschutz und fehlender gesundheitlicher Unterstützung. Zigaretten dienen neben dem Konsumverhalten auch als soziales und strukturelles Mittel im Haftalltag. Internationale Studien zeigen, dass Rauchverbote in Haft die Passivrauchbelastung senken können, jedoch nur dann langfristig erfolgreich sind, wenn sie mit wirksamen Entwöhnungsprogrammen kombiniert werden. Der Artikel betont die Bedeutung umfassender Tabakkontrollstrategien, die bauliche, organisatorische und individuelle Maßnahmen kombinieren. Er fordert passgenaue, geschlechts- und kultursensible Angebote zu Rauchreduktion und -entwöhnung für Gefangene und Bedienstete, einschließlich Schulungen, individueller Hilfen, gesundheitsfördernder Strukturen sowie Monitoring und Evaluation. Abschließend wird ein differenzierter Ansatz empfohlen, der Gesundheitsförderung und Schadensminderung vereint, ohne pauschale Rauchverbote unkritisch zu übernehmen.

This book offers readers a well-founded yet accessible insight into professional social work in total institutions – an area of practice characterized by involuntariness, complex organizational structures, and the constant tension between support and control. The focus lies on correctional system, forensic psychiatric facilities, and juvenile detention as central fields of practice. Theoretical foundations, practice-relevant methods, and specific target groups are presented in a clear and illustrative manner. The book is rounded out by interviews with two experienced practitioners who describe their everyday professional lives in prison and forensic settings. The authors possess extensive expertise in social work and in the context of correctional institutions. This title is also available as Open Access.

BACKGROUND:There were 2227 drug-related deaths in Germany in 2023, corresponding to a rise of 12% over the previous year and a doubling over the course of a decade. Approximately 60% of these deaths were related to opioid consumption. In this narrative review, we discuss whether take-home naloxone (THN) might lower the mortality of persons with opioid dependency. METHODS:This review is based on pertinent publications that were retrieved by a selective search in PubMed. RESULTS:Seven observational studies of the mortality of persons with opioid dependency were included in the analysis. The available evidence for the intervention is on a low level. The studies indicate an overall lowering of mortality even though a significant reduction in drug-related deaths was not always achieved. It was concluded in a meta-analysis of 9 observational studies that 9.2% (95% confidence interval, [5.2; 13.1]) of the THN kits provided were actually used in the first three months to prevent opioid overdose-related death. In a Canadian study, 43% [41; 45] of the naloxone kits that were handed out over a period of 8 years were used and successfully prevented opioid overdose-related death. The latter figures suggest that the use of THN may have been systematically underestimated to date. CONCLUSION:Demonstrating the efficacy of THN is difficult because of the nature of the research topic. Current evidence implies that THN lowers the mortality of persons with opioid dependence. It is estimated that only about 1.3% of opioid dependent people have been provided with THN in Germany thus far. A major expansion of the provision and use of THN could contribute to a further reduction in opioid-related deaths.

BACKGROUND:States have a heightened duty of care owed to persons deprived of their liberty extending beyond the prohibition of torture and discrimination. Due to their complete reliance on the State, provision of adequate and quality nutrition in prison is a fundamental human right of those detained. Failure to meet the basic requirements of sustenance or deny/restrict food constitutes cruel, inhuman or degrading treatment, or even torture. METHODS:In order to examine global progress in protecting and upholding the rights of people living in prisons to adequate food and nutrition, we conducted a global socio-legal assessment of the United Nations (UN) Human Rights Treaty Bodies (Committee against Torture, Committee for the Rights of the Child, Human Rights Committee, Committee on the Elimination of Discrimination against Women); and the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) mission reporting on selected prisons since 2015. A comprehensive global search in English and French was conducted on the Council of Europe and the UN Human Rights Treaty databases. Following double screening, the final dataset of 237 reports spanning six continents (129 countries) was charted, tabularized against norms and standards (UN Nelson Mandela Rules, Bangkok Rules, the European Prison Rules) and analyzed thematically. RESULTS:Identified areas of concern and possible human rights violations documented by prison inspections centered on six key themes: geographies where the right to adequate food in prisons is of concern; inadequacy of food provision; poor food preparation practices, environmental health standards and disease; reliance on external support for food, corruption and exploitation; food as punishment and control measure; and vulnerability of special populations in prison. CONCLUSIONS:Despite international and regional human rights norms and assurances, prison inspections revealed that standards and adequacy of food and nutrition in prisons are often lacking due to resource scarcity, violence, punishment, inter-personal dynamics and corruption. UN Human Rights Treaty Bodies and CPT inspections must continue to thoroughly assess food standards and provision in prisons, ensure that the denial or restriction of food as punishment is prohibited, and include a focus on those with gender and age-related, religious and medical needs.

