Drink and Drugs News DDN December 2018 | Page 14

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. www.drinkanddrugsnews.com