Drug users in prison

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6949.271b (Published 23 July 1994) Cite this as: BMJ 1994;309:271
  1. M Farrell,
  2. J Strang
  1. Addiction Research Unit, National Addiction Centre, Institute of Psychiatry, London SE5 8AF.

    EDITOR, — Michael Ross and colleagues make an impassioned plea for better provision of care for drug users in prisons.1 Dependent drug users presenting to the prison service should have access to appropriate treatment, and, as the Advisory Council on the Misuse of Drugs recently pointed out, there should be continuity of treatment between the community and prison.2 There has been considerable pressure to ensure that the delivery of methadone detoxification to opiate users presenting to prison is adequate, and guidelines have been drawn up, with the cooperation of key people involved in drug treatment services, to promote this. Opiate users should be given sufficient methadone during drug withdrawal to reduce the likelihood of them injecting and using contaminated equipment.

    Ross and colleagues insist that the existing seven day withdrawal regimen is unethical. Colleagues and I run an inpatient unit where we provide a 10 day withdrawal regimen for all our opiate dependent patients, and we can see no grounds for arguing that reducing this to seven days is unethical or fails to replicate the physiological rates of withdrawal.3,4 In my view such withdrawal regimens should be spread evenly throughout the prison system. According to the most recent report of the director of health care for prisoners, a survey of prison treatment establishments found that only a fifth of respondents were providing methadone detoxification for opiate withdrawal. All prison medical officers should provide approved treatments for drug withdrawal; more individualised treatment approaches can evolve in the wake of the widespread provision of a basic minimum of treatment.5


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