CAT/OP/PRT/1/add.1 73. Lastly, it is worth mention that the DGRSP has currently 32 physicians and 160 nurses, which are responsible for 50% of the number of hours of medical care provided. In turn, as of April 30 of this year, 34 doctors and 95 nurses of the private sector provide services for prison establishments. 74. The Subcommittee recommends the State party to ensure that tranquilizers are not given without a prior, free and informed consent. 75. This recommendation is fully followed since all medications, including tranquilizers, as previously mentioned, are prescribed by qualified doctors and patients are always elucidated about the pathology and medication prescribed. This procedure is naturally also adopted in Porto prison and only the patients who need medication (and not all inmates as mentioned) will receive it and its intake is always witnessed by the nurse. To this extent, all medication intake or its refusal is always observed by the nurse. 76. The Subcommittee recommends that substitution therapy for drug users is available to all who need it and is administered in a pro-active manner. 77. Access to drug substitution programs is a reality trough protocols in 61% of prisons. This access is carried out in coordination with the National Health Service through the DICAD’s (Portuguese acronym for Intervention Units for Addictive Behaviours and Dependencies) and respective teams of the Comprehensive Response Centres of the geographic area where the prison is located. The access to the programs of the remaining 39%, though there are no signed protocols, is guaranteed by the DICAD teams whenever necessary. 78. With respect to the provision of health care in addictive behaviours and dependencies, it should be stressed that coordination with the National Health Service is guaranteed during flexibilization measures of imprisonment and when inmates are released. Opioid substitution treatments are available as a pilot phase in Alcoentre, Lisbon, Porto and Paços de Ferreira prison establishments and the extension to other prisons is being considered. Lastly, abstinence programs are provided in prisons with free drug units with a special focus on the acquisition and development of skills. D. Forensic units 79. The Subcommittee urges the State party to ensure that Pavilion 16 of the Psychiatric Hospital of Coimbra has adequate staffing, maintains detailed and regularly updated medical records, and adheres to all provisions stipulated in law, including providing alternative care for patients formally released from the hospital. 89. The scarcity of medical resources is a reality in this forensic unit and has to be considered as something that should be corrected. However, it should be noted that psychiatrists also have other tasks outside the unit, such as outpatient and emergency room, so they cannot be in the unit on a permanent basis. 90. With regard to the compulsory review every two months, which is entered in Mental Health Law 36/98 (article 35), there is a mistake in the report: article 35 applies only to patients in compulsory confinement in general hospitals, not to forensic patients, where the review timings are different (mandatory each 2 years, or at any time whenever the court ask for it). E. Psychiatric units 91. The Subcommittee recommends the State party to ensure that: a) multidisciplinary care is provided to all patients, and rehabilitation, occupational or recreational activities is proposed on regular basis; b) detailed medical justification is provided for individual risk assessment as basis of admission to psychiatric care under court order and the person concerned has the possibility to appear before the judge before such decision is taken; 10