Addressing Drug Misuse in UK Prisons

Introduction

Drug misuse in prison is currently one of the significant challenges facing the United Kingdom’s criminal justice system, making criminology dissertation help a valuable resource. Its prevalence is condemned because it contributes to crime, violence, and exposes the addicts to further vulnerabilities while in prison, thereby endangering the safety of prison staff and affecting their ability to deliver quality regime. Against this backdrop Ministry of Justice (2016) contend that it is impossible to prevent re-offending and improve prison safety if drug misuse within prisons is not addressed. However, the issue of prison drug misuse may be complex to address due to its extensive prevalence in UK prisons. For instance, recent years have been characterized by a significantly increased prevalence of prison drug misuse as evidenced by statistics from Ministry of Justice (2016), which indicates that between the year 2013 and 2018, there was a 50% increase in random positive tests for traditional drugs.

Moreover, according to the Ministry of Justice (2016), there is now widespread use of drugs in UK prisons, especially in male category C prisons. Interestingly, research has attributed this increased prevalence to the proliferation of various psychoactive drugs, including synthetic cannabinoids used together with other traditional drugs as well as misuse of prescription drugs (Home office, 2017). Furthermore, HM Government (2018) argues that the increased prevalence of drug misuse in prisons is also attributable to the emerging trends and patterns of drug misuse in the community, as well as the challenges experienced by prison departments to control new prison entrants who are already under drug misuse.

But several interventions have been introduced to address drug misuse among both inmates and ex-prisoners (i.e., during and after-prison interventions) that are notable. For instance, in 2003, the UK government introduced the Drug Intervention Program as an initiative to reduce community drug-related crimes by rehabilitating offenders under drug misuse during prison and after prison release (Home Office, 2007). According to Home Office (2007), the program involves a wide range of community-based treatment interventions including methadone prescribing as well as other less intensive treatment alternatives such as counselling as well as support towards addressing some of the underlying causes of drug misuse including relationship issues, housing, and mental health. Home Office (2017) also identifies a program, launched by the NHS in 2013 to commission substance misuse services in prisons and improve the health and well-being of prisoners by supporting community safety and cohesion. This would be achieved through the provision of care to ex-prisoners after release and subsequently reduce re-offending.

A major intervention widely used in the UK, Opiate Substitution Therapy (OST) is one of the evidence-based therapies with a significant positive impact on mortality rates in heroin users who take overdose amounts of heroin (European Monitoring Centre for Drugs and Drug Addiction, 2016). Hence, some of the recommended drugs for such individuals include buprenorphine and methadone. Furthermore, research by World Health Organization (WHO, 2009) indicates that former prisoners who were on OST are at the highest risk of fatal overdose because their stay in prison and exposure to OST have contributed to a decreased physical tolerance to heroin. Against this backdrop, reports by the Office for National Statistics (2017) indicated that more than 50% of drug overdose-associated deaths are caused by opiates such as heroin.

Connock et al. (2007) observe that former prisoners have the highest risk of a fatal drug overdose within the first two weeks after their last treatment. Furthermore, this risk stays elevated until the end of the first month. According to Merrall et al. (2010), this reveals the vital need to promote ex-prisoners’ access to and engagement in substance abuse treatment services for at least one month after release and last treatment dose.

Statistics by Fingertips.phe.org.uk (2019) indicate that in the past year (2017-2018), 24.1% of ex-prisoners in need of drug misuse treatment services received the services at Lambert substance misuse treatment centre within 21 days after release. Furthermore, while existing reports indicate that 23.1% and 32.1% of that population received the services in London and England respectively, there is no clear data on the attendance at Lorraine Hewitt House (LHH).

Preventing heroin overdose-related dose requires people to gain access to Naloxone, a medicine that reverses the effects of heroin or opioid overdose (WHO, 2009). However, according to the Advisory Council on the Misuse of Drugs (2019), only 12% of prisoners in England left prison with Naloxone in the year 2017/2018. This proves the low number uptake of Naloxone and the risk exposure of ex-prisoners who are likely to engage in overdose heroin abuse. Thus, the main ain of the current study is to evaluate the number and characteristics of ex-prisoners who access care at LHH substance misuse services within 28 days of prison release, which is the period within which the risk of drug overdose deaths is elevated. In doing so, the study will evaluate the number of people attending the LHH with prescribed Naloxone from prison settings as well as the number of individuals who received Naloxone prescription after visiting the LHH.

Study Objectives

To identify the predictors of initial community drug misuse treatment service attendance

To identify predictors for engagement during one month of immediately after prison

To determine the number of attendees with prescribed Naloxone before attending LHH

Justification of the study

The PHE and other national organizations such as the NHS and the National Probation Service and Community Rehabilitation Companies responsible for substance misuse services and prisoner healthcare consider continuity of care a strategic priority (Public Health England, 2018). Hence, to facilitate their responsibility of coordinating ex-prisoners resettlement and reducing reoffending, they need accurate data on ex-prisoners’ access to community drug misuse services. The data will enable them to identify treatment gaps and suggest various factors related to prisoners characteristics that hinder access to community drug misuse treatment and adherence to such treatment. In sum, this will contribute to the development of better policies and guidelines for practice that contribute to reduced opioid-related mortality rates.

References

HM Government (2017) 2017 Drug Strategy

Ministry of Justice &Public Health England (2017) The Impact of community-based drug and alcohol treatment on re-offending

Public Health England (2018) Continuity of care for adult prisoners with a substance misuse need. Report on the London ‘deep dive,’ Public Health England.

Drug Misuse and Dependence (2017) UK guidelines on Clinical management, Drug Misuse and DependenceUpdate 2017 Independent Expert Working Group.

World Health Organization. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO; 2009

Connock M, Juarez-Garcia A, Jowett S, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess 2007;11:1-171.

Advisory Council on the Misuse of Drugs (2019). ACMD report on Custody-Community Transitions (CCT). Drug Misuse and Dependency. [online] London: Public Health, p.2. Available at:

Merrall, E., Kariminia, A., Binswanger, I., Hobbs, M., Farrell, M., Marsden, J., Hutchinson, S. and Bird, S. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction, 105(9), pp.1545-1554.

Fingertips.phe.org.uk. (2019). Public Health Profiles. [online] Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/1/gid/1000042

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