Substitution therapy for drug addicted detainee denied

EGMR: Bavaria has treated addicts in prison inhumane
Long-term drug dependent offenders must be granted a medically necessary replacement therapy in custody. This was decided by the European Court of Human Rights (ECtHR) in a judgment pronounced on Thursday, September 1, 2016, thus proving that a heroin-dependent former prisoner of a Bavarian correctional facility was right (Ref .: 62303/13). The Strasbourg judges complained that the German courts had not sufficiently examined whether the man was medically dependent on substitution therapy to alleviate his health complaints.

(Image: peshkova / fotolia.com)

The 61-year-old severely handicapped complainant has been addicted to heroin since 1973 and HIV-positive since 1988. From 1991 to 2008, the drug addiction of the man was treated as part of a replacement therapy with a heroin substitute. When the man was sentenced to six years' imprisonment for drug trafficking and was detained at the Kaisheim prison in the Donau-Ries district, he had to interrupt the substitution therapy against his will.

While in prison, he was treated at times in a Bavarian drug rehabilitation clinic, but there was only a so-called "cold withdrawal" made. The original replacement therapy did not continue.

In June 2011, he applied for a substitution treatment. Only this can alleviate his chronic pain, so the drug addict, who referred at the same time to appropriate guidelines of the German Medical Association. Alternatively, he requested that an independent specialized specialist in addiction check the medical need for substitution treatment.

The district court of Augsburg and the Higher Regional Court of Munich rejected this and said that the treatment was neither medically necessary, nor is this provided for in the Bavarian Prison Rules.

Only after the release from prison was the substitution therapy of the complainant continued, as it had been before the entry into prison.

The ECtHR ruled that the drug-dependent complainant was treated inhumane and degrading and the German courts violated the European Convention on Human Rights. It is true that states have some room for maneuver on how to ensure the health of detainees.

Here, however, there were very clear indications that substitution therapy was medically necessary. For example, the 61-year-old had already received appropriate treatment for 17 years prior to his entry into prison. Also had been clear after the stay in the drug rehabilitation clinic that the long-term drug addict inmate was not cured of his addiction.

The Strasbourg judges also referred to a study by the Federal Ministry of Health, according to which substitution therapy is the best possible treatment for long-term drug addicts. This treatment is also carried out in prisons in individual federal states, but not in Bavaria.

The Bavarian authorities should have instructed at least one external doctor to verify the medical need for substitution treatment to the complainant, the ECtHR said. However, the judges did not award the addicted person a compensation for pain.

According to the German Society for Addiction Medicine, up to 30 percent of all prisoners in Germany are dependent on illegal drugs such as heroin. While in federal states such as Bremen, Hamburg and in parts also in North Rhine-Westphalia, a substitution therapy in detention is made possible, pass in Bavaria and the East German states despite the current guidelines of the German Medical Association nothing. The result is an illegal drug use in custody, combined with the risk of hepatitis and HIV infections.

END fle / mwo