in the community. In addition, opiate‑maintenance substitution in prison has been proved to reduce considerably the excessive death rate of drug users on the frst day after release from prison.14 Because of all these factors, at least 26 countries in Europe have introduced opiate‑maintenance substitution in prisons and in seven European countries more than 10% of all prisoners are undergoing opiate‑substitution treatment.15 Methadone is the most frequently used substitution drug but other oral opioids are also used. There is already extensive experience with elaborate guidelines on how to run opiate‑substitution programmes in prison.16 However, recent CPT country visit reports have emphasised that, in several prison systems in Europe, still much needs to be done in order to comply with this important prevention strategy.17 Psychotherapeutic treatment and psychosocial care may help to reduce demand for drugs among opiate‑dependent intravenous drug users, especially when combined with opiate‑substitution treatment, and thus may also help to prevent the spread of blood‑borne virus diseases, particularly since psy‑ chotherapeutic treatment concepts currently focus more on harm reduction than on complete abstinence. 3.5 Harm reduction of risky behaviour Evidence has shown that it is unrealistic to presume that security measures in prison can end risk behaviour related to the spread of HIV/Aids and hepatitis B and C. It has also shown that risk behaviour under prison conditions may create even greater risks than in the community, so measures for reducing such harm in prison are just as important as in the community.18 14. WHO Europe: Prevention of acute drug‑related mortality in prison populations during the immediate post‑release period (Geneva 2010). 15. EMCDDA: (2010) 16. WHO Europe: WHO guidelines on HIV infection and AIDS in prisons (Geneva 1993); Møller L. et al: Health in prisons: a WHO guide to the essentials in prison health (Geneva 2007); Kastelic A., Pont J. and Stöver H: Opioid substitution treatment in custodial settings: a practical guide (Oldenburg 2009). 17. CPT/Inf (2011)3; (2011)20; (2011)29; (2012)4; (2012)9; (2012)17; (2012)32. 18. WHO Europe: Policy HIV/AIDS in prison; Jürgens R., Nowak M. and Day M: “HIV and incarceration: prisons and detention”. Journal of the International AIDS Society 14:26 (2011); WHO/UNODC/UNAIDS: Interventions to address HIV in prisons: comprehensive review, Evidence for Action Technical Paper (Geneva 2007); WHO/UNODC/UNAIDS: Effectiveness of interventions to address HIV in prisons, Evidence for Action Technical Paper (Geneva, 2007); CM: The ethical and organisational aspects of health care in prison. Preventing the spread of HIV/Aids and hepatitis B/C in prisons Page 57