Written evidence submitted by Camurus Ltd (PEC0009)

Context

In the wake of prison overcrowding, and Government commitments to provide 20,000 additional prison places by the mid-2020s, the Public Accounts Committee has launched an inquiry on capacity in the prison estate.

The Committee’s 2020 report on improving the prison estate found that the Prison Service had been operating hand to mouth, by reacting to immediate crises rather than developing a long-term strategy for the prison estate, with just 206 new prison places delivered out of 10,000 promised by the year of the report. It further warned that many prisons were crowded, unsafe and with dangerously high levels of violence and self-harm, while the MoJ had failed to protect taxpayers’ interests through its naive approach to the outsourcing of facilities management services.

The National Audit Office’s (NAO) report on increasing the capacity of the prison estate to meet demand considers progress in the planned expansion of the prison estate and oversight and management of recent pressures on prison capacity. It also looks at how Government is modelling, understanding and planning for the number and type of prison places it needs. The Public Accounts Committee is now looking to gather evidence on prison capacity and the steps to alleviate it.

Response structure

Camurus submission to Public Accounts Committee’s inquiry on prison estate capacity, January 2025

Overview

1. Camurus is a pharmaceutical company working to improve outcomes in opioid dependence treatment. We work with drug treatment services across the UK, both in the community and across the prison estate.
2. We are committed to supporting the development of a system that enables people living with drug dependence to choose the best treatment for their needs, from the full range of treatment and support options, regardless of whether they receive treatment in prison or in the community.
3. We have worked extensively with drug treatment teams working across the secure estate in the UK, as well as those with lived experience of drug treatment in prison. This engagement has provided us with significant insight into the day-to-day challenges of supporting people living with drug dependence across the secure estate. It has also provided us with an understanding of the importance of effective and accessible drug treatment in the rehabilitation process in the criminal justice system.
4. Our recent work has included a comprehensive report focusing on women’s access to drug treatment services in the community and across the prison estate, informed by those working in prisons and women with lived and living experience.
5. We are currently undertaking a project to explore the gaps and challenges in the criminal justice system as it seeks to meet the needs of people with drug dependence. This work will be informed by a roundtable attended by drug treatment experts, leaders in the criminal justice system, and people with lived experience, to build consensus around system-wide reforms.
6. It is on the basis of this experience that we are pleased to provide this submission to the Public Accounts Committee.

Context

7. Demand for prison places has increased rapidly over recent years, by 10% between July 2021 and July 2023, and supply of much-needed prison infrastructure has failed to keep pace.[i] As a result, the prisons are operating at near maximum capacity, as high as 99.7% in the adult male estate.[ii]
8. Overcrowding has several implications for the conditions within prisons and rehabilitation services for people while detained. It can lead to diminished safety, and limited access to health and wellbeing services including drug treatment.[iii]
9. Addressing these concerns across the prison estate requires interventions to increase capacity but also, critically, reduce demand. To achieve this, it will be essential to break the cycle of offending; between April 2020 and March 2021, 38% of adults released from prison reoffended in the 12 months following their release.[iv] Improving access to rehabilitation services can work to stem rates of reoffending and alleviate concerns over prison capacity.
10. Drug dependence is a critical consideration in the criminal justice system; more than 50% of people in prison are estimated to be dependent on drugs.[v] Evidence shows that acquisitive crimes, such as burglary and robbery, are disproportionately committed by individuals with heroin or crack cocaine dependence, who are responsible for nearly half of all such offences.[vi] Rehabilitation strategies targeting this cohort must be central to any efforts to ease capacity challenges.
11. Short custodial sentences can be ineffective at providing meaningful rehabilitation for those with a substance use treatment need. Nearly 75% of individuals receiving drug treatment in prison are incarcerated for less than six months, and many for less than one month.[vii] Such brief sentences can interrupt ongoing community treatment without allowing enough time to establish or complete prison-based rehabilitation.[viii] This can lead to disrupted care, unmet treatment needs, and increased likelihood of reoffending, exacerbating the pressures on the prison estate.
12. These issues are particularly acute for women in the criminal justice system, who receive a disproportionate number of short sentences compared to men. In 2021, 41% of female offenders who were given custodial sentences were sentenced for three months of less, compared with 26% of men.[ix] Sentences of this length do not allow for enough time for drug treatment programmes to be effective and can disrupt any treatment and support they are already receiving in the community.[x]
13. In contrast, treatment in the community has been shown to be effective in supporting people to manage their dependence and reduce their risk of reoffending. Public Health England found that, following a two-year period of community drug treatment, the number of reoffenders was reduced by 44%, resulting in a 33% reduction in offences committed.[xi] For those that are sentenced to prison, it is critical that they are given the support and resource to access rehabilitation services, such as education, vocational skills, trauma-informed care, and critically, drug and alcohol treatment.
14. Drug treatment services, both in the community and within prisons, aim to address the underlying causes of criminal behaviour. When done effectively, these services can be a critical tool in reducing the risk factors for reoffending, in turn reducing pressures on prison capacity.[xii]

