Drugs in British prisons. Policies need outside scrutiny if they are to do more good than harm

Evidence-Based Policy Making?

This article is concerned with the role of evidence, research and knowledge in the recognition, definition and framing of drugs issues in prisons and in the development, implementation and reformulation of policy. As the drugs issue in prison has become more politicized and policies have become more explicit and defined over time, research and evidence have become increasingly important dimensions within the policy process. Drawing on semistructured interviews with key policy players and an analysis of documentary materials, this article examines research utilization in the development of contemporary prison drugs policy since 1980, situating this process within its political, economic and social contexts. In order to make sense of the interplay between research and policy in this area, the analysis employs the various models of research utilization put forward by Carol Weiss (Weiss, 1986). Within the current context of increasing managerialism and new commitments to evidence-based policy making, the article concludes by suggesting that researchers should become more active agents at all stages of the policy process.

An exploratory study investigating the impact of the procedures used to manage patient substance misuse on nurse-patient relationships in a medium secure forensic unit

The role conflict experienced by forensic psychiatric nurses between their therapeutic responsibilities and their responsibility to operationalize security procedures is well established in the literature. There has been less investigation into how this role conflict is played out specifically in the management of inpatient substance misuse in forensic units. This study, therefore, aimed to explore the views of nurses working in one medium secure unit of the impact of the procedures used to manage substance misuse (partial strip searching, room searching, canine searching, 'pat' (or 'rubdown') searching, urine drug screening) on their relationships with patients. Ten interviews of registered mental health nurses working in a medium secure unit in the Northwest were carried out. The interview data were transcribed verbatim and framework analysis used to identify emergent themes. The impact of the procedures on nurse-patient relationships was reported as largely negative by the participants. They reported that the intrusion of the procedures had a detrimental effect on their relationships with patients. The relative degree of intrusion posed by each of the procedures was an important factor in determining the extent and duration of damage to nurse-patient relationships, as was the communication skills of the nurse conducting the procedure.

Drugs, detention, and death: a study of the mortality of recently released prisoners

It has been theorized that drug abusers recently released from prison have an increased risk of fatal drug overdose. The objective of this study was to determine whether persons released from prison in the state of New Mexico have an increased risk of death due to unintentional drug overdose in the time immediately after release from prison. A total of 96 people were identified who had been released from prison and subsequently suffered an unnatural death in 2001 through 2003. Among those who had drug-caused deaths, there was a significantly increased risk of dying in the first 2 weeks after release versus the subsequent 10 weeks RR = 3.08 (P < 0.001, 95% CI: 1.83-5.16). For those who died in the first 2 months after release, there was an increased risk of fatal drug overdose compared with dying of other unnatural causes (P = 0.025). Of those who died of fatal drug overdoses within the first 2 months, the average incarceration time was significantly longer than those who lived longer than 2 months after release (P = 0.021) and they were more likely to have used opiates (P < 0.0001) and sedatives (P = 0.01). Prisoners are at an increased risk of a fatal unintentional drug overdose immediately after release. The time surrounding release provides an opportunity for education on the risks of accidental overdose and the development of interventions to mitigate these risks.

Persistence of drug use during imprisonment: relationship of drug type, recency of use and severity of dependence to use of heroin, cocaine and amphetamine in prison

AIM

To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence.

DESIGN

The use of heroin, cocaine and amphetamine by current prison inmates has been examined and, in particular, the relationship between drug use within prison and the type of drug used prior to imprisonment, recency of use and severity of dependence.

SETTING AND PARTICIPANTS

A randomly selected sample of 1009 adult male prisoners in 13 prisons in England and Wales during 1994/95; structured confidential interviews conducted by independent research staff. Enquiry about prior use of heroin, cocaine or amphetamine focused on three time-periods (ever, last year and last month pre-prison) and the use of these drugs during the first month of imprisonment.

FINDINGS

A total of 557 (55%) of the 1009 prisoners had used previously one of the three drugs selected for study: 58% had used heroin, 69% cocaine and 75% amphetamine. More than half (59%; 327/557) had used these drugs in the month before the current imprisonment. Drug use in prisons was most likely to occur among those who had used in the month prior to imprisonment. The persistence of heroin use in prison occurred more frequently (70%) than use of cocaine (20%) or amphetamine (15%). Of those using heroin pre-imprisonment, 67% considered they were dependent, compared to 15% and 22%, respectively, for cocaine and amphetamine users.

