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4. ADDICTIONS
Introduction
4.1 The head of healthcare also has lead responsibility for addictions services. This means that the health and social care components of addictions services are jointly managed and well linked. Glenochil has a well formulated addictions strategy and close links with the Forth Valley Drug Action Team. There are 2.5 addictions nurses whose main task is to administer methadone and work with prisoners on the methadone programme. Medical input is provided by a GP addictions clinic every Thursday. One of the addictions nurses spends 2.5 days each week with the local community team. This team offers the facility of external clinical review in more complex cases.
Interventions
4.2 The main clinical intervention at Glenochil is the methadone programme. Phoenix House is contracted to provide a harm reduction package to prisoners at induction and to undertake assessments and interventions with cases referred to them. These cover both drug and alcohol use. Specialist alcohol counsellors are available through the Scottish Council on Alcohol. The Programmes Unit offers 'Lifeline', 'Alcohol Awareness' and 'First Steps'. Needle exchange packs are available on liberation together with clear information about the risks of 'overdosing'.
4.3 The mandatory drug testing programme is in a period of transition. The majority of tests being carried out are now voluntary and linked to progression and assessment for, or participation in, the methadone programme. In September 2006, 25% of the tests carried out were random or suspicion tests. Detoxification is used sparingly, normally in conjunction with withdrawal from methadone.
4.4 There is a Substance Misuse Strategy Group and a Substance Misuse Review Group in place. Both groups have wide and appropriate representation. The latter group provides for the regular review of individual cases.
4.5 Glenochil does not receive prisoners direct from the courts, and if a prisoner is receiving methadone in a sending prison he will receive it in Glenochil. For those not receiving methadone who want to access the programme there is an assessment process to establish suitability. This involves interviews and drug testing. The prisoners' perspective was that there was a waiting list for methadone (reinforced by the use of the term "waiting list" by staff and by a suggestion that there was a ceiling in the number of prisoners who could participate in the programme). The term "waiting list" is unhelpful. Prisoners were also critical of both the availability and length of detoxification.
4.6 Staff noted that their approach to work with prisoners participating in the methadone programme is 'patient led'. The key focus is on harm reduction and on stabilising drug use so that the prisoner can participate in the life of the prison. The GP oversees all methadone prescription in the prison. Addictions nurses administer the methadone daily and are responsible for the prisoners' care plans and related counselling and support. They aim to see each prisoner at least every 4-6 weeks. Each case is formally reviewed every three months.
4.7 Prisoners confirmed the 'patient led' approach saying that they could stay on methadone until they felt ready to stop. In practice this meant that many prisoners were staying on maintenance prescriptions for extended periods, some running into years. Some saw themselves staying on methadone throughout their sentence and not tackling reduction until after they were released. However they also said that not a great deal of help to reduce their dependency was on offer during their sentences.
4.8 The extent of methadone prescribing has increased significantly in recent years. Prescription of methadone should follow a full assessment and there should be alternatives. It would also be helpful if the length of the assessment of suitability for methadone was shortened (the strategy highlights 4-6 weeks but some assessments were taking up to three months).
4.9 All staff providing addictions services were concerned about the challenges posed by the forthcoming expansion in prisoner numbers in Glenochil and the possible introduction of short-term prisoners.
Phoenix House
4.10 Phoenix House staff appear to be integrated into the overall substance misuse and wider Integrated Case Management strategies. The team comprises one manager and 2.5 addiction counsellors. As well as delivering the harm reduction package, they contribute assessments and provide an individual counselling service to those referred to them. They commented that their intervention did not appear to count for as much as approved SPS programmes when prisoners were considered for progression. Some group work and family awareness sessions were planned.
Linking Prison and Community Services
4.11 Linking prison based with community based services is largely achieved through the arrangement with the local Drug Action Team. Because Glenochil does not receive prisoners direct from the courts, and because prisoners may move on to the Open Estate before liberation, staff do not normally have to make arrangements for prisoners to continue interventions in the community. The issue is more about transfer of information between prison establishments.
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