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.

whats the wierdest thing a prisoner has smuggled in and how did they do it?

This is obviously not for me but as they come via us before prison, we see phones and drugs being the most common things. There are tiny phones that fit up your bum. We also have seen wraps of drugs hidden under the foreskin 😬.

Yes bananafish, that's exactly what I was told re Tramadol vs Oxycodone - you have explained much better than me. I did take Tramadol for a while but it kept me awake, and once I got to the max dose I suffered nausea and dizziness too. No side effects on the Oxycodone apart from a little fatigue! And duloxetine was the most evil drug ever for me, and has left me with intolerance to all SSRIs/SNRIs.

Why is all this money spent in the first place?? Why aren't they just not to expected to go cold turkey? It's supposed to be prison. Their addictions shouldn't be encouraged. I doubt alcoholics are given alcohol or supplementary alcohol when they are sent to prison.

Methadone costs about 1p a ml. I would rather the government spend a small amount on methadone to prevent unnecessary suffering and reduce the risk of suicide - I really don't like trying to resuscitate prisoners that have hung themselves and detox increases the risk of suicide enough even with medication.

Alcoholics are given benzos for the first 11 days to stop them from dying.

Are you seeing issues with crystal meth?

Weirdly I didn't see anyone on crystal meth until the spring then I've met 4 prisoners since. It's definitely spread out of London now, which is worrying.

Thanks for answering. Interesting that detoxing is prioritised over pain management.

No, patient safety is prioritised over giving addictive medication to addicts. Interesting view point though!

Is drugs or drink the worst for people arriving in prison? I'm assuming once you're in the bar facilities aren't so great so drugs reign inside.

Most patients are poly drug users, the amount of people addicted to alcohol alone is very small. Most need detoxing from heroin, benzos, alcohol and pregabalin.

How do you detox someone from alcohol and how long does it take

4 week diazepam detox for mixed benzo and alcohol withdrawal, 20mg every morning for 7 days then drop 5mg a week OR 8 week detox starting at 20mg a day dropping by 2.5mg a week if they were taking more than 160mg a day before they came into custody.

8-11 day alcohol detox using chlordiazepoxide, 11 days being the most common. 40mg 4 times a day for 3 days, 30mg 4 x a day for 2 days, 20mg 4 x a day for 2 days, 10mg 4 x a day for 2 days, 10mg 2 x a day for 2 days then off,

Sorry I know this may be a naive question but I'm dying to ask
Have you ever felt physically threatened by your patients? And when you see them, are you accompanied by prison officers?
Thanks

If a corrupt member of staff was passing drugs what would you do?

If I found out a corrupt member of staff was passing drugs then I would go and talk to the security lead for that day and the governor, then fill out an anti corruption intelligence report and call the outside police when the governor gives me the go ahead.

whats the wierdest thing a prisoner has smuggled in and how did they do it?

Tattoo needles. I've got no idea how!

Sorry I know this may be a naive question but I'm dying to ask 
Have you ever felt physically threatened by your patients? And when you see them, are you accompanied by prison officers?
Thanks 

I've only felt really threatened on a small number of occasions, I have an alarm and tend to use it preemptively, I also wear a body worn camera and I believe this has made a difference.

I'm not always escorted by prison officers if moving around the wing as I have keys and a radio (which has my alarm on it), but if I'm seeing a prisoner in their cell or at the medication hatch there is always an officer present. If I'm seeing prisoners in a clinic room there will be an officer close by but not in the room unless I ask them to be.

We also have seen wraps of drugs hidden under the foreskin 😬.

That's where they tend to hide pills I've given them during medication round too.

I'm being stupid but what is the difference between decriminalising drugs and legalising them?

I'm being stupid but what is the difference between decriminalising drugs and legalising them?

Decriminalisation means people can still be prosecuted for dealing drugs but there is an amnesty on prosecuting people for having small amounts for personal use in their possession. Whereas legalising them would mean you may be able to buy crack in your local Tesco.

Best thread ever - thanks OP.

How do prisoners 'pay' for the drugs they get in prison from other prisoners?

Thank you fruitcider for answering.
That sounds an interesting idea.
However, just to be the devil's advocate for a moment, do you think that could lead to an increase in addicts?
In US doctors handed out opiates very readily for pain on the strength of one paper by a professor who said that only 1% of patients prescribed opiates would get addicted.
Now there is a major problem as when finally doctors wised up to what was happening and refused to prescribe further opiates, heroin dealers moved in with an efficient system to make up the shortfall.

However, I fully appreciate you work on the front line and know what you are talking about.

How do prisoners 'pay' for the drugs they get in prison from other prisoners?

They get people on the "out" to transfer the money to someone else on the out, who stores the money until they are released or puts some on their spend list.