CONCLUSIONS

Changes in the drug-taking behaviour of drug users after imprisonment vary according to the type of drug being taken. Prisoners were much more likely to continue to use heroin than either cocaine or amphetamines while in prison. Heroin was most likely to be used by those who had been using heroin during the immediate pre-imprisonment period, and particularly by the two-thirds of heroin users who considered themselves dependent. In view of the high prevalence of prior use of these drugs by individuals currently imprisoned, continuing attention is required to study of their behaviour and of the impact of interventions that may be introduced during or following their incarceration.

Drugs, prisons, and harm reduction

The use of drugs in society raises important considerations for health and social policy. Critical health and social care issues arise when drugs are used inside prisons. This paper argues that there is an urgent need for prison drug policies to adopt the principles of harm reduction. However, current policy orthodoxy emphasises the control of drugs and punishment for drug taking. Key components of harm reduction are operationalised in this article by exploring the potential for harm reduction in prison within the context of English drug policy. Whilst the focus is on English policy debates, the discussion will have wider international resonance.

Mathematical biology and medical statistics: contributions to the understanding of AIDS epidemiology

Some of the many ways in which mathematical biology and statistics have been used in investigating the acquired immunodeficiency syndrome (AIDS) epidemic are reviewed. Aspects of the spread of the disease via social and sexual networks are discussed. The different kinds of data involved are critically compared. Some studies of the incubation period are briefly reviewed and some comments made on the role of adherence to therapy.

Drug testing in Canadian jails: to what end?

Since 1995, Corrections Services Canada (CSC) has conducted randomized urinalysis screening of a minimum of 5% of the federal inmate population on a monthly basis. Urine samples are screened for a broad range of psychoactive substances. The stated purpose of such screening is to reduce substance use in federal jails. Analysis of data provided by CSC for testing between 1994 and 1998 reveals small but statistically significant increases in the percentage of all urine samples that tested positive over that time. Analysis of the results of screening for opiates, cocaine and THC from data provided by CSC for the same time period, shows steady rates of opiate and cocaine detection at maximum and medium levels of security, decreases in opiate and cocaine detection in minimum security, and statistically significant increases in THC detection at all levels of security. The implications of these findings are discussed.

Drug testing in Canadian jails: to what end?

Since 1995, Corrections Services Canada (CSC) has conducted randomized urinalysis screening of a minimum of 5% of the federal inmate population on a monthly basis. Urine samples are screened for a broad range of psychoactive substances. The stated purpose of such screening is to reduce substance use in federal jails. Analysis of data provided by CSC for testing between 1994 and 1998 reveals small but statistically significant increases in the percentage of all urine samples that tested positive over that time. Analysis of the results of screening for opiates, cocaine and THC from data provided by CSC for the same time period, shows steady rates of opiate and cocaine detection at maximum and medium levels of security, decreases in opiate and cocaine detection in minimum security, and statistically significant increases in THC detection at all levels of security. The implications of these findings are discussed.

Suicide in prisons. Reflection of the communities served, or exacerbated risk?

BACKGROUND

A recent review showed that opioid users' deaths from suicide were 10 times as common as expected on the basis of age and gender. Surveys showing prisoners' high prevalence of injecting or opioid dependence have led to a new statistical approach to prison suicides.

AIMS

To estimate the expected number of UK prison suicides annually, having taken account of inmates' age, gender and opioid dependence.

METHOD

By gender, estimate the effective number of individuals (in terms of community-equivalent suicide risk) for whom prisons have a duty of care as 10 times the number of opioid-dependent inmates plus the number of non-opioid user inmates. Apply the gender and age-appropriate national suicide rates to work out the expected number of prison suicides.

RESULTS

The Scottish Prison Service can expect 7.1 suicides per annum, and annual totals up to 12 without exacerbation of suicides due to incarceration. For the Prison Service in England and Wales, 19.3 suicides per annum can be expected in prisons, and annual totals may range up to 28 without indicating incarceration; the total of self-inflicted deaths was 47 in 1993-94.

CONCLUSIONS

Prisons cannot prevent all suicides. An alert may be warranted if prison suicides exceed 12 per annum in Scotland, or 28 in England and Wales.