Tuesday, June 29, 2010

Smoking ban in prison - no tick here

The government's decision to ban smoking in prisons is not an easy one to support from any kind of liberal perspective. Health-wise it aims to protect people from themselves and others, but it is also quite likely to endanger people, both guards and inmates. Total prohibition has practical staffing and enforcement implications that may render it unworkable. The only positive I am attracted to is the deterrent potential. Maybe it will reduce crime as would-be offenders try to avoid a custodial sentence? But if the ban is unenforceable in practice, then the deterrent effect will disappear.

The piece below, Should smoking be banned in prisons? is reasonably balanced and provides evidence against the bans but this is the case when no or little cessation aid was given.

The success rate for cessation programmes is however fairly low. Having just consulted the in-house pharmacist he thinks around 1 in 5 patients actually quits. And these are people who are well-motivated - who want to quit.

Read on and make your own mind up.

The rush to ban smoking in prisons has occurred in the absence of evidence regarding their overall effectiveness in terms of long term cessation once the individual is released into the community, whether it achieves its main goal of actually stopping prisoners smoking during incarceration, and the consequences arising from tobacco prohibition.

The major impact of smoking bans appears to be the creation of another black market and its associated problems—standovers and intimidation, trading sex for tobacco, smuggling and policing another illegal substance. In California recent reports indicate that packets of cigarettes are fetching $125 within the prison system. Prisoners, visitors and prison staff have all been caught smuggling and selling tobacco on the prison black market.

The effectiveness of a smoking ban is evidenced locally in the juvenile justice system where smoking is currently prohibited in centres throughout NSW. According to a recent survey of the state's juvenile (under 18 years) offender population, 86% smoked before coming into custody and 66% of regular (at least weekly) smokers before detention also smoked in custody despite the ban. Cropsey also reports the ineffectiveness of smoking bans in the United States where 76% of prisoners continued to smoke in prison following the ban and 97% smoked when released to freedom.

In 1997 Queensland opened the Woodford Correctional Centre in which smoking was banned. Three weeks after it was opened the prisoners rioted and attempted to burn down the new complex. A government inquiry found that the smoking ban was partly to blame.

From a human rights perspective, a ban on smoking in prison represents the erosion of yet another freedom to an already disenfranchised group. However, this is likely to appeal to those who favour all punitive measures as part of the punishment spectrum. This attitude was reinforced recently when public outcry followed media reports that a high profile prisoner in NSW was allowed to have a bread‐toaster in his cell!

Banning and quitting are not the same thing

Banning smoking is different from quitting. Requiring people to give up smoking while in prison will undoubtedly have health benefits but these benefits are lost if they recommence smoking after release. There is no evidence that simply banning smoking is effective in reducing smoking rates over the long term. Quitting smoking while in prison and maintaining this in the post‐release period would undoubtedly save prisoners' money and could be part of the overall rehabilitation process. However, this has yet to be demonstrated.

Demand for quit smoking programmes among prisoners is considerable. According to both the 1996 and 2001 inmate health surveys, around half of all prisoners report needing help to quit smoking. While demand is high, only eight (6%) individuals in 2001 had received help or treatment since coming into custody. Many jurisdictions require prisoners to pay for smoking cessation aides such as nicotine replacement therapy—this is an unrealistic expectation.

Smoking cessation programmes for prisoners are few and far between and little reliable evidence exists regarding their effectiveness if the medical literature is anything to go by. However, in 2003 we undertook a trial at Lithgow Correctional Centre of a multi‐component intervention for smoking cessation involving combined nicotine replacement therapy, a pharmacotherapy (bupropion, Zyban), and brief cognitive behaviour therapy. The results were promising with a 40% abstinence rate at 5 months. This trial has evolved into a randomised controlled trial (placebo versus nortriptyline) currently under way in the NSW correctional system.

Health has been remarkably absent from the debate on smoking in prison, but more recently a NSW government response to the inquiry into tobacco smoking in NSW recognised that smoking rates need to be addressed in vulnerable groups such as those with a mental illness, injecting drug users and Aborigines—all of whom are over‐represented in prisons. The challenge is likely to be formidable as these groups are probably the most difficult in which to reduce smoking rates, as many report commencing smoking from an early age and are therefore highly dependent on nicotine, have co‐occurring mental health and substance misuse problems and lack access to community smoking cessation programmes.

The future?

Prisoner populations comprise some of the most disadvantaged groups in the community and are recognised for high levels of smoking. With around nine million prisoners worldwide at any one time (more if younger offenders and those serving part‐time and community sentences are included) and significantly more passing through the criminal justice system each year, there is scope for accessing this group and initiating smoking cessation interventions as a means of impacting on the general community.

