Cannabis use remains a challenge inside Indian prisons

Background and objectives Large-scale studies on the prevalence of substance use disorder among people in prisons from developing countries such as India are limited, despite a sizeable number of individuals lodged in prisons. The present study aimed to assess the prevalence of various psychoactive substance use among people in prisons in India, and to assess factors associated with psychoactive substance use in prison. Methods Seventeen prisons from 9 States representing different geographical regions of the country were selected. 7004 incarcerated people selected by systematic sampling were interviewed using a structured questionnaire. Results Majority were incarcerated for the first time (n=5372, 77%) and were under remand awaiting trial or sentencing (n=4537, 65%). The proportion of incarcerated persons with lifetime use of alcohol, cannabis, and opioids was 51% (n=3579), 20% (n=1383), and 11% (n=758), respectively. 21% (n=752) of alcohol users, 30% (n=411) of cannabis users, and 45% (n=340) of opioid users used alcohol, cannabis, and opioids respectively daily in the one month before their current imprisonment. 5.9% (n=412) used a psychoactive substance (including alcohol and illicit drugs) during their current imprisonment, most commonly, cannabis (3.9%, n=273). Multivariable regression showed that psychoactive substance use in prison was significantly associated with younger age [odds ratio (OR): 1.4, 95% confidence interval (CI): 1.1, 1.8], multiple imprisonment (OR: 1.6, 95% CI: 1.3, 2.0), cannabis use before imprisonment (OR: 5.5, 95% CI: 4.1, 7.4), and substance withdrawals inside prison (alcohol OR: 1.8, 95% CI: 1.4, 2.4, cannabis OR: 2.9, 95% CI: 2.1, 4.1, opioids OR: 3.1; 95% CI: 2.3, 4.2). Interpretations and conclusions The study documents high lifetime substance use among individuals in prisons in India and identifies various factors associated with substance use during current imprisonment.