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The prevalence of smoking among prisoners is exceptionally high and is often comorbid with alcohol and drug problems, mental illness and other health problems. This review paper summarises the literature and available research related to smoking prevalence and smoking cessation initiatives among prisoners and identifies areas of need for further research and intervention.This paper highlights three studies conducted in the New South Wales prison system which attempt to address these high rates of smoking including a feasibility study, a focus group study and a randomised controlled trial.The challenges of making systems-level changes to address these high rates of smoking are discussed including a recent National Summit on Tobacco Smoking in Prisons.Dissemination of research findings has assisted in highlighting the importance of tobacco smoking among prisoners and the need to develop culturally and setting appropriate smoking cessation initiatives for prisoners.As one of the most marginalised and socially disadvantaged populations in Australia, prisoners represent an important population to target for smoking cessation programs and interventions. This paper highlights a number of initiatives undertaken to address this problem and suggests directions for the future.

Harm-reduction approaches are more easily embedded in policy when drugs are legally regulated.

A Bill currently being considered by the Australian Parliament (the Disability Discrimination Amendment Bill 2003 [Cwlth]) would, if enacted, make discrimination lawful against people who are currently addicted to prohibited drugs and not currently in drug treatment. The government argues that the Bill is needed to keep the work and social environment safe, respond to community concerns, provide certainty to individuals and organisations, and force drug users into treatment. If enacted, we believe the Bill will infringe several national commitments to human rights, damage the wellbeing of family and other associates, and generate expensive litigation because of the difficulty of proving current addiction and current drug treatment; risk deterring drug users from seeking drug treatment and impair their ability to obtain employment and accommodation; represent a further attempt to reduce drug use by increasing the health, social and other costs of using illegal drugs, rather than assisting drug users to deal with their problem through health and social interventions that are less expensive, more effective and less counterproductive.

Journal publications and conference presentations on prison-based syringe exchange (PSE) programmes were identified by a comprehensive search of electronic databases. Experts involved with development and evaluation of current PSE programmes or policy were contacted for reports, documents and unpublished material. Spanish information on PSE was translated for this review. We identified 14 papers specifically on PSE programmes in Switzerland (six papers), Germany (four) and Spain (four). The first PSE programme started in 1992 in Switzerland. As of December 2000, seven PSEs were operating in Switzerland, seven in Germany and five in Spain. There have been six evaluations of prison syringe exchange programmes and all have been favourable. Reports of drug use decreased or remained stable over time. Reports of syringe sharing declined dramatically. No new cases of HIV, hepatitis B or hepatitis C transmission were reported. The evaluations found no reports of serious unintended negative events, such as initiation of injection or of the use of needles as weapons. Staff attitudes were generally positive but response rates to these surveys varied. Overall, this review indicated that prison syringe exchange programmes are feasible and do provide benefit in the reduction of risk behaviour and the transmission of blood-borne infection without any unintended negative consequences.