Optimising opioid substitution therapy in the prison environment

• Pages: 293-307
• Published date: 05 December 2019
• Date: 05 December 2019
• DOI: https://doi.org/10.1108/IJPH-12-2017-0061
• Author: Farrukh Alam,Nat Wright,Paul Roberts,Sunny Dhadley,Joanne Townley,Russell Webster
• Subject Matter: Health & social care

Optimising opioid substitution therapy in

the prison environment

Farrukh Alam, Nat Wright, Paul Roberts, Sunny Dhadley, Joanne Townley and

Russell Webster

Abstract

Purpose –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.

Design/methodology/approach –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).

Findings –Disruption to the management of addiction and reduced treatment choice for OST adversely

influences adequate pr ovision of OST in prison. A key c oncern was the routine dive rsion of opiate

substitutes to other pr isoners. The new control led drug formulations wer e 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.

Originality/value –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.

Keywords Health in prison, Prison, Drug abuse, Drug dependence, Opioid substitution therapy,

Prison medicine

Paper type Viewpoint

The current delivery of OST in prisons shows inconsistencies and is often carried

out in isolation from routine clinical assessments

A recent Freedom of Information Request (2017) revealed that over 22,500 prisoners received

opioid substitution therapy (OST) during the 2016 calendar year; an average of 205 individuals

per prison. An online survey of 102 opiate-using detainees across the UK assessed the real-life

access to OST by prisoners during their previous detention period (Webster, 2017).

The survey employ ed two main methods to gain servic e-user views. First, an onli ne survey was

completed by 102 opiate users who had been in an English or Welsh prison in the previous two

years. Opiate-using prisoners were identified and recruited by ten peer researchers trained,

supervised and supported by the Revolving Doors Agency. Researchers were based

throughout England and Wales and each was set a target of recruiting ten survey respondents.

Peer researchers received a payment of £100 each for recruiting survey respondents.

Analysis of this survey data informed the second stage of the research study; a focus group

comprising nine individuals with recent experience of OST in prison was convened by the

Revolving Doors Agency and held on 10 May 2017. The focus group was structured to allow

respondents to give detailed first-hand accounts of their experiences of seeking OST in prison

and on their release.

Received 18 December 2017

Revised 8 June 2018

18 September 2018

Accepted 2 October 2018

© Farrukh Alam, Nat Wright,

Paul Roberts, Sunny Dhadley,

Joanne Townley and

Russell Webster. Published by

Emerald Publishing Limited. This

article is published under the

Creative Commons Attribution

(CC BY 4.0) licence. Anyone may

reproduce, distribute, translate and

create derivative works of this

article ( for bothcommercial and

non-commercial purposes),

subject to full attribution to the

original publication and authors.

The full terms of this licence may

be seen at http://

creativecommons.org/licences/by/

4.0/legalcode

This paper was developed based

on a meeting organised and

funded by Martindale Pharma.

Writing support was provided by

Succinct Medical Communications

and funded by Martindale Pharma.

All drafts were fully reviewed and

updated by the authors.

Farrukh Alam is based at Central

and North West London NHS

Foundation Trust, London, UK.

Nat Wrightis a Clinical Research

Director at the Transform

Research Alliance,Leeds, UK.

Paul Roberts is based at HM

Inspectorate of Prisons,

London, UK.

Sunny Dhadley is based at

Wolverhampton Volunteer

Sector Council,

Wolverhampton, UK.

Joanne Townley is based at

Pathways to Recovery,

Warrington, UK.

Russell Webster is an

Independent Consultant in Drugs

andCrimebasedinLondon,UK.

DOI 10.1108/IJPH-12-2017-0061 VOL. 15 NO. 4 2019, pp. 293-307, Emerald Publishing Limited, ISSN 1744-9200

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