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NEW DELHI — In one of the most comprehensive investigations into correctional healthcare in South Asia, a landmark multicentre study has revealed that nearly 6% of incarcerated individuals in India continue to use psychoactive substances while serving time behind bars.
The research, published in the Indian Journal of Medical Research, surveyed 7,004 incarcerated adults across 17 prisons in nine Indian states. Led by specialists from the National Drug Dependence Treatment Centre (NDDTC) at the All India Institute of Medical Sciences (AIIMS), New Delhi, the study exposes a profound gap between pre-admission substance use, managing severe withdrawal symptoms behind bars, and the accessibility of evidence-based medical treatment within the criminal justice system.
The findings highlight a urgent public health mandate: correctional facilities must shift from purely punitive approaches toward integrated clinical screening, medically supervised withdrawal management, and continuous addiction care.
High Rates of Prior Use Follow Inmates Behind Bars
To capture an accurate picture of substance use within the prison system, researchers from AIIMS collaborated with leading psychiatric centers across India, including the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bengaluru, King George’s Medical University in Lucknow, and the Central Institute of Psychiatry in Ranchi.
Participants were selected using systematic sampling between June 2019 and March 2020. To ensure confidentiality and minimize fear of disciplinary action, interviews were conducted privately by trained medical research staff independent of prison administration.
Substance Use Prevalence Among Incarcerated Individuals (N=7,004)
Lifetime Use (Prior to/During Incarceration):
Alcohol [#################### ] 51.2%
Cannabis [######## ] 19.7%
Opioids [#### ] 10.8%
Sedative-Hypnotics [## ] 4.2%
Active Use During Current Imprisonment:
Overall Psychoactive Use [## ] 5.9% (412 participants)
Cannabis [# ] 3.9%
Opioids [# ] 1.8%
Alcohol [# ] 0.9%
Note on Terminology: In this study, psychoactive substances included alcohol, cannabis, opioids (such as heroin and pharmaceutical painkillers), recreational sedative-hypnotics, cocaine, amphetamine-type stimulants, inhalants, and hallucinogens. Commercial tobacco was excluded from the primary prevalence definition.
While active use inside facilities was recorded at 5.9% (412 participants), prior usage was extraordinarily high. Prior to arrest, 21% of alcohol users, 30% of cannabis users, and 45% of opioid users reported daily consumption during the month preceding their imprisonment.
The Withdrawal Trap: How Unmanaged Symptoms Drive In-Prison Use
One of the study’s key insights is the direct physiological link between unmanaged withdrawal and continued illicit substance seeking behind bars.
Withdrawal refers to the physical and psychological distress that occurs when an individual with chemical dependence abruptly ceases substance intake. Symptoms range from acute anxiety, severe insomnia, and muscle distress to life-threatening complications such as seizures or delirium tremens.
The study revealed that when individuals enter prison dependent on substances without immediate clinical intervention, the intense distress of withdrawal becomes a primary driver for acquiring drugs inside:
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Opioid Withdrawal: Inmates experiencing unmanaged opioid withdrawal had nearly three times the odds (adjusted odds ratio) of using substances inside prison compared to those without withdrawal.
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Cannabis Withdrawal: Those suffering from cannabis withdrawal similarly showed nearly three times higher odds of active use during incarceration.
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Alcohol Withdrawal: Unmanaged alcohol withdrawal increased the odds of continued substance use by 1.8 times.
Furthermore, individuals who used cannabis in the month prior to arrest faced more than five times the odds of using drugs while incarcerated. Younger age and a history of repeated incarcerations were also strong statistical indicators of continued use.
“These findings underscore a critical gap in our intake protocols,” noted lead author Dr. Ravindra Rao, Professor at AIIMS’ NDDTC, in commentary regarding the study. “There is an urgent need for systematic screening, structured withdrawal management, and evidence-based addiction treatment implemented across all correctional facilities.”
Undertrial Vulnerability and the Healthcare Opportunity
The demographics of the study reflect broader structural realities within India’s penal system. According to Prison Statistics India, compiled by the National Crime Records Bureau (NCRB), approximately 75% of the country’s prison population consists of undertrial prisoners—individuals awaiting trial or sentencing who have not been convicted of a crime.
