Highlights Abuse of prescription opioids is widespread within prisons. There is significant variation internationally in the type of opioid abused. Further research is needed regarding how to effectively respond to such abuse. Assertiveness and safer prescribing training for prescribing staff is needed. More research is required on the development of less abuseable preparations. Abstract Background
BackgroundThe size and mean age of the prison population has increased rapidly in recent years. Prisoners are a vulnerable group who, compared with the general population, experience poorer health outcomes. However, there is a dearth of research quantifying the prevalence of non-communicable diseases (NCDs) among prisoner populations.AimTo explore both the prevalence of NCDs and their risk factors.Design & settingA cross-sectional survey was undertaken that was compared with clinical records in two male prisons in the north of England.MethodSelf-report surveys were completed by 199 prisoners to assess sociodemographic characteristics, general health, NCD prevalence, and risk factor prevalence. Data were checked against that retrieved from prison clinical records.ResultsIt was found that 46% reported at least one NCD and 26% reported at least one physical health NCD. The most common self-reported NCD was 'anxiety and depression' (34%), followed by 'respiratory disease' (17%), and 'hypertension' (10%). Having a physical health NCD was independently associated with increasing age or drug dependence.The level of agreement between clinical records and self-report ranged from 'fair' for alcohol dependence (kappa 0.38; P<0.001) to 'very good' for diabetes (kappa 0.86; P<0.001).ConclusionCompared with mainstream populations and despite high prevalence of risk factors for NCDs physical illness NCDs, with the exception of respiratory disease, are less common. However, poor mental health is more common. These differences are possibly owing to the younger average age of prison populations, since prevalence of risk factors was reported as high.Secondary data analysis of clinical records is a more methodologically robust way of monitoring trends in prisoner population disease prevalence.
including the URL of the record and the reason for the withdrawal request. AbstractPurpose: Recovery is the predominant discourse within current UK drug policy, promoted as freedom from dependence. In support of such a policy driver, prison drug recovery wings have been piloted in ten prisons in England and Wales to address high drug prevalence rates in prisoner populations. This article explores the development of these specialist wings within the context of wider developments to tackle reoffending among drug-using prisoners.Design/methodology/approach: The first part of the paper offers an analysis of the emergence of the recovery paradigm in the prison context through analysis of official policy documents. The second draws predominantly upon two process evaluations of the drug recovery wings, alongside literature on prison drug treatment.Findings: There is limited empirical evidence to inform the debate about whether prisons can provide settings to facilitate recovery from the effects of illicit drug use. What is available suggests that effective therapeutic environments for recovering drug users could be established within prisons. Key components for these appear to be sufficient numbers of staff who are competent and confident in providing a dual role of support and discipline, and a common purpose of all prisoners committing to recovery from illicit drugs and supporting each other. Further research regarding the impact of drug recovery wings upon health, crime and wider social outcomes is needed.Originality/value: This paper provides an updated perspective on the development of drug treatment in prisons, with a particular focus on the implications of the new recovery paradigm.
Background Prisoner populations have a disproportionately high prevalence of risk factors for long-term conditions (LTCs), and movement between community and prisons is a period of potential disruption in the ongoing monitoring and management of LTCs. Method Nineteen qualitative interviews with staff, recruited by purposive sampling for professional background, were conducted to explore facilitators and barriers to screening, monitoring and medicines management for LTCs. Results There is variability in prisoner behaviours regarding bringing community GP-prescribed medication to prison following arrest and detention in police custody, which affects service ability regarding seamless continuation of community prescribing actions. Systems for actively inputting clinical data into existing, nationally agreed, electronic record templates for QOF monitoring are under-developed in prisons and such activity is dependent upon individual “enthusiast(s)”. Conclusion There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework, supported by connectivity between prison and community primary care records, including all activity related to QOF compliance.
Health-based social enterprises are spun out of the NHS, yet continue to provide NHS-funded services. With the spin-out, however, formal processes for research governance were lost. Patients have a right to take part in research, regardless of where they access healthcare. This paper discusses the barriers to social enterprises undertaking applied health research and makes recommendations to address the need for equivalence of governance processes with NHS trusts.
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