Substance misuse in prisons

18 Aug 2016 Amyholgate

Caring for patients with multiple addictions is a delicate balancing act, but custodial sentences can be a chance for patients to turn their health and lives around, says Tania MacDonnell

Many patients who go to prison with drug problems are addicted to opiates such as heroin, but new psychoactive substances (NPS – previously known as ‘legal highs’), alcohol and, to a lesser extent, amphetamines also cause problems. Patients often arrive with several addictions and helping them is rarely straightforward. As well as helping patients break their dependency, the Substance Misuse teams who work in the south west prisons help them detox safely in a controlled environment so that they don’t fit, hallucinate, convulse or even have a heart seizure.

Ashfield prison
Ashfield prison

The teams help patients withdraw slowly and carefully and increase their chances of staying drug-free and this reduces the chances of them re-offending in the future. NPS, particularly synthetic cannabis known as ‘Spice’, are a particular concern in prisons because the components are always changing so there is no real way of knowing what someone has taken – if something does go wrong it can be very difficult to help.

Long haul

Sheila Shatford, the Clinical Team Leader in the Substance Misuse wing in HMP Bristol, explains some of the difficulties for patients: “Being sent to prison is very tough for anyone but patients who arrive addicted to drugs often have the additional problem of actively withdrawing when they are admitted. This is usually due to the length of time they have spent in custody. We need to take things slowly in terms of counselling and support as a person who is withdrawing can’t think beyond their next drug fix.” Addicts usually also have other health problems related to their drug use and lifestyle; these can include dental problems, ulcers and sexual health issues.

A full health assessment is carried out and then there is an immediate need to stabilise the patient as soon as possible.

Sheila explains, “The patient is seen by a GP as soon as they arrive. We find out where they were given prescriptions previously and confirm the amounts given. Next, we have a delicate balancing act – we need to find the correct amount of medication to help them detox safely. If we give them too much withdrawal medication they will need high quantities and eventually find it harder to detox completely but if they are given too little their withdrawal could be dangerous and potentially fatal – this is the case with alcohol withdrawal in particular.”  Patients lose their tolerance to drugs like methadone very quickly so the teams start with a low dosage which is increased gradually until the patient has stabilised and is ready to start withdrawing.

The prison environment

Withdrawing in a prison environment can present its own challenges – Sheila explains, “Many patients receive short sentences so the time we have to help them is limited and when they return home the temptation to relapse can be strong as they are surrounded by all of the things that caused them to get addicted in the first place.

We also have to work within the prison environment and we sometimes find that they are unable to attend a counselling session due to an incident on the wing, for example.” However, patients are offered a great deal of support while they are in prison that, due to their often challenging home lives, can be difficult to access in the community; they are offered a wide range of interventions, counselling and support as well as prescription medications to relieve their withdrawal.

Sometimes patients even welcome custodial sentences as a chance to detox and turn their lives around and they are offered continued care after release (such as referral to Narcotics Anonymous) to increase their chances of success when they return to their community.

Ultimately, though, a patient in prison is like anyone else who is trying to break an addiction – they need to actually want and be ready to make changes. If you recognise the signs and symptoms of addiction (see right) in a loved one, consider talking to a professional, such as a GP, for advice.

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