Substance use characteristics, health risk practices and associated factors among people imprisoned in Catalonia: a cross-sectional study.

Introduction: There are gaps in the available knowledge about substance use and risky practices among prison inmates witch we proposed to clarify in order to improve interventions. Material and method: We conducted a specifically adapted survey with 178 potential users imprisoned in the Brians 1 Prison of Barcelona. We applied a snowball sampling method, with peers as privileged access interviewers, which is particularly recommended to bring out hidden information. Results: 74.7% of participants admitted to excessive use of addictive substances throughout their life. In the last 6 months in prison, 75.8% accepted that they had used drugs, while 18.5% injected them. 36.4% of the latter group participated in the needle exchange program (NEP) of the facility and 54.5% acknowledged that they shared the needles. Spanish people (adjusted odds ratio (AOR = 4,79), recidivists (AOR = 2.67), penalised individuals (AOR = 2.70) and those involved in serious transgressions of prison regulations (AOR = 3.01) showed greater probability of substance use in prison. A longer sentence (AOR = 1.13), having undergone treatment for drug problems (AOR = 3.84) and being a carrier of blood-borne infections (AOR = 3.95) were linked to intravenous drug use. Injectors in the NEP were predominantly women (66.7%) and were more interested in caring for their health (90.9%). Discussion: The study reveals use of addictive substances and health risk practices among inmates in Catalonian prisons, despite their exposure to prevention policies mainly focused on abstinence; relates health risk behaviours to marginalization processes within the institution, and then consider the need to extend the scope of harm reduction interventions and to reinforce its appeal by incorporating the users' perspectives on the issue.