BACKGROUND:Within punitive, under-resourced, and male-dominated incarceration systems, the healthcare needs of incarcerated women are often overlooked and inadequately addressed. This study aimed to explore the healthcare needs and access to care among formerly incarcerated women in Israel. METHODS:We employed an exploratory-descriptive qualitative design, and interviews were conducted with eighteen formerly incarcerated women, purposively recruited from the Prisoner Rehabilitation Authority in Israel. Data were analyzed inductively using thematic analysis. RESULTS:We group our findings into three overarching themes, representing the time-points illustrated by the participants: before incarceration, during incarceration, and after release from prison. Our themes illustrate the complex physical and mental health needs of formerly incarcerated women in Israel, perceived impact of incarceration on health, challenges faced by women with disabilities, discontinuity of care across stages of incarceration, mistrust in the prison medical system, systemic barriers to accessing timely and appropriate healthcare, and post-release support. CONCLUSIONS:This study emphasizes the urgent need for a trauma-informed, gender-responsive, and continuity-based approach to healthcare within carceral settings. Our findings support the need for integration of prison health services into the national health system and call for system-wide, cross-sectoral, and human rights-based policy frameworks that promote prevention, rehabilitation, and adequate mental and physical healthcare in prison. Integrating prison healthcare within the broader national health system is crucial for reducing health inequalities by improving continuity of care, transparency, and the effective sharing and reporting of health information.

Conjugal visits in prisons remain controversial, with the bulk of literature concentrated in the United States. A socio-legal study mapped and described conjugal visitation rights and provision in prisons in the Council of Europe region, where over half a million are detained. A systematic search and socio-legal assessment of empirical literature, Committee for the Prevention of Torture (CPT) country missions, and European Court of Human Rights jurisprudence was conducted. No date restriction was applied. Despite Article 8 of the European Convention on Human Rights not guaranteeing a right for people deprived of their liberty to receive conjugal visits, many member states allow unsupervised intimate visits of varying duration (several hours/days) in prisons. Jurisprudence (from only male applicants) describes differences of permissibility based on type of detainee (remand, convicted, life imprisonment). Allowance and provision of these visits is for member states to decide ('the margin of appreciation doctrine'), with discretionary decisions by prison authorities based on maintenance of order. 35 CPT missions (1993-2023) document permissibility of conjugal visitation rights awarded to male prisoners and their spouses (to a lesser degree to intimate partners), with entitlement, frequency and duration generally dependent on security considerations. Only one CPT report refers to availability for female prisoners. Quality of provision of appropriate space for such visits varies. Empirical research is scant, with only one Spanish study referring to sexual relationships occurring during conjugal visits. The study illustrates the evolution of conjugal visitation rights across Europe, with the majority of CoE member states providing access to conjugal visits (generally to males) in prisons. Enhanced CPT scrutiny on the extent of accessibility and provision of conjugal visitation rights (including for women and homosexual partners) across Europe is warranted. Empirical and theoretical research on this aspect of European prison life and sexual well-being is equally important.

In 2018, in response to a lawsuit and years of civil society advocacy for prison-based syringe distribution due to elevated rates of injection drug use, HIV, and hepatitis C virus among incarcerated people, the Correctional Service of Canada (CSC) developed a Prison Needle Exchange Program (PNEP). Implementation of the PNEP has been slow and has faced significant critiques and challenges. As of early 2025, the PNEP is only available at eleven of forty-three federal prisons in Canada. Employing realist review methodology, an iterative process for synthesizing evidence concerning complex policy interventions, this article investigates CSC’s approach to, and implementation of, the PNEP. By recognizing broader social and institutional contexts, and through the integration of environmental considerations, realist reviews consider policy outcomes and implications in addition to efficacy. In our study, we draw upon 114 distinct documentary sources, comprised of scholarly articles, news media, program evaluations, and correctional policies, as well as 257 pages of federal government disclosures acquired through Access-to-Information requests. Together, these allow us to identify factors that have either facilitated or impeded the PNEP’s ongoing rollout and uptake among people in prison. Our results find that perceived risks regarding the circulation of needles and the use of a “Threat Risk Assessment” to determine eligibility function as major impediments to program efficacy. Findings also reveal incarcerated people seeking to enroll in the PNEP are frequently denied access and that the active involvement of correctional officers in enforcing compliance to program requirements acts to the detriment of participation. Results indicate the absence of meaningful confidentiality protections along with elevated rates of program discontinuation. Over roughly seven years of its existence, the PNEP has had extremely low uptake, particularly among women. We propose a significant revisioning of CSC’s PNEP to bring it into alignment with the best practices of similar prison-based harm reduction initiatives internationally, and according to professionally accepted standards of syringe distribution. The Canadian experience provides a cautionary tale to other jurisdictions considering implementing a carceral syringe program.