Effective community drug treatment

15. Accessible and effective community drug treatment services play a vital role in breaking the cycle of offending, offering support to individuals before they enter the criminal justice system and providing alternatives to custodial sentences for those already within it.
16. Community drug treatment programmes, such as Drug Rehabilitation Requirements (DRRs), can also form a central component of alternatives to custodial sentences, offering a rehabilitative approach that addresses the underlying causes of criminal offending. DRRs also offer a cost-effective alternative to short custodial sentences. The most expensive community order costs approximately £5,000, compared to £11,000 for six months of incarceration.[xiii] Expanding the use of these evidence-based programmes can alleviate pressures on the prison estate while delivering better outcomes for individuals and society.
17. Research consistently shows that community-based alternatives to custodial sentences, when combined with structured treatment plans, are more effective at reducing reoffending rates, fostering long-term recovery, and benefiting the wider community.[xiv] Community sentences allow individuals to access tailored, trauma-informed interventions that address the root causes of drug dependence. For example, drug treatment programmes associated with DRRs have been shown to substantially reduce the reported use of opiates, from 75.7% of offenders using opiates at the start of their treatment to 53.5% after approximately one year.[xv]
18. In contrast, short custodial can fail to adequately meet substance use treatment need, as they are often not long enough to implement a successful drug treatment programme for people while incarcerated.[xvi] A lack of support while in prison can subsequently mean that individuals are released to the same environment and behaviours that led to their criminal offending prior to incarceration.
19. This issue is particularly significant for women. In 2019, 73% of women were issued custodial sentences of less than 12 months, compared to 55% of male admissions.[xvii] For women with substance use treatment needs, short custodial sentences can disrupt any care or treatment they may have been receiving in the community. Based on our work with drug treatment providers in community and prison settings, we have heard examples, where women were moved off their preferred medication due to unavailability in prison. This interruption can exacerbate existing trauma, undermine progress in treatment and reduce chances of successful rehabilitation.
20. By providing individuals with access to treatment, including evidence-based interventions such as opioid substitution therapy, community drug services can reduce the likelihood of individuals committing crimes to support a drug dependence habit and divert prolific offenders with drug and alcohol dependence away from reoffending.[xviii]
21. For those receiving treatment and support in the community following release from prison, drug treatment services also offer a pathway towards recovery. These services address the root causes of dependence through a combination of pharmacological interventions and holistic support, such as trauma counselling, housing assistance, and vocational training.
22. Reducing reoffending is a vital step for reducing pressures on prison capacity; but to achieve this, community drug treatment services must be well-resourced over the long term, with sufficient funding to expand their reach and capacity to deliver tailored support. They must also be fully integrated into the criminal justice pathway, both to allow comprehensive, holistic support through DRRs, and to ensure continuity of care when patients are released back into the community from the secure estate.

