’ d all much

prefer to be wise before the event ,’

chair of the Independent Advisory Panel on Deaths in Custody ( IAPDC ), Juliet Lyon , told the Managing drug and alcohol problems in primary care conference . When it came to reducing drug-related deaths in custody settings there ‘ could be a much greater use of harm reduction initiatives , and a much better dissemination of recommendations ’ following a death – ‘ to learn what could have been done and apply that ’.

Her panel – which advises the Home Office , DHSC and the Ministry of Justice – had recently produced a report concluding that it was vital to take a whole-systems approach to deaths in custody ( www . drinkanddrugsnews . com / whole-system-approach-needed-totackle-prison-drug-deaths ). There needed to be a better database for understanding the extent of the problem , as well as improved courtbased liaison and diversion services when it came to sentencing .

While community sentences with treatment requirements had been on the statute book for decades they remained ‘ spectacularly underused ’, she said . There was a problem in terms of both magistrates ’ confidence around them and availability . Magistrates ‘ would say these things aren ’ t available in our area or we simply don ’ t have enough information . It ’ s a terrifically wasted opportunity .’

CONTEXT A letter from a prisoner had pointed out that any attempt to tackle alcohol and drug-related deaths in custody would need to address ‘ many aspects ’ of prison life . ‘ It ’ s the overall context in which people are living , and of course this has been exacerbated massively by COVID . The kind of desperation we ’ ve been seeing , the crushing boredom , living 23 hours a day in a six-by-nine cell often shared with a stranger .’ It was clear why people would turn to ‘ any substance ’ to try to block this out , she said . Unless someone had gone through it they could ‘ never comprehend ’ it , the letter had stressed .

‘ We haven ’ t yet created a safe environment , that ’ s responsive to the often very vulnerable people who live within it ,’ she said . ‘ If we focus too narrowly then we ’ ll miss something that ’ s hugely important and we won ’ t reach our aim of reducing the level of deaths in custody .’

MORE THAN TREATMENT ‘ It ’ s much wider than just a treatment need ,’ agreed chair of the RCGP ’ s secure environments group , Caroline Watson . ‘ It ’ s that holistic health , housing and employment need that will stop the cycle of people coming in and out of custody related to their substance misuse .’ Short sentences for drug-related acquisitive crime meant there was very little time for meaningful rehabilitation work , and in the prison where she worked prisoners were released into a number of counties , she said . ‘ Multiple locations , multiple services , short times in prison , a transient population and multiple providers .’

Coordinated communication between services was vital , she stressed . ‘ We need to build trust and connections not only between

people in treatment and providers , but also between the staff of different providers .’ Group work had been badly affected by a prison regime that had locked down for far longer than the wider community , and lack of meaningful activity remained a key driver of prison drug use . Pilots of long-acting buprenorphine – either weekly or monthly injections – were helping to give people an opportunity to connect with community services on release and lessening the risk of dropping out .

When it came to reducing demand , many prisons had enhanced airport-like security and trained drug dogs , partly to address the issue of staff bringing in drugs . ‘ But people are ingenious and prisons are being targeted as institutions where serious money can be made ,’ said Lyon . ‘ The x-ray scanners have proved useful but engaging people in something that provides a bit of hope and sense of future is much more important . I think too often people think that because you ’ ve got someone detained it ’ s a brilliant treatment opportunity , and it can be . But the

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18 • DRINK AND DRUGS NEWS • APRIL 2022

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