Prescribing for people in custody

Abstract

People who are, or have been, in custody often have multiple morbidities and multi-dimensional disadvantage.A thorough clinical evaluation and multidisciplinary approach will assist in managing these patients. Treatment plans should be pragmatic and simple, and explained in an understandable manner.Caution should be used in the prescription of any medicines that have the potential for abuse. There is also a risk of drug diversion. Prison environmentThe prison environment impacts on the delivery of health care, as security requirements coexist alongside the medical requirements of the prisoners. This often provides additional challenges to the provision of health care. Health in prisons and forensic facilities is managed by state government agencies or private corporations. There is no access to the Pharmaceutical Benefits Scheme so medicines are purchased through contract arrangements. On admission, medicines may be changed to

Examining clinician choice to follow-up (or not) on automated notifications of medication non-adherence by clinical decision support systems

“…Accessing these data constitutes a form of follow-up; while the person flagged as non-adherent was not directly contacted, non-AI 2 data provided veracity for the clinician’s decision. This code also highlights the impact of the lack of integration within Australian contexts in which medical support is provided on attempts to monitor adherence and, indeed, on the maintenance of comprehensive records for people with complex interactions with health and carceral systems [ 73 ].…”

A global review of prison drug smuggling routes and trends in the usage of drugs in prisons

“…The misuse of prescription medications apart from OST medications, such as tranquilizers, antidepressants (mirtazapine), benzodiazepines, antipsychotics (quetiapine, olanzapine), anticonvulsants (pregabalin, gabapentin), and even paracetamol (acetaminophen), has also been reported to be an increasing problem in many prisons, particularly for women (Bi‐Mohammed et al, 2017; Duke & Trebilcock, 2022; Hampton et al, 2015; May et al, 2019; O'Hagan & Hardwick, 2017; Penfold et al, 2005; Rousselet et al, 2019; Sahajian et al, 2017; Tamburello et al, 2017; Zurhold et al, 2005). Women have been found to be more likely to misuse prescription medications than men in both prisons and the community (UNODC, 2021).…”

Audit of epilepsy healthcare provision in a large UK category B prison

“…The UK prison population is currently around 80,000 and has risen by 74 percent in the last 30 years [3] There are important demographic challenges in this population with respect to delivering consistent and effective healthcare, these include increased rates of mental health problems and substance misuse [4], lack of a stable home [5] and high rates of recidivism (reoffending) [6]. Some of these demographic issues raise important issues for prescribing for epilepsy, as medications such as pregabalin, gabapentin and benzodiazepines have high rates of diversion (potential for illicit use) in prison settings [7,8]. Analyses of healthcare needs in prison settings recurrently reflect the need for improvement [9] but data on epilepsy healthcare provision is often brief or even lacking in these analyses (ibid).…”