Effective rehabilitation in prison

23. For those who receive custodial sentences, prisons must offer an opportunity for rehabilitation, with drug treatment services playing a key role in supporting recovery and reducing reoffending rates. Effective rehabilitation can help alleviate pressures on prison capacity by breaking the cycle of reoffending.
24. The prevalence of drug dependence in prisons is significant, with around half of the prison population estimated to have a drug dependence.[xix]
25. When delivered effectively, prison-based drug treatment programmes can support people to manage their dependence on drugs and support them in their rehabilitation, which can substantially reduce reoffending rates. Studies show that individuals who complete rehabilitation in prison are 19 percentage points less likely to reoffend compared to those who do not receive adequate treatment.[xx]
26. To maximise their effectiveness, prison-based treatment programmes extend beyond drug treatment to include broader support services that address the interconnected challenges faced by offenders. Trauma counselling, mental health support, and vocational training are essential components of effective rehabilitation. When delivered in conjunction with medical interventions, such as medication-assisted treatment, this represents a holistic approach to care, which is vital to supporting sustainable recovery.
27. This additional support is particularly crucial for women in the criminal justice system. Women are overrepresented in drug treatment services in prisons. Despite making up 4% of the prison population, in 2022-23, women comprised 9% of those in treatment in adult secure settings, highlighting the significant need for treatment and support in womens prisons.[xxi] This support must extend beyond treatment for drug dependence, as women in the criminal justice system are comparably more likely than their male counterparts to have additional needs including mental health problems.[xxii]
28. Prison-based drug treatment programmes play a vital role in breaking the cycle of reoffending, in-turn reducing pressures on prison capacity. However, disparities in service access across the prison estate undermine their effectiveness; coupled with an absence of national treatment standards, prisoners experience a postcode lottery of care. [xxiii] Standardising drug treatment provision and integrating psychosocial support, such as trauma-informed care and skills training, ensures equitable access and better prepares individuals for reintegration into society post-release.[xxiv]
29. For those in prison with a substance use treatment need, effective rehabilitation relies on support before and after their incarceration. In particular, the transition from prison-based to community treatment is a critical point of vulnerability. In 2022-23, Only 43% of individuals successfully engaged in community drug treatment services within three weeks of release, leaving many without the necessary support to sustain their recovery.[xxv] Strengthening pre-release protocols, such as engaging community treatment teams prior to release and implementing resettlement strategies, can reduce treatment gaps and prevent relapse or reoffending.[xxvi]
30. Drug treatment services across the prison estate and in the community represent a critical element of the rehabilitation process for individuals with drug dependence. The treatment and support offered by these services can reduce risks of reoffending upon release. However, for services to work effectively, they must be properly resourced, offer equitable service delivery and be fully integrated to ensure that people can continue to access support when transferring in and out of prison. This inquiry must consider the critical role of drug treatment services across the prison estate, and their role in reducing reoffending and supporting people towards rehabilitation while incarcerated.

Conclusion

31. Reducing prison overcrowding requires innovative, evidence-based solutions that tackle the root causes of offending. Drug dependence must be seen as a key consideration in the criminal justice system, and effective drug treatment, both in prisons and the community, should be viewed as a vital tool for breaking the cycle of reoffending and easing pressures on prison capacity.
32. Investing in drug treatment services provides a cost-effective strategy to reduce pressure on the prison estate, enhance public safety, and support long-term recovery. Expanding and standardising these services across the secure estate, alongside robust community treatment options, can significantly alleviate demand for prison places and improve outcomes for people with a substance-use treatment need.
33. Camurus is committed to supporting the development of comprehensive drug treatment solutions that ensure equitable access to high-quality care. We urge the Public Accounts Committee to prioritise drug treatment as a core element of its inquiry into prison estate capacity, recognising its transformative potential for individuals, communities, and the justice system as a whole.