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This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March –June 2020).

The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies.

The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care.

Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored.

The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic.

No one knows what the future holds. Not least for substance use and addictions. Few predicted the psychedelic movement in the 1960s, the crack ‘epidemic’ in the 1980s and the ‘E’ generation of the 1990s ‐ all of which had a profound influence on our culture, youth and our health. So what of the Naughties, Teenies and Twenties? With increased globalisation, new technologies, increasing spending power and the scope for increased pleasure‐seeking we are destined for more and new addictions. In this groundbreaking article, Jane Mounteney applies the technique of scenario planning to investigate a future dominated by technology, smart and nanodrugs and an ever‐increasing availability of drugs. With the emergence of the super nerd and groovy geek, who will be there to help the fallen?

People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic.

The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, “changes in illicit opioid consumption,” was measured using the question “Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?” The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated.

A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14–8 vs 18–39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9–55 vs living alone) and 9% (95% CI 0–18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively.

The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.

Substance use treatment (SUT) among migrants and ethnic minorities is an underresearched domain in European countries, although preliminary studies point out disparities in treatment use and access compared to general populations. This paper aims to identify the main characteristics of and the types of services solicited by non-nationals in Belgium.

This paper compares the types of SUT services used by Belgian and non-national clients. Second, the referral source for Belgian and non-national clients is considered. Third, the study compares the client characteristics of Belgian and non-national clients. This descriptive analysis is based on aggregated data sets in the European treatment demand indicator (TDI) registry including all Belgian treatment episodes between 2012 and 2014.

Non-national clients were more often located in outpatient SUT and were less often referred by general practitioners and hospitals, compared to Belgian clients. Third-country clients appear to have lower socioeconomic statuses (education, employment, housing) than Belgian clients. Non-national youngsters and third-country females appear to be underrepresented in Belgian SUT compared to their presence in the general population. The gender gap is larger among third-country clients than among Belgian clients.

These associations between nationality and solicited services, gender, education, employment, housing and referral document treatment gaps among some non-nationals that require special attention in targeted treatment. In the European context, further research is needed on better monitoring migration background in the European TDI registries.

The overrepresentation of non-nationals in low-threshold opioid substitution treatment services and their underrepresentation in high-threshold residential services requires an in-depth analysis of the core goals of these respective services. Residential services, for instance, should consider how a dominant focus on speech therapy hampers access to treatment for these populations and how access for these populations could be enhanced by modifying or diversifying methods in treatment.

To the best of the authors’ knowledge, this is the first paper that analyses the national indicator in a European TDI data set.