Cost implications of random mandatory drugs tests in prisons

Background Compulsory urine testing of prisoners for drugs, a control initiative, was introduced in eight prisons in England and Wales early in 1995. Despite no evidence of effectiveness, testing was extended to all prisons in England and Wales by March 1996. We consider the cost of testing. Methods We combined the costs of refusals, confirmatory tests, punishment of confirmed positives for cannabis or for class A drugs to estimate the average costs of random compulsory drugs testing. These costs were then compared to: i) the healthcare budget for a prison; and ii) the cost of putting in place a credible prisonsʹ drugs reduction programme. We then used Scottish data on incarceration and regional prevalence of injecting drug users to estimate the extent of the injecting drug use problem that prisons face. Findings Costs per 28 days of the random mandatory drugs testing control initiative in an establishment for 500 inmates where refusal rate is a) 10% or b) nil; and 35% of urine samples test positive, one tenth of them for class A drugs were estimated at between a) £UK22 800 and b) £UK16 000 per 28 days [a) $ US35 100 and b) $ US24 600]. This cost was equivalent to twice the cost of running a credible drugs reduction and rehabilitation programme, and around half the total healthcare expenditure for a prison of 500 which averaged £UK41 114 per 28 days [$ US64 860]. Major cost-generating events were the punishment of refusals–over one third of cost a)–and testing positive for cannabis-over 50% of cost a). In Scotland, around 5% of injecting drug users (IDUs) are incarcerated at any time: 5% of Lothianʹs drugs care, treatment and prevention costs and 2•5% of its HIV/AIDS prevention budget in 1993–94 amounted to £UK101 300 per annum–or £UK7770 per 28 days ($ US11 970)-and about 35% of monthly MDT costs. Interpretation We suggest that 5% of current resources for drugs prevention and treatment and for IDU-targetted HIV/AIDS prevention should be directed towards the prisons because in the prisons, where 5% of the clients are at any time, injectors have less access to harm reduction measures than on the outside.