Behind bars and under the influence: understanding substance use among prison inmates in Sri Lanka

Introduction: Substance use among prison inmates is a challenge for many countries around the world and this problem has imposed great waste of human, financial capital which leads to several health costs and social harm to the general community. Objective of this study is to determine the pattern of substance use among prison inmates in Sri Lanka. Methods: The study design was a descriptive cross-sectional study. This study was conducted in 22 selected prison institutions in Sri Lanka covering the entire country. Multi-stage probability proportionate to size stratified cluster sampling method was used. The total sample used for the study was 1730 prison inmates. A validated interviewer administrated questionnaire was used for the data collection. Results: Among the 1730 prison inmates the response rate was 98.7%. The total study sample (1708) was consisted with 938 (55%) convicted prison inmates and 770 (45%) un-convicted prison inmates. The mean age of the study sample was 39.2 years, with a standard deviation of 13.6 years. The highest educational qualification of the majority (36.9%) of the study sample was passing grade 9-11. More than four fifths (1373, 80.4%) of prison inmates had ever used a substance while 335 (19.6%) prison inmates had never used a substance. Among ever users of substances 760 (55.3%) were convicted prison inmates. The most prevalent (81.6%) substance used by prison inmates before imprisonment (82.3%) as well as after imprisonment (19.2%) was cigarettes. Almost four fifth (79.3%) of prison inmates had used alcohol before imprisonment followed by betel (47.6%) and heroine (35.2%). Usage of all the types of substances have declined after imprisonment. More than one tenth (10.8%) of prison inmates had used heroine after imprisonment followed by betel (10.8%) and cannabis (2.7%). Thirteen prison inmates (0.9%) had used injectable non prescribed drugs following imprisonment. Among study participants 14.9% had newly started substance use after imprisonment. Conclusions: The habits of substance use among prison inmates before imprisonment shows a higher value compared to the general population. Significant number of prison inmates had continued their habits substance use even after being imprisoned considering the restricted environment within the prison institutions. Among prison inmates a significant number has started the use of substances for the first time in their life while they were imprisoned.