In the AIIMS-led study, 65% of participants were undertrials, and 77% were incarcerated for the very first time, with a median stay of nine months.
India Prison Population Structure
+---------------------------------------------------+
| Undertrials (Awaiting Trial/Sentencing) (~75%) |
+------------------------------------+--------------+
| Convicted Inmates (~24%) | Other (1%) |
+------------------------------------+--------------+
Because hundreds of thousands of individuals cycle through detention facilities annually, prisons represent a crucial, yet underutilized, public health interface. For many marginalized individuals, entering a correctional facility is their first encounter with formal clinical personnel.
A Clinical Shift: Treating Addiction as a Disease, Not Conduct
Public health experts and addiction psychiatrists maintain that managing substance use disorders inside facilities requires treating addiction as a chronic, relapsing brain disease rather than a moral failure or purely security concern.
In a comprehensive report on correctional mental health published by NIMHANS, researchers led by Dr. Pratima Murthy and Dr. Suresh Bada Math emphasized that undertrial detainees require immediate medical triage:
“Individuals entering custody require structured detoxification, comprehensive psychiatric assessment, harm reduction strategies, diagnostic screening for blood-borne viruses, and direct referrals to long-term clinical care,” the authors stated.
Evidence-Based Interventions in Prisons
To address substance dependence effectively, health authorities advocate for several medical strategies:
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Opioid Agonist Treatment (OAT): Administering supervised, prescribed medications such as buprenorphine or methadone prevents painful withdrawal and eliminates cravings. Pilot programs, such as those conducted at New Delhi’s Tihar Jail, demonstrated high treatment retention rates and sharp reductions in high-risk behaviors (e.g., needle sharing) during custody.
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Harm Reduction & Disease Screening: Because illicit drug injection carries severe risks of HIV, Hepatitis B, and Hepatitis C transmission, custodial systems must offer voluntary blood testing, infection management, and overdose prevention protocols.
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Continuity of Care Upon Release: The period immediately following release from prison poses the highest risk for fatal drug overdose due to reduced physiological tolerance. Transition planning that connects former inmates to community-based clinical clinics is vital.
Study Scope and Limitations
While this multi-centre study represents a major leap forward in Indian epidemiological research—offering private, systematically sampled data across 17 facilities—researchers note several methodological boundaries:
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Not Fully Nationally Representative: While nine states were covered, three of the initially selected 20 facilities denied research access, meaning results cannot be generalized to every prison in the country.
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Self-Reported Data: Findings relied on self-reported answers rather than mandatory biological assays (urine or blood toxicological screens). Due to lingering social stigma or fear of legal repercussions, actual substance use rates may be underreported.
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Lack of Supply-Chain Data: The study mapped individual consumption patterns but was not designed to evaluate the physical avenues through which contraband enters institutional perimeters.
Public Health Implications
For clinicians, policymakers, and the public, the study reinforces that substance use disorder does not stop at facility borders. Treating addiction within the correctional system protects community health, reduces institutional violence, and prevents re-arrest upon release.
Experts recommend that correctional departments implement standard health protocols immediately:
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Intake Screening: Standardized clinical assessments for all newly admitted inmates to identify acute dependence and overdose risks.
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Medically Supervised Withdrawal: Immediate access to non-punitive, medically managed withdrawal protocols for alcohol, sedatives, and opioids.
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Voluntary Pharmacotherapy: Access to long-term maintenance medications (such as buprenorphine) for opioid dependence.
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Community Health Bridges: Structured hand-off mechanisms ensuring patients released from custody do not experience interruptions in their medical treatments.
By framing substance dependence as a medical priority within the justice system, healthcare providers and correctional authorities can turn a moment of incarceration into a turning point for long-term recovery.
References
- https://www.indiatoday.in/health/story/india-prison-substance-use-study-6-percent-inmates-used-drugs-inside-jails-2965730-2026-08-07
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
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