NaloxoNe
Beyond the
Prisons have a unique opportunity to introduce a life-saving naloxone
strategy, so is the message getting through? DDN reports
N
aloxone saves lives, and for people leaving prison it can be a vital
component in their survival kit. We know that the first few weeks
following release carry a much higher risk of dying from a drug-
related overdose, as tolerance is low while the availability of drugs in
social situations returns.
Despite the strong link with unacceptably high drug-related death figures, there
has been an absence of clear strategy and accountability. Both Public Health
England and the government have recommended that local areas need to have
naloxone provision in place, but when John Jolly reviewed the situation in July
(DDN, July/August, page 14), he found that it was rare for any of Blenheim’s service
users to have been provided with naloxone on release from prison.
Jolly investigated further and found that of the 36 prisons in England and Wales
claiming to give out naloxone on release, many were failing to give out kits, citing
‘operational difficulties’.
Since Jolly’s research, the government has responded to parliamentary questions
from Grahame Morris MP, stating that new data on prisons issuing naloxone is
being collected and is ‘expected to be published in January 2019’. Apart from that,
any progress depends entirely on regional interest, with a continued lack of
engagement on the issue from NHS England, according to Jolly.
‘There is no national oversight and accountability for providing take-home
naloxone to people released from custody,’ says Zoe Carre from Release, adding ‘It is
therefore crucial that every prison strategy includes take-home naloxone
programmes.’ Many unnecessary deaths could be prevented if all prisons adopted
the strategy, but ‘while some prisons are leading the way, sadly others are still not
making this life-saving medication available,’ she adds.
In Scotland, where a naloxone programme was made an important part of
public health policy in 2011, there has been effort to adapt to the challenges of
making it a part of prison culture. Naloxone kits are given to people at risk of
overdose, or likely to witness overdose, on release from all 15 prisons in the country.
‘This is a crucial component of the programme due to the increased risk or
overdose for individuals within the first four weeks of release,’ says Kirsten
Horsburgh, strategy coordinator for drug death prevention at the Scottish Drugs
Forum (SDF). The results speak for themselves: ‘The percentage of opioid-related
deaths within four weeks of prison release is substantially lower now that it was
14 | drinkanddrugsnews | December/January 2019
pre-implementation of the programme,’ she says.
The programme depends on a clear strategy in place to be effective, she stresses,
and that includes key stakeholders being fully engaged in the process. ‘The majority
of the obstacles faced in a prison setting are operational and should be addressed
with clear communication, training and guidance.’
In a paper published in the Australian journal, Drugs and Alcohol Review,
Horsburgh and co-author Andrew McAuley gave a detailed account of the
challenges involved in implementation. These included availability of staff (for
escorting prisoners as well as co-facilitating sessions), and problems around a group
format for training sessions – the subject under discussion had the potential to be
emotive for those involved, as ‘the majority of people who use drugs will have had
personal experience of overdose or experienced the loss of friends and loved ones’.
Bringing in peer education had helped, giving the choice of a one-to-one training
session delivered by peers themselves as well as the option of a group session. This
had also achieved collaborative working between prisoners and staff.
T
he other area highlighted for attention had been staff training
throughout the prison. Once a prisoner had been trained, nursing staff
needed to label a naloxone kit and deliver it to the reception area for
prison officers to add it to prisoners’ valuable property, ready for them to
collect on release. It was vital that prison officers knew what this
medication was, so there was no disruption to a streamlined process of release.
The authors concluded that the naloxone programme had been an ‘important
milestone’ in drug policy in Scotland and that prisoners on release were ‘reaping the
benefits in terms of reduced opioid-related mortality’.
Karen Blatherwick, nurse manager at Turning Point’s substance misuse services
at HMP Leicester, underlines the risks during the first two weeks after release,
particularly for those who inject.
‘We encourage service users to carry the naloxone kits at all times, so if they are
found with signs of overdose a friend or family member can use the naloxone on
them,’ she says. ‘We also train service users to use the naloxone and encourage
them to use it on other people if necessary.’
The need for a clear strategy seems to be working its way into the infrastructure of
some of the larger providers of prison healthcare, including Care UK Health in Justice.
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