I'm a prison detox nurse, ask me anything!

[fruitcider]

Jumping on the band wagon!

Obviously I cannot give out any info that breaches official secrets act or may put prison security at risk but I'll do my best to be as open as I can.

Have you known anyone get off spice ?

Yes it does happen

Justanother well a rat and cockroach infested holiday camp isn't my idea of a nice time by any means

This may be outside your remit, but once they have been detoxed to they get any further support?

What punishment do inmates get if they get caught with drugs on them?
I visit a relative in a Cat c prison and most of them look like zombies so presumably on spice.. can't you put them in seg or something if you can see that they have taken something

We can't put the hundreds of prisoners on spice in the seg we don't have capacity.

We send them for adjudication with the governor or punish them through the IEP system eg their TVs get taken away so they are more bored and smoke more spice...

I used to work in prisons as a drug worker and I left partly because I felt that many offenders were being treated with substandard care than they were receiving in the community solely due to their offender status. I found this discriminatory, and in my experience it was mostly brushed off by medical staff such as the prison nurses.

An example would be a man prescribed pregabalin in the community for severe neuropathic Pain being denied it in prison as it’s a drug liable to be abused, and there weren’t the staff to supervise it being taken. Rather than see this as a problem and disagree with it, most nurses had the attitude of ‘well he shouldn’t have committed crime should he?’ as though that was anything to do with his right to adequate healthcare. I accept nurses weren’t able to magic up more staff to supervise the medication administering, but the attitude of ‘oh well they’re prisoners what do they expect’ was awful, and totally contrary to ethical codes which require professionals to treat patients without prejudice.

Do you see much of this going on? What are your thoughts?

If somebody is going into prison with a cocaine addiction (so physical withdrawal not a massive issue, and unlikely to be much coke going round in prison), a severe addiction to cannabis (10 joints a day at least), severe bipolar disorder and a very addictive personality, what do you think the chances of them getting hooked on spice are? They've never done it before and it's not much of a 'thing' in our area, but I've heard it is in nearby prisons (probably for the reasons you explain).

Second question, are talking therapies available in prisons for people with severe mental illness? Understand this may not be your area of expertise.

This may be outside your remit, but once they have been detoxed to they get any further support?

Yes we have a psychosocial team that run relapse prevention groups, we also have AA/NA/CA/SMART run groups in the prison.

No questions but what a fascinating thread - thank you for posting.

lovemyjob I work in a pregabalin free prison, we decided to become pregabalin free because of the dangers eg prisoners have died from using it. I wouldn't deny anyone treatment on the basis of them being an offender but everything is risk assessed.

notlean I cant answer your first question because everyone has their own level of stress tolerance.

We have clinical psychologists who are very good at providing talking therapies, should people be referred. The problem is the lack of referrals from some nurses, not the lack of service.

fruitcider Thanks for your response!

What happens then if an offender needs pregabalin for whatever reason, and is prescribed it outside, and enters your prison? Surely just not giving it is unthinkable as what about the issues it’s being prescribed to treat?

Also, long term pregabalin use causes dependency and leads to severe withdrawals if stopped immediately (without a taper), how are patients cared for to prevent withdrawal? Is there a substitute medication given like there is for people dependent on alcohol or heroin?

Sorry if I didn’t make my point clear about another aspect of my question: have you had any issues with nurses you work alongside with the attitude I describe? Some of the nurses I worked with were fab (usually more newly qualified ones), but many were outright dismissive of and rude about their patients (in this occasion it was almost always the veterans but that could just be my prison). I come from a social work background originally and it was very tough to witness/stomach, though I understand people get jaded and ground down by the system.

What happens then if an offender needs pregabalin for whatever reason, and is prescribed it outside, and enters your prison?

We do a slow detox. If they are caught diverting it (most are) then they undergo a rapid detox. Most are also on a slow benzo detox so the diazepam seems to hold them quite well, though the withdrawals from a rapid detox are quite horrific. We always offer an alternative, usually duloxetine.

We have clinical psychologists who are very good at providing talking therapies, should people be referred. The problem is the lack of referrals from some nurses, not the lack of service.

Thanks for your response. Why is this, do you think? Is it because they suspect the prisoner won't engage? I think the person in question (family member) would benefit greatly from this, and would probably be open to it. He's thought about it before, but services are pretty dire on the outside. And when there's less drugs to take to do, I guess it's easier to make appointments!

As an aside, I'm hoping to become a clinical psychologist one day. What an interesting setting to work in.

Thank you for answering my question. Do you think harder punishments for people bringing drugs into prisons would work. Eg discourage staff and visitors from doing so.

Would there be anyway to change letters to emails or laminate etc.

It seems odd to me that an establishement such as a prison can’t get a control on drugs.

Sorry if I didn’t make my point clear about another aspect of my question: have you had any issues with nurses you work alongside with the attitude I describe?

On occasion, it's usually when they are burning/have burnt out. No nurse enters prison with that attitude.

Thank you for answering my question. Do you think harder punishments for people bringing drugs into prisons would work. Eg discourage staff and visitors from doing so.

No, prohibition and punishment does not work, that's why our prisons are full of addicts. Decriminalising drugs and legalising cannabis would probably help a lot.

Oh they do photocopy post in some prisons, mine doesn't but I wish they would.

Ah that’s a relief to know you do offer a detox. When you said pregabalin free I assumed you meant 100% no pregabalin in the prison.

I always found it strange that the patients who would have taken their medication appropriately were preemptively tarred with the same brush as those who divert/misuse. It wouldn’t happen in a community hospital that Bob is refused his meds because John before him who takes the same medication diverted his, so it shouldn’t happen in prison. The punishment is losing your freedom, not having your right to adequate healthcare jeopardised, if you see what I mean!

Mad props to you still being there. I volunteered in prisons for years (listeners scheme and then as a rehab volunteer) before becoming a fully paid up CARAT. I stayed five months before leaving as the job was futile. No time for any proper psychosocial work just pure harm reduction. It was a remand cat B so there often wasn’t the time for any real psychological help.

Mad props to you still being there.

I've been there 2 years now and I'm become more frustrated every day so I have another job interview next week! Hopefully I'll go back one day x

Do you envisage using subdermal buprenorphine in the prison setting once its available in the UK, and do you see any potential for diversion?

After seeing it from the inside do you think the system works? Do you see more people leave in a better place, having dealt with some of their issues or are there more that are angrier and therefore more aggressive as a result of being inside?

If you could do whatever you wanted, what changes would you make to make prisons the place you'd like them to be? (So changes in law, rules inside prison etc.)

Do you envisage using subdermal buprenorphine in the prison setting once its available in the UK, and do you see any potential for diversion?

God no imagine if someone else wanted it, and how they would get it from the person it's imbedded in?