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NETWORK A national newsletter on substance misuse management in primary care
network
NETWORK 24 DECEMBER 2008
Network Prison
Special Edition
The prison Integrated Drug
Treatment System (IDTS)
Providing good quality, effective drug treatment in prisons expanded to 91 of a total of
is vital for a number of reasons, including:
133 adult prisons in England.
IDTS offers clinical and
■ People in prison are more likely than the general population to
psychosocial support including substitute prescribing and support
be socially excluded, to have substance misuse problems and
for detoxification. Some prisons offer brief interventions for alcohol.
to have mental health problems.
■ Women prisoners have higher rates of self-harm and overdose
IDTS presents a challenge to prisons in terms of multi-agency
than male prisoners.
working, organisational changes and the introduction of new policies

and procedures. One of the key challenges is to balance the culture
Injecting drug users are eight-times more likely to die in the two
of drug treatment, which has its roots in a harm reduction philosophy,
weeks following release from prison than at any other time in
and the prison culture which, by necessity, has security as its central
their lives: 97% of these deaths involve opiate drugs.
guiding force. The success of IDTS rests in effective communication
■ Half of prison suicides occur in the first 28 days of custody, and
between all professionals involved in the prison system.
drug-dependent individuals have double the risk of suicide in
the first week of custody as compared to the general prison
Service user involvement and advocacy for service users is as
population.
important within the prison system, as it is within the community, and
systems should enable access to both for prisoners.
■ 60% of men and 37% of women in prison have a history of
serious drink problems; half of men and women have current or
Two-thirds of those coming into prison will lose their jobs. Some 30%
past drug dependence
of those leaving prison will be homeless. Effective care pathways
are essential to resettlement and continuity of care across a number
Therefore, getting drug treatment in prisons right can address a
of domains including health, housing, and employment. The families
range of health and social exclusion issues. Particularly, substitution
and carers of prisoners can play a crucial role in their care and
treatment in prison can reduce rates of re-offending and the rate of
should be informed about and involved in these care pathways
mortality among released prisoners.
wherever possible.
The prison Integrated Drug Treatment System
Whilst it has generated debate and disagreements regarding clinical
Although drug treatment has been provided in prisons for many practice at times, IDTS has been welcomed by practitioners and
years now, it has not always been done well. The prison Integrated prisoners as a positive way of improving people’s health and well
Drug Treatment System (IDTS) was introduced in 2006 to provide being, and breaking down barriers between different professions
evidence-based drug treatment to people in prison, and has since and between staff and patients.
In this issue
Dave Marteau outlines the events that led up to the development of IDTS, and
setting can play in supporting prisoners to address problematic alcohol use.
the risks and challenges involved in its successful implementation. Page 3.
Page 13.
Nat Wright offers advice on how to overcome potential barriers to setting up a
John Podmore argues that release from prison is often a time for risky
clinical drug substitution service in a prison setting. Page 4.
substance misuse patterns, increased mental health problems and a return to
offending. He suggests that services should do all they can to support pathways
Jack Leach argues for optimising drug treatment in prison and for improved
between prisons and the community. Page 14.
care pathways between prisons and the community. Page 6.
Firoza Saloo outlines the key aims and components of the psychosocial
Si Parry discusses the important role advocates can have in prisoners’ lives element of IDTS. Page 16.
and yet the difficulties prisoners can face when trying to access advocacy
Mark Williamson is Dr Fixit for a question from a GP about care pathways
services. Page 8.
between the prison and the community. Page 18.
Cathy Cooke takes us through the experience of implementing IDTS at HMP
Nat Wright gives advice as Dr Fixit to a prison doctor regarding a patient with
Bristol pharmacy and encourages other prison pharmacists to get involved with
dual diagnosis. Page 19.
the Prison Pharmacy Forum. Page 9.
See the bulletin board for the latest training events, including information
Jan Palmer outlines the specific issues faced by female prisoners for whom
about the Royal College of General Practitioners Secure Environments courses.
issues of self-harm, suicide and overdose are greater than for male prisoners.
Page 20.
Page 10.
We hope you enjoy this edition.
Leanne Coulson discusses the experiences of family members and carers
when their loved one goes into prison, and the important role they can play in
Editor
their rehabilitation. Page 12.
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Gail Styles describes the role that brief interventions for alcohol in a prison
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