Smoking bans appear to have little impact on whether prisoners continue to smoke during incarceration and the long term decision to quit smoking following their release to freedom, thereby bringing into question the health benefits of prohibition.

Smoking bans create another black economy in prison and the problems this creates for custodial authorities who have to enforce the ban. These problems impact on all levels of the prison system from the debts accumulated by prisoners to buy contraband tobacco to the staff who have to enforce and police them.
While smoking bans are laudable and have a clear role in the public health arsenal, prisons cannot be viewed in the same light as restaurants, hospitals and office buildings. Clients [prisoners] cannot just pop out for a quick smoke or hold off the urge for a couple of hours; prisoners are locked in their cells for prolonged periods with little to do. By the same token, a non‐smoker prisoner cannot leave his/her cell to avoid the harmful effects of his/her cellmate's smoking. The solution appears to be a better management of this problem with guarantees that non‐smoker prisoners are not subjected to environmental tobacco smoke in cells, prison transport or communal living areas and that smoker‐prisoners have access to free interventions with proved efficacy. The challenge is likely to be considerable and the responsibility should not be left to prison authorities alone.

Perhaps the most important aspect of this issue is that any moves towards smoking bans in prison need to be implemented in tandem with cessation programmes proved to work for this population group and offer the prospect of long term cessation. This approach will also reduce the disorder often caused by hurriedly implemented bans.


Oswald Bastable said...

They have to do without a whole host of other drugs inside- tobacco is just one more.

The biggest plus I see is the removal of lighters.You would not believe how useful a tool they are for causing mischief!

Charmaine said...

Call me naive in my thinking but wouldn't this act as an incentive NOT to break the law.

Maybe it is time we took a leaf out of the past and made prison something you don't want to experience.

workingman said...


Why is this seen as a public health issue, which is what this article seems to concentrate on. Prisoners lose access to many things when they go to prison. Do we serve beer, do we supply P?

I am sure a black market will grow around tobacco, just it does for other drugs, alcohol, cell phones etc. So it will need to be controlled and enforced, and that is the failure at the moment on the other items.

I am also not in favour of supplying patches to ease the lack of tobacco, although I could accept this for current prisoners when the ban comes into force. For a limited time though.

Dave Christian said...

I can't support this ban.

The underlying issue is the purpose of imprisonment: Punishment, Deterrence, Rehabilitation, Public Safety.

As far as I'm concerned, it is all about Public Safety. The first three are all deeply unsatisfactory justifications for imprisonment.

We put Tigers in cages because they are dangerous to humans if they are free near human habitats. We then treat them will as much decency as we can muster in that context. It baffles me that people see dangerous people differently. I guess this goes back to the weird desire that people have to imagine themselves to be somehow exceptional and not just another animal.

Anonymous said...

It baffles me that people see dangerous people differently.

The problem is we let them out...

We put Tigers in cages because they are dangerous to humans

Actually no. Any actually Dangerous tiger - hell even a biting dog - we put down without a second thought

I agree with Boscowen: this would certainly deter crime and - more importantly - greatly reduce our spending on prisons. Hell we can't afford to splash out on the DPB, or Dole, let alone the pension - and prisions at, what, 100K per person per year, are far more expensive.

I guess private prison is an option for inmates who are able to meet that cost themselves. As for the rest - yep, I'm with Dave, treat 'em as dangerous dogs - captive bolt pistol to the back of the head on conviction (or better still, on "arrest")

Luke H said...

Oswald: They have to do without a whole host of other drugs inside

Um, no they don't. It is relatively easy for prisoners to get hold of all sorts of drugs in prison.

Even when people are locked up in a secure facility, the government cannot really control them. There is always a way around any law, rule or regulation.

Oswald Bastable said...

My point is that Corrections do not SUPPLY them with drugs.

Yes, you CAN get drugs inside- it isn't quite that easy and certainly isn't cheap.

With more political will and better resourcing, the drug supply can be cut right back. Body scanning, non-contact visits only, better perimeter patrolling...

Anonymous said...

With more political will and better resourcing, the drug supply can be cut right back.

More of my fucking money wasted on bludgers who cost $100,000 per year to keep!

We can't afford to keep spending on prisons, or benefits, or hospitals or anything.

We absolutely pay back the $300 MILLION Key and English are borrowing every fucking day.

At least privatise the prisons and let prisoners or their families pay for their damn upkeep!

Anonymous said...

I sincerely hope they intend to stop dishing out methadone to the junkies. Smokers can't have smokes, alcoholics can't have piss, so why should junkies get junk.
Murray M

Oswald Bastable said...

I'm also a fan of the idea that a day of no working is a day of no eating

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