The Potential of Prisons to Support Drug Recovery

Purpose 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. The purpose of this paper is to explore 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

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The ongoing impacts of hepatitis C - a systematic narrative review of the literature

Extent: 13p.BackgroundMany countries have developed, or are developing, national strategies aimed at reducing the harms associated with hepatitis C infection. Making these strategies relevant to the vast majority of those affected by hepatitis C requires a more complete understanding of the short and longer term impacts of infection. We used a systematic approach to scope the literature to determine what is currently known about the health and psychosocial impacts of hepatitis C along the trajectory from exposure to ongoing chronic infection, and to identify what knowledge gaps remain.MethodsPubMed, Current Contents and PsychINFO databases were searched for primary studies published in the ten years from 2000-2009 inclusive. Two searches were conducted for studies on hepatitis C in adult persons focusing on: outcomes over time (primarily cohort and other prospective designs); and the personal and psychosocial impacts of chronic infection. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness and methodological coherence. Outcomes reported in 264 included studies were summarized, tabulated and synthesized.ResultsInjecting drug use (IDU) was a major risk for transmission with seroconversion occurring relatively early in injecting careers. Persistent hepatitis C viraemia, increasing age and excessive alcohol consumption independently predicted disease progression. While interferon based therapies reduced quality of life during treatment, improvements on baseline quality of life was achieved post treatment--particularly when sustained viral response was achieved. Much of the negative social impact of chronic infection was due to the association of infection with IDU and inflated assessments of transmission risks. Perceived discrimination was commonly reported in health care settings, potentially impeding health care access. Perceptions of stigma and experiences of discrimination also had direct negative impacts on wellbeing and social functioning.ConclusionsHepatitis C and its management continue to have profound and ongoing impacts on health and social well being. Biomedical studies provided prospective information on clinical aspects of infection, while the broader social and psychological studies presented comprehensive information on seminal experiences (such as diagnosis and disclosure). Increasing the focus on combined methodological approaches could enhance understanding about the health and social impacts of hepatitis C along the life course.Emma R Miller, Stephen McNally, Jack Wallace, Marisa Schlichthors

Comparative prices of diverted buprenorphine/naloxone and buprenorphine in a UK prison setting: A cross-sectional survey of drug using prisoners

Background There is evidence regarding the abuse potential of buprenorphine in prison settings. There is also emerging evidence from community settings that buprenorphine/naloxone is less amenable to abuse than the single preparation buprenorphine hydrochloride as evidenced by cost-differentials of diverted medication. This study sought to explore cost-differentials within a prison setting of diverted buprenorphine/naloxone medication relative to either single preparation buprenorphine hydrochloride or methadone. Methods Cross-sectional survey in one remand prison. Results A total of 85 prisoners participated in the survey. Prisoners estimated buprenorphine to have a significantly (p < 0.001) higher cost than buprenorphine/naloxone both inside and outside of prison. This finding was supported when the analysis was restricted to both the prisoners with a longer-term experience of taking opioid substitution drugs during their current prison stay and those with a longer-term experience prior to reception. Conclusions Consideration should be given to the recommendation that buprenorphine/naloxone medication is the prescribed buprenorphine preparation of choice for clinicians offering opiate substitution therapy to prisoners, pending developments of buprenorphine preparations that have less abuse potential than sublingual preparations