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HM INSPECTORATE OF PRISONS Report on HM Prison Barlinnie

4. ADDICTIONS

Levels of Drug Use

4.1 The SPS Mandatory Drug Testing Policy requires that a random sample of 10% of the prison population is tested each month. In the year April 2002 - March 2003 a total of 1923 tests were carried out. Within that period, random mandatory drug testing indicated an underlying negative rate of 92%. This means that the KPI target of 92% of prisoners who are randomly tested will test negative for drug use was being met. That is a significant achievement.

4.2 A summary of the number of tests carried out and the key results are shown in the two tables and summary below.

Number of Tests Carried Out

Test Results

(Total test results may differ from No. positive samples due to poly-drug abuse)

4.3 From all tests completed in Barlinnie, the most common failure is for opiates - 55% of all positive tests, (ranging from 45% on reception testing to 71% on suspicion testing). Cannabis accounts for 38% of all positive tests and benzodiazepines 29%. A significant number of individuals test positive for more than one substance. All individuals testing positive are automatically referred to Cranstoun Drug Services. Over the last year, 24 individuals refused to be tested. Reception testing numbers are extremely low, only 18 such tests conducted.

The Scale of the Problem

Detoxification Medication

4.4 Prescribed detoxification is available to all prisoners on admission should they present with a drug or alcohol problem. All should be subject to urinalysis, conducted by the addictions officers. However, due to other commitments these tests are not always carried out. The exception to this are the young remands who are always tested prior to prescribing of medication. The detoxification takes place over an 18-day period and consists of reducing doses of dihydrocodeine and diazepam. The administration of this medication is supervised and dispensed within the residential Halls. On the first day of inspection 95 individuals were in receipt of a prescribed detoxification. These individuals require medication to be administered twice a day, which means that there were 190 detoxification medications being administered on that day. This is extremely time consuming for the nurses and for uniformed staff.

Substitute Medication

4.5 The prison also prescribes methadone, provided the prisoner's urinalysis is positive for methadone and he has no new injection sites, (which would suggest continued intravenous drug usage). If an individual is untried or serving a sentence of 6 months or less, maintenance prescribing is undertaken. If serving more than 6 months a detoxification is commenced. From January to 5 May 2003, 486 new admissions were urine tested for continuation of methadone prescribing. Every one tested positive for methadone, confirming that methadone was being taken whilst in the community.

4.6 On admission and following urinalysis an individual is seen by a doctor and an addictions nurse. The individual's community prescriber is contacted by fax requesting confirmation of prescribed medication. Once confirmation is received the individual is commenced on prescribed methadone. This can usually be achieved within two days of admission. Until the methadone prescription is confirmed an individual will be commenced on a detoxification programme.

4.7 Methadone is dispensed by the addictions nurses within the addictions centre. On the first day of inspection 171 individuals were in receipt of methadone. This is extremely high - much higher than any large methadone clinic in the community. The process of escorting individuals from the Halls to the addictions centre and back, is also extremely time consuming for the addictions officers involved and for uniformed staff within the Halls. The whole process can at times take a full day, impacting on other aspects of the regime.

Staffing

4.8 The establishment has 20 MDT trained staff (including residential staff). The MDT Unit is staffed by the Addictions Team, which comprises three addiction nurses, two supervisors and nine officers (eight at time of inspection). Two administrative staff support the team. The Unit is responsible for Mandatory Drug Testing, local admission testing, delivery of drug related programmes and the escorting and supervision of individuals in receipt of prescribed methadone.

4.9 The MDT Unit records information to a high standard and provides valuable information on drugs used. The Unit does not test seven days a week: no weekend testing is undertaken, and staff struggle at times to meet the 10% random rate. However, 10% of individuals in receipt of a methadone prescription are tested monthly, this being split between random and voluntary tests.

4.10 Requests for suspicion tests are not always acted on due to the pressure of meeting the random test numbers. This should be addressed.

Assessment and Treatment

4.11 A local addiction strategy has been in place for approximately three years, although a copy could not be located during inspection.

4.12 The Governor-in-Charge represents the establishment at the Greater Glasgow Drug Action Team. Within the establishment, a Drug Strategy Team has been established. This Group is chaired by the Deputy Governor, meets monthly and is responsible for overall strategy implementation. The Drug Strategy Co-ordinator; Addictions Manager; Clinical Manager; Social Work Manager and Head of Activities attend, as do representatives from the Residential and Operations functions.

4.13 A multidisciplinary team also meets on a fortnightly basis. This comprises the Drug Strategy Co-ordinator; Cranstoun Team Leader; Alcohol Service Co-ordinator; Addictions Nurses; Doctor and a representative from Social Work. The Group concentrates on practical issues, and decides on action plans for individual prisoners. Recently, briefings for addictions officers, addictions nurses and administration staff have taken place to disseminate information from the Drug Strategy Team.

Cranstoun Drug Services

4.14 Cranstoun Drug Services are located next to the Addiction Centre within the establishment. In the six months from June - November 2002 a total of 843 assessments were completed. Once a referral has been made, an addictions assessment is conducted using the Common Addictions Assessment Recording Tool (CAART) and a care plan is completed. The caseworkers will conduct one-to-one sessions and reviews. Referrals to transitional care partners are made if required.

4.15 Two major difficulties face Cranstoun workers within the establishment, the first being the volume of individuals entering and leaving, with many only in the prison for a very brief period of time. The second difficulty is the lack of interview space in the Halls (which is not unique to Cranstoun and is addressed elsewhere in this report).

