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The presence of drugs in prisons is an increasing concern worldwide. This scoping review synthesizes empirical evidence on drug trafficking routes and prison drug market dynamics. Ten empirical studies met the inclusion criteria, the majority of which were qualitative studies conducted in the United Kingdom. Findings indicate that drugs are primarily smuggled into prisons via visitors, mail, staff, newly admitted or returning prisoners, and perimeter throwovers. In recent years, new smuggling techniques have emerged, such as drone deliveries and the impregnation of mail with novel psychoactive substances. While prison drug markets share structural similarities with external drug markets, they also exhibit distinct characteristics, including unique pricing structures and alternative payment mechanisms. Keeping drugs out of prison remains a complex challenge, as reducing supply is an ongoing struggle. A solely repressive, supply-focused approach is unlikely to be sufficient in addressing the presence of drugs in detention. Instead, an integrated prison drug policy should not only focus on enforcement but also incorporate measures aimed at reducing demand.