PRESCRIBING
BACK TO REALITY
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elphi were one of the first community drug services in England to offer a flexible-dose, prolonged-release buprenorphine( PRB) solution for subcutaneous injection. In 2021 Delphi proposed to introduce a PRB trial at HMP Manchester and HMP Buckley Hall – the trial began with an expectation of ten clients maximum, shared across two groups.
PRB has multiple advantages within prison settings. Firstly, the subcutaneous injection route allows for completely supervised administration, with a NICE evidence review for PRB finding no risks for diversion. Additionally, the prolonged release formulation allows for long-term in jec tions which reduces the frequency of dispensing and thus also supervision. The weekly or monthly doses also remove the daily administration requirements necessary for oral methadone and sublingual
Prolonged-release buprenorphine could be a game changer when it comes to supporting prison populations, says Claire Illingworth
buprenorphine – this supports future recovery by allowing individuals to attend work in prison regimes and may facilitate easier transition post-release.
The HMP Manchester and HMP Buckley Hall trial was led by the head of medicines management within the DARS( drugs and alcohol services) team. The proposal and costings were approved by Greater Manchester Mental Health NHS Foundation Trust and Delphi proposed to complete case studies for each PRB client to measure qualitative and quantitative data.
INCLUSION CRITERIA AT INITIAL PROPOSAL Group 1 maintenance option( three clients)
• Currently maintained on buprenorphine tablets
• Sentenced for more than six months and not likely to be transferred or released
• Actively engaging with DARS psychosocial interventions
Group 2 detox option( seven clients)
• Currently prescribed methadone, maximum of 30mg
• Sentenced for more than six months and not likely to be transferred whilst on treatment
• Actively engaging with DARS psychosocial interventions
• Looking to be abstinent from OST within four weeks
IN THE PRISONS DELPHI INTRODUCED PRB:
• To offer services that mirror the community
• To provide choice in detox options
• To support plans for future recovery
• To allow clients to attend work in prison regime
• To remove the daily requirement for methadone
• To reduce diversion chances
In June-July 2021 preparations began and the DARS team started speaking to clinical clients who met the criteria. The head of prisons shared information about the trial with governors across both prisons, the commissioner, and the regional drug strategy lead, and the PRB trainer delivered an administration session to all staff.
Following the information session 16 clients in HMP Buckley Hall expressed interest and the head of medicines management reviewed their records to plan 1-1 sessions. In November 2021, a delivery test order was made to HMP Buckley Hall with a start date of December. The maintenance clients were prioritised at this point, recognising their previous feedback about detox over Christmas with January for detox options.
A smaller number of clients at HMP Manchester were identified as ready for review and change. PRB officially started at HMP Buckley Hall on 1 December 2021 with two doses successfully delivered. The prison governors and commissioner were updated, and the numbers increased to five clients by 17 December.
Irina Kryvasheina / Dreamstime. com
14 • DRINK AND DRUGS NEWS • MAY 2025 WWW. DRINKANDDRUGSNEWS. COM