Individual Counselling and Support

4.16 The addictions nurses see every individual on methadone on admission and explain the need for information to be faxed to and from the community prescriber as well as informing them of the practicalities of methadone dispensing within the prison. When an individual is detoxing on methadone the addictions nurse sees him at least once a week on an individual basis to check how he is coping and discuss any difficulties he is experiencing. The detoxification can be slowed down if an individual is finding withdrawal symptoms difficult. This individualised approach mirrors what would happen in the community and is good practice.

4.17 The administrative staff within the addictions team notify the addictions nurses of individuals who are approaching their liberation date. Again the addictions nurses will see these individuals to discuss reduced tolerance to drugs and alcohol and will stress the dangers associated with a return to illicit drug usage. These one-to-one sessions are conducted in free time outwith methadone dispensing and on an ad-hoc basis. It would be desirable that allocated time is given for this to take place. Group sessions also took place for prisoners leading up to their date of liberation.

Blood Borne Virus Group

4.18 Each Wednesday afternoon the addictions nurses facilitate a blood borne virus information session which lasts approximately one hour. All participants have self-referred and following this session can request blood tests for HIV and for Hepatitis C. This is an extremely important session, which addresses confusion and fears about blood borne viruses.

Programmes

4.19 The addictions team facilitate two addictions programmes: - First Steps and Lifeline. Referrals are taken from all sources, though all individuals should have been assessed by Cranstoun Drug Services. The addictions team then conduct their own assessment for participation. Individuals are commenced on a programme based on their liberation date.

4.20 First Steps is under consideration for approved activity status. It lasts four weeks, with five, two-hour sessions per week. Participation is open to all convicted prisoners, including those on methadone. The programme consists of drug education and awareness of effects of drug usage on self and others. The programme also aims to increase motivation to modify drug taking behaviour.

4.21 Lifeline is a programme for convicted prisoners who are drug free. It lasts four weeks, with morning and afternoon sessions, five days per week. Group sessions take place in the mornings and alternative activities such as art, physical training and healthy eating in the afternoon. The fifth Lifeline programme commenced during the week of inspection and the local target for 2003-2004 is 50 individuals completing. (In the first four programmes run, 38 individuals completed from a starting number of 40).

New Developments

Substitute Medication

4.22 The dispensing of methadone will be relocated in the summer of 2003. A dispensing area has been identified within the Drug Support Unit ('D' Hall) and individuals within this Hall will receive their methadone there. This will eliminate the need for staff to escort to and from the addictions centre and will free up much needed time to provide meaningful interventions. A second dispensing site has been identified in 'C' Hall. Untried individuals from 'A' and 'C' Halls will receive their methadone there. This again will free up time for other interventions to take place.

Liberation Packs

4.23 All individuals liberated from the establishment are given a pack containing leaflets outlining the dangers of reduced tolerance to drugs and alcohol, useful telephone numbers and a condom. This simple measure attempts to reinforce the dangers of overdose in the high risk days following release from custody, as well as safe sex health promotion. It is an example of good practice.

Summary

4.24 Overall, the scale of the substitute and detoxification prescribing within the establishment leaves uniformed addictions staff extremely stretched. With the numbers of individuals receiving methadone increasing each month this year there may be a case to review processes, systems and staffing levels. This might allow for more in depth programmed one-to-one work with individuals, the importance of which cannot be overstated.

4.25 The care and attention given on admission and liberation to those in receipt of methadone is high, and ensures that these transition periods are as safe as possible for the individual concerned. The paperwork and recording are of an extremely high standard and the administrative support provided is crucial to the addictions team.

4.26 The number of prisoners receiving medication is extremely high and can fluctuate greatly on a day-to-day basis. All staff approach their work in a positive manner and the prison is to be commended on its handling of the drugs issue.

Alcohol

4.27 The alcohol service is contracted and comprises a Co-ordinator and two counsellors. Groupwork as well as individual counselling are offered. The contract runs from July 2002 -

June 2005.

Referrals

4.28 From July 2002 - April 2003 the team has received 1,346 referrals as follows:

4.29 Just over one half of referrals come from admission staff although they can be made from a wide range of sources.

Assessment and Treatment

4.30 Following referral, the team conducts an assessment and a care plan is drawn up. An individual is offered one-to-one sessions for counselling and one-to-one sessions for advice, as well as general information or a group programme.

4.31 The Co-ordinator attends the fortnightly multidisciplinary meeting with the addictions team. A weekly meeting also takes place with the Alcohol Service Co-ordinator; Medical Staff; an officer from the High Dependency Unit; Supervisor from the Mental Health Team; and a representative from Cranstoun Drug Services. This group meets to discuss on-going cases weekly.

Individual Counselling/Support

4.32 The team sees clients individually for counselling sessions lasting approximately 45 minutes. Advice and information sessions are shorter. Staff receive regular supervision from within the team. On-going progress notes are kept.

Alcohol Programme

4.33 This is a local programme consisting of 10 two-hour sessions. The programme covers a variety of topics such as alcohol facts; problems of intoxication; health; first aid; changing behaviour; relapse prevention and next steps. The programme is usually run monthly with 8-10 individuals. It is facilitated by two workers and the completion rate is high. Following the programme, an individual can be seen on a one-to-one basis by a member of the team for more in-depth work. This is an area of good practice. An alcohol information session has also been presented to young untried prisoners.

Alcoholics Anonymous

4.34 Alcoholics Anonymous (AA) hold one meeting each week within the establishment. Numbers attending are small (three to four at each meeting). These meetings should be encouraged.

4.35 Overall, the small alcohol team is highly motivated and provides a service to a high standard. Difficulties exist however. Interview space is difficult to come by and staff also report difficulties with prisoners not turning up for group sessions. Residential staff from the Halls are responsible for escorting the prisoners to the addiction centre for the group programme. Due to other commitments of the residential staff this does not always go smoothly.

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