‘A number of the prison healthcare services we manage give training in
naloxone use to prisoners close to their release dates,’ says their national medical
director, Dr Sarah Bromley.
She calls the training sessions ‘critically important to saving lives’ as they also
teach participants to recognise symptoms and respond to people who are
experiencing an overdose, supporting them until the emergency services arrive.
‘These group sessions are set to increase nationwide as more NHSE commiss -
ioners ask us to incorporate the training and dispensing into broader community
strategies,’ she says, adding that the commissioners’ understanding and buy-in has
been crucial: ‘We believe that commissioners recognise that prison healthcare is in
a unique position to teach and reinforce messages on preventing overdose deaths
at a time when prisoners are more stable than at other points in their journey.’
E
lsewhere there are also signs that naloxone has a firm footing in prison
healthcare. Inclusion, part of South Staffordshire and Shropshire NHS
Foundation Trust, were early adopters and pioneers of naloxone
strategy, including in their prison-based services. ‘We have been issuing
naloxone with Birmingham and Solihull Mental Health Trust at HMP
Birmingham since 2005,’ says head of Inclusion, Danny Hames.
When Change, Grow, Live embraced naloxone strategy, they made it ‘an
objective to ensure that those integrating back into society from the prisons with
which we work are provided with take-home naloxone kits, as well as guaranteeing
that they receive advice, information and support around access to local
community services,’ says CGL executive director, Mike Pattinson. ‘We have been
taking this approach in our prison-based services for some time and shall continue
to do so as part of our overall harm reduction plan.’
For Forward Trust, whose substance misuse work spans 18 prisons, ‘a more
organised and structured approach to promoting naloxone’, began at HMP Lewes.
By having a designated ‘naloxone lead’ in the team, they make sure each new
service user is added to the naloxone waiting list, regardless of whether their
release date has been set. They also make sure clients who are ready for release are
booked in for an appointment in the two weeks before they leave.
They believe the scheme is working well because of the staff and client training,
good organisational skills, and efforts to improve communication – between
Forward team members and with other departments in the prison. Keeping a
database of staff members who have completed their training helps them to
analyse progress.
‘Sometimes clients refuse the naloxone or training when we first offer it, but
change their minds later on,’ says Forward’s Amy Williams. They are offered more
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chances to engage including, crucially, when they are close to their release date,
which ‘lets them know that even if they don’t think they will need it, it could be
used to save the life of someone else. This ensures that we are not only helping
them on their recovery journeys in prison, but out into the community too.’
The naloxone programme has
been an ‘important milestone’ in
drug policy in Scotland. Prisoners
are ‘reaping the benefits in terms
of reduced opioid-related
mortality’ after release.
W
DP’s substance misuse team have also come across the issue of
prisoners refusing naloxone, during their work at HMP
Woodhill. As part of each prisoner’s release plan they are
offered training, harm reduction advice, and a kit on release.
‘Some inmates who are on a stable dose of methadone, or
who have recently detoxed, may decline the offer of a kit, saying that they feel that
they have achieved stability or detox in the prison and have no intention of using
drugs or associating with their drug-using former associates,’ says WDP’s Kate
Bonner. ‘But they are reminded that prison is a false environment and that while
they may be perfectly capable of managing their own lives, they have no control
over who they might meet on the street or who might come to their home.’
From those who have come to realise the value of naloxone as they prepare to
leave prison, there is gratitude. Whether all prisons will extend this safety net to
their inmates in the new year remains to be seen.
This article has been produced with support from Martindale, which has not
influenced the content in any way.
December/January 2019 | drinkanddrugsnews | 15