Intended for healthcare professionals


Safer prescribing for prisoners

BMJ 2012; 344 doi: (Published 26 January 2012) Cite this as: BMJ 2012;344:e447
  1. Michael Levy, professor
  1. 1Medical School, College of Medicine, Biology and Environment, Australian National University, ACT 0200, Australia
  1. michael.levy{at}

New guidance fails to deal properly with this complex area of practice

Most prisoner health services in developed countries are modelled on primary care, with nurse led health services. Prescribed drugs are a major component of clinical practice within prisons and usually form the central point of contact between the patient and prescribing medical staff; however, little information is available on how much care centres around prescribed drugs and the nuances of patient care in prisons. Much that supports the care of prisoners is excluded from public scrutiny because of generalised fears of disclosure of “in confidence” information. This impedes peer review and leaves a substantial void in an important area of primary care.

The Australian Institute of Health and Welfare is developing a surveillance system for prisoners in that country.1 A survey conducted in 2010 showed that 40% of prisoners were prescribed drugs—on average 2.3 drugs per person—and that women were more likely to be medicated than men (47% v 39%). Antidepressants and mood stabilisers accounted for 18% of repeat prescriptions and anti-inflammatory drugs for 12%.

Drug seeking behaviours in prison populations are underpinned to a large extent by psychological trauma, neuropathic pain, dependence on pain relief drugs, dependence on illicit drugs, …

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