PRISON PHARMACY


these drugs of abuse but rather we inherit their prescribing.


With patients committed from all across nI we find ourselves dealing with a concentrated population of individuals showing very clear signs of addiction to prescription medications.


WIth patIEntS


commIttED from all acroSS nI WE


fInD oUrSElVES DEalIng WIth a concEntratED popUlatIon of


InDIVIDUalS ShoWIng VErY clEar SIgnS of aDDIctIon to


prEScrIptIon mEDIcatIonS


medications in the community and the Ip policy aims to identify those who can safely continue to do so within the prison environment.


Within one week of committal to prison, each patient will have an Ip risk assessment completed by one of the nursing team. three areas are taken into account:


firstly, patient factors are considered, such as whether a patient has a history of overdose or self harm. the self-harm potential is particularly relevant to the risk of overdose and so medications such as tricyclic antidepressants will come in for particular scrutiny. these medications are very toxic in overdose and so are only given by nursing staff.


Secondly, environmental factors are assessed, such as whether a patient is sharing a cell.


thirdly, we look at medicine factors, such as how potentially dangerous a medication is in overdose, or is liable to misuse. When a medication is known to be potentially toxic in overdose, or liable to misuse, a decision is made by the nursing team


whether to allow the patient to be issued this medication on a weekly basis or to have it directly administered (supervised swallow).


With other medications, such as omeprazole, where the risk of self harm or misuse is unlikely, most patients will receive a full month’s supply.


mEDIcatIon abUSE as with other UK prisons, abuse of medication is a major issue. there have always been misuse issues with ‘traditional’ drugs, such as heroin, cannabis and cocaine, but in recent years we’ve increasingly had to deal with issues with new psychoactive substances and prescription medicines, such as pregabalin and tramadol.


this is an increasing problem in the general population as a whole and isn’t simply a prison problem. It is, in fact, an nI-wide problem.


on a patient’s committal to prison we access their Electronic care record in order to ensure continuity of care from their community gp. as such we don’t generate new prescriptions for


as a result, we are increasingly facilitating reduction programmes for medications such as benzodiazepines. patients who enter prison will automatically have their benzodiazepines reduced and the mental health team will start to work on any mental health issues that are evident.


We also work to reduce addiction in other areas and we are currently focussing on issues around the prescribing of medications such as pregabalin and tramadol for neuropathic pain.


abuse of pregabalin and tramadol is particularly prevalent and, as such, the numbers who are addicted to these prescription medications is on the increase.


holIStIc proJEct at the moment we have a project up and running which comprises a multi-disciplinary healthcare professional team led by a physiotherapist. It’s very much a holistic approach and comprises gp, pharmacist, physiotherapist and occupational therapist.


this team is working with a small cohort of patients at a time, mainly in the area of education; discussing with them why they have pain, assessing what their perception of their pain is, and working with them to understand how they can manage their pain by moving away from their reliance on painkillers.


We bring in activities such as exercise to move them away from their previous conception of pain management.


We work with twelve patients at a time over a ten-week period and we’re currently on the fourth cycle of this project. the results, to date, have been mixed, with some patients very positive and others less engaged.


We’re offering incentives to attend, such as increased visiting time and


increased family interaction and this has certainly proved very positive.


the patients involved are offered a place on the project, which they are free to take up, but they can also drop out at any time if they so wish, and so it’s a matter of keeping them interested and engaged.


the evaluation of the first three cycles of the project is currently being carried out and that will determine the future of the pilot which is, at the moment, still ongoing.


pharmacY SErVIcES In prison healthcare pharmacy we try to mirror community pharmacy as much as possible. for example, just as in community pharmacy, we carry out medicines Use reviews (mUrs) where we discuss issues such as inhaler technique and adherence.


We’re also increasingly running additional pharmacy services for our patients, such as smoking cessation clinics. We also provide a point of contact for medicines information, receiving and answering queries from fellow healthcare professionals and from prison officers.


there’s no doubt that prison healthcare pharmacy is a niche market and yet it reflects what is happening in community pharmacy.


We are, for example, now seeing more elderly patients – an offshoot of the ageing population which community pharmacists will also be experiencing, and we’re also seeing more cardiac and transplant patients. pain management and mental health issues are becoming increasingly prevalent – just as they are in the community.


We want to let the pharmacists of tomorrow know what happens in prison healthcare pharmacy and so, for that reason, I currently lecture to pharmacy students at both Queen’s and the University of Ulster.


prison healthcare pharmacy is undoubtedly an interesting, and, at times, eye-opening sector of pharmacy in which to work, providing an unique opportunity to engage with some of the most challenging patients in our healthcare system. •


pharmacY In focUS - 9


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