Guidance for GPs working in prisons

GPs who work in prisons can access new prescribing guidance from the RCGP.

Safer prescribing in prisons from the RCGP Secure Environment Group covers common problems such as prison patients’ misuse of prescribed medicines, prisoners trading medications and bullying amongst prisoners relating to this trade.

The report, which is also aimed at pharmacists, highlights that “a significant proportion” of patients in prison, many of whom have a history of substance misuse, “will seek prescribed medication for the psychotropic effect rather than its therapeutic or licensed use”.

It explains: “Many prisoners, though not all, are accustomed to using illicit and prescribed drugs to ameliorate or treat symptoms and perceived wants and needs. They may not have considered or tried other types of therapy to improve health and wellbeing.

“Time spent in custody can be used to encourage prisoners to change their lifestyle and the use of non-drug therapies can challenge the over-reliance on pharmacological treatment.”

The guidance categorises medicines into three groups: red, considered inappropriate for prison due to the potential for misuse; amber, may be prescribed with caution where appropriate alternatives are unavailable or unsuccessful; and green, generally first choice because of their lower potential risk (even if this goes against usual NICE guidance).

The guidance, which is endorsed by the Royal Pharmaceutical Society, also gives prescribing guidance relating to:

• possession of medicines

• pain

• neuropathic pain

• depression

• epilepsy and other convulsive conditions

• psychoses

• attention deficit hyperactivity disorder

• benzodiazepines

• use in anxiety and other related disorders

• insomnia

• palliative care

Chair of the Secure Environments Group, Dr Marcus Bicknell, said: “There are 136 prisons in England and approximately 250,000 people move through the prison system each year, many of whom will have health issues and need care. We hope this guidance will prove helpful to the different healthcare teams who have a responsibility to work with patients in secure settings.”

Link

Safer prescribing in prisons - Guidance for clinicians, RCGP Secure Environments Group