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BMJ No 7099 Volume 315 Press Releases Saturday 5 July 1997 Embargoed: 00.01 Hrs 4 July 1997 UK time
Drug and alcohol abuse in prison [Substance use in remand prisoners: a consecutive case study] Prison reception health screening consistently underestimates drug and alcohol use, and a positive finding should be considered the norm rather than the exception, says a paper in this week's BMJ. The authors studied 548 adult men awaiting trial in Durham prison, and found that, before remand, 57% were using illicit drugs, 33% had problems of drug dependence, and 32% had drink problems. 71% were judged to require help for their drug or alcohol use and 36% were assessed as needing a detoxification programme. Prison reception health screening for the same problem produced consistently lower figures, and fail to identify the extent to which substances are used and misused by people newly remanded to prison, say the authors. Provision of detoxification programmes for those prisoners who were identified at reception screening as having serious drug and alcohol problems were inadequate, they say; of 113 men needing a course of tranquillisers to ease withdrawal from drugs or alcohol, only 6 received one. Prisoners who need help but think that asking for it is more likely to result in punishment than treatment are not likely to be truthful about their substance abuse, say the authors. "More consideration needs to be given to reducing substance abuse in prisons by improving assessment at reception and providing better treatment for misusers rather than using random urine screening to detect and punish offenders", they conclude.
Contact:
Parkhead Hospital,
Tel: 0141 211 8480 [Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire study] Another paper highlights the underestimation of prison drug problems based on random mandatory testing. Half of injector inmates of two Scottish prisons (Lowmoss and Aberdeen) who had been in custody for more than four weeks had injected in the previous four weeks, an average of six times in four weeks, say the authors . Because heroin stays in the urine for only three days, the random urine tests are likely to detect only one third to two thirds of heroin users, and so seriously underestimate injector inmates' drug reduction needs, they say. As people continue to take Class A drugs by injection inside prison, they must be able to do so safely, say the authors. Although 41% of prisoners at Lowmoss and 37% at Aberdeen had a history of injecting drug use, only 4% of inmates had ever been offered vaccination against hepatitis B, and specific resources should be made available to enable the universal offering of this immunisation to become routine, as it is for prison officers, they say. Sterilising tablets, used to clean injecting equipment and freely obtainable by prisoners in Scotland, should also be made available in England and Wales. "If the current limited access to harm reduction measures is perpetuated it represents a serious gulf between the standards of health care and public health available to the same individuals in prison and outside. Prison medical service policy promotes equality but is short on delivery", conclude the authors.
Contact:
MRC Biostatistics Unit,
Tel: 01223 330368 or Dr. A Graham Bird
Department of Immunology,
Tel: 01865 225991 [Prevalence of HIV and injecting drug use in men entering Liverpool prison] Prisons represent a valuable opportunity to educate drug users, familiarising them with safe injecting practices and the range of health services available, if not when incarcerated then certainly on release, says a further paper. Of 219 new arrivals at HM Prison, Liverpool, who had a history of drug use, only 36 had ever injected in prison. Though this suggests that prison reduces injecting behaviour, say the authors, for those who continue to inject while incarcerated levels of risk behaviour are substantially increased. The frequent exchange of subjects between the local injecting community and the prison population means that drug use in prison cannot be taken in isolation, they say.
Contact: University of Liverpool
Tel: 0151 794 5774 [Should prisoners have a say in prison health care?] In a Personal View, Luke Birmingham, a forensic psychiatrist at the University of Newcastle upon Tyne, calls for prisoners to play an active role in determining and organising their health care. Many do not trust the prison health care system enough to help them and try to manage their problems themselves while incarcerated. But adequate healthcare for prisoners is not a privilege, it is a basic necessity, he says. "Prison is supposed to be about rehabilitation as well as punishment. Rehabilitation involves promoting health, so perhaps it is about time that we stopped thinking that we know what is best for them and took more notice of what some of them have to say on this matter."
Contact: University of Newcastle upon Tyne
Tel: 0191 223 2503
Men aged 50-70 in Finland, the Netherlands and Italy who ate a healthy diet (according to WHO guidelines) reduced their risk of dying from any cause by 13% compared with those who ate less healthily. A study in this week's BMJ says that studying the dietary pattern as a whole is more important than looking at specific dietary components when measuring survival. The food intake of 3,045 men from eastern and western Finland, Zutphen, the Netherlands, and Crevalcore and Montegiorgio, Italy was studied during 1970, and information on smoking and alcohol consumption collected. Causes of death were noted for those who died in the period to 1990, and the researchers found a clear correlation between healthy diet and mortality, particularly where cardiovascular disease was concerned. The results show that the WHO recommendations for a healthy diet are effective in helping to prevent premature mortality, say the authors.
Contact:
National Institute of Public Health and the Environment, Tel: (in Spain) 00 34 07 693 120
Medical students who are highly self-critical are likely to become prone to stress when they become doctors, says a paper in this week's BMJ. The author questioned 224 general practitioners who had been investigated for self criticism and stress as fourth year medical students. 43 (33%) scored above the threshold for stress symptoms - considerably higher than in the general working population. Stress levels were not correlated with hours worked, but self criticism as students was strongly correlated with current stress levels. The study shows that it should be possible to reduce stress symptoms in future GPs by recognising those students who may be vulnerable, and teaching them how to allocate responsibility less self-destructively, says the author. Contact:
Tel: 0113 233 5732
Embargoed: 00.01 HRS 4 July 1997 UK time
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