HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2026, 28: 195-208

‘Balancing human rights, access and governance’: European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) mission reporting on opioid agonist treatment and naloxone provision in European prisons

Marie Claire Van Hout, Ulla-Britt Klankwarth, Lannah Kent, and Heino Stöver

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-22

Summary: Background International human rights frameworks require drug use disorder treatment in prisons to be equivalent to community-based care, person-centred, non-discriminatory, and integrated across detention and release. Opioid agonist treatment (OAT) is an effective, evidence-based treatment for opioid use disorder. Access to and retention in OAT including naloxone can reduce drug-related harms, including blood-borne virus acquisition and overdose, in prison and on release. Whilst European monitoring provides data on the availability and coverage of OAT and naloxone in prisons, the findings of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) prison inspections have not been systematically examined. Methods A systematic review was conducted of CPT country mission reports published since 2020 for reference to OAT and naloxone. 34 periodic and 19 ad hoc reports were charted and analysed thematically. Five crosscutting themes emerged. Results CPT reporting indicates growing recognition of evidence-based OAT in prisons across Europe, but substantial and inconsistent gaps between policy and practice. Concerns included punitive approaches leading to severe withdrawals, reliance on medical detoxification, the interruption or withholding of OAT, restricted OAT eligibility to those engaging in prior community treatment, weak clinical governance, and limited choice of OAT therapies, and naloxone provision. Treatment was sometimes denied to particular prisoner groups (e.g. foreign nationals awaiting deportation). Collectively these practices undermine non-discriminatory equivalence of care and may constitute inhuman or degrading treatment. Conclusions The examination of CPT reporting reveals continued implementation challenges in OAT and naloxone provision in European prisons. Achieving meaningful equivalence of care and respecting the rights of detainees requires universal and timely OAT access, therapeutic choices, strengthened clinical governance, and integrated prison-to-community pathways. Continued CPT, national inspectorate and clinical audits are essential to ensure minimum standards are upheld.

Keywords: Prison; Opioid Agonist Treatment; Methadone; Buprenorphine; Naloxone; European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment