Abstract
The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales. A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017). Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison. Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.
Highlights
The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales
The expert group shared the view that one of the key factors affecting the lack of patient choice around OST medications was the concern that opiate substitutes were routinely diverted and sold illicitly to other prisoners
Owing to the large numbers of people entering prison with OST needs, an initial goal of stabilising on methadone or buprenorphine should be set, after which they should be assessed to determine whether maintenance or reduction treatment is more appropriate, with flexibility being provided for prisoner involvement in relation to their preferred choice of dosage and treatment type
Summary
293-307, Emerald Publishing Limited, ISSN 1744-9200 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 293 Using these methods, the survey asked whether respondents wanted and were able to access OST in prison and on release, and how easy or not this access was. Respondents were asked to consider the aforementioned questions with respect to whether, if they received medication in prison, they were offered a continuing prescription on release. The survey showed that the choice of OST was largely limited to methadone or buprenorphine and that OST provision often differed from that requested by the individual, with methadone being the most common substitute medication provided (Figure 1(a))
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