Using wastewater analysis to measure the prevalence of prison drug use and the effectiveness of prison drug use supply reduction strategies

Drug use by prisoners is a significant problem that is recognised worldwide. It has been linked to violence, assault, sexual assault, the spread of blood borne viruses, overdose, death as a result of overdose, and recidivism. In response to this problem Australia has implemented the National Corrections Drug Strategy 2006-2009, a strategy under which numerous supply, demand and harm reduction methods are used by corrections facilities to combat drug use by prisoners. In Australia, mandatory drug testing (MDT) is the most commonly used intervention. However, the effectiveness of MDT continues to be questioned. More significantly, MDT is reported to create unintended consequences that can negatively affect prisoners, the prison environment, and the wider community. What adds a further layer of complexity to this issue is that from a human rights perspective, the unintended consequences of MDT raise questions about its encroachment upon two internationally recognised human rights: the prohibition against self-incrimination; and the right to security of the person. In an effort to adequately address prison substance use, the need for an effective drug-monitoring system has been highlighted. The issue here is that because substance use levels cannot be measured accurately, a proper evaluation of the current strategies cannot be carried out. This has important implications not only for future policy responses, but also for the cost-effective distribution of both resources and funding in the corrective services sector. Moreover, the fact that drug use impedes the rehabilitative goals of incarceration, means that some individuals may return to the community with a greater risk of reoffending. The focus of this thesis is to analyse samples of prison sewage water to accurately measure the levels and types of substance use that occur within a prison facility. Since its inception, this method, which is called wastewater analysis (WWA), has been used to measure substance use in large populations. However, nowadays its application to specific sites and smaller populations is becoming more common. In applying WWA to the central prison in Tasmania, this thesis seeks to answer three questions: (1) can WWA be used to effectively measure the levels and types of substance use that occur within the facility?; (2) can WWA be used to examine the use of two prescription substances known to be subject to misuse and diversion?; and (3) can WWA be used to evaluate the effectiveness of MDT to monitor and measure levels of prison substance use? As part of this study, samples of wastewater were collected for three periods of 7-12 days during 2012. These samples were analysed for 12 target substances by a laboratory in Queensland. Pharmaceutical prescribing data were obtained from the prison's healthcare centre to examine the potential misuse of methadone and buprenorphine. Data from the prison's MDT program were obtained to evaluate the effectiveness of MDT to monitor levels and types of substance use within the prison. This is the second study in the world to successfully apply WWA to a prison facility. However, it is the first to apply a criminological and legal lens and it is the first Australian study of its kind. The results reveal that not only does WWA have the potential to act as a drug-monitoring tool, but it also has the capacity to detect and monitor prescription misuse. Significantly, the results also suggest that WWA has the potential to measure the effectiveness and cost-effectiveness of current supply reduction measures. This thesis makes a novel and significant contribution to two areas of knowledge. First, it adds to the literature surrounding the use of WWA and its application to both a specific site and a defined population. Second, it provides a tool for conducting criminological studies in the prison environment. The ability to accurately measure substance use in this setting provides a reference point so that comparative studies can be carried out. This includes an evaluation of the most effective and costeffective drug-intervention methods such that drug treatment programs can be improved, and the rehabilitative goals of incarceration can be better attained. In this respect, it also raises important questions regarding the use of these strategies in the prison environment and their compliance with internationally recognised human rights.