They trade canteen items eg chocolate or possessions such as radio, trainers etc

They "work" for it eg will clean the dealers cell, run errands, beat people up

Prostitution

However, just to be the devil's advocate for a moment, do you think that could lead to an increase in addicts?

Definitely not, here's a video on the Portuguese model and the success this has had.

It's important to remember that the opposite of addiction isn't sobriety, it's human connection. People bond with drugs instead of people. That's why the posters upthread can take opioids long term and not become addicted, whereas it is completely inappropriate to prescribe these drugs to addicts.

However, I fully appreciate you work on the front line and know what you are talking about

Thanks but I'm a very small fish in a very big pond in terms of knowledge

We always hear about female prisoners having a lesbian relationship inside. Does this happen regularly in a male prison? The women tend to have stable relationships (ie until one is released) - does that happen in male prisons?

Thank you fruitcider very interesting thread

Yes we are dealing with more use of crystal meth

Drug addiction is an ongoing battle with our service users and alcohol but I think as I deal with mainly young males drugs are a far bigger problem older ex offenders it tends to be both or just alcohol

Cannabis is still for us the biggest issue as the impact on their mh and the risk of cannabis induced psychosis

It’s a great job you do it’s often overlooked the huge drug issues and mh issues within our prisons

No, patient safety is prioritised over giving addictive medication to addicts.

Patients who take prescribed medication as prescribed are not addicts. Doctors who treat this type of patient describe it as dependence, not addiction.

Addicts are typically seeking their next high. Patients taking prescribed pain medication as prescribed are seeking pain relief from diagnosed conditions.

I get that there are a lot of addicts in prison, and maybe not many people who are being treated with opiates for serious conditions. Are there any at all?

If you were a nurse in a hospital, would you withhold medication from patients when it had been prescribed by a doctor?

My Dad is currently serving 2 weeks for drink driving. First offence but a high breathalyser reading. The probation officer, court clerk and duty solicitor all surprised at a custodial sentence as the magistrates were recommended to give him a suspended. But that's by the by, it's more his treatment in prison I'm wondering about....

Apparently my Mom gave someone at the court a list of all his medications he takes, but he's been in over a week now with no sign of his medication.

They also moved him and put him on a top bunk, then said they would move him again as he's 66 and struggles a bit with mobility - but he's still there now 2 days later.

I know he is being punished but surely this isn't acceptable treatment?

Patients who take prescribed medication as prescribed are not addicts. Doctors who treat this type of patient describe it as dependence, not addiction.

I'm a prison detox nurse, all of my patients are addicts and that's why we do not give them medication that either they can get addicted to or give to someone else.

Addicts are typically seeking their next high. Patients taking prescribed pain medication as prescribed are seeking pain relief from diagnosed conditions.

My patients don't take their medication as prescribed, chronic pain or not, because they are addicts.

I get that there are a lot of addicts in prison, and maybe not many people who are being treated with opiates for serious conditions. Are there any at all?

Addicts may also have serious conditions, but the temptation to misuse the medication is too great for them, and due to their addictive tendencies it's not suitable to give them any addictive medication,

If you were a nurse in a hospital, would you withhold medication from patients when it had been prescribed by a doctor

If the dose was wrong, or the medication was wrong, or the combination was dangerous yes absolutely I would, because if I harmed the patient by giving them medication the doctor had prescribed it would be me that got struck off and not them.

I know you feel frustrated at my perceived attitude to your medication, but my patients are a different kettle of fish to patients that take long term opioid medication responsibly and who don't have addict tendencies.

My Dad is currently serving 2 weeks for drink driving. First offence but a high breathalyser reading. The probation officer, court clerk and duty solicitor all surprised at a custodial sentence as the magistrates were recommended to give him a suspended. But that's by the by, it's more his treatment in prison I'm wondering about....

Apparently my Mom gave someone at the court a list of all his medications he takes, but he's been in over a week now with no sign of his medication.

They also moved him and put him on a top bunk, then said they would move him again as he's 66 and struggles a bit with mobility - but he's still there now 2 days later.

I know he is being punished but surely this isn't acceptable treatment?

Hi Regina

When we receive a new prisoner (late at night usually), we fill out a consent form giving us permission to contact their GP. The following morning we fax then requesting a summary of medical history and any medicine prescribed.

There's usually 2 reasons why medication has not been prescribed: the GP does not confirm the medication, or the last prescription date is not consistent with the prescription length eg someone was last prescribed 4 weeks of medication 8 weeks ago.

The bunk issue is a tricky one, because generally the person who has been in the cell the longest will take bottom bunk (it's seen as a privilege). If your dad is concerned that he cannot get down from the top bunk quick enough in a fire then he can request the officers to refer him to safer custody for a PEEP assessment, if he is found to need a PEEP they will put him on the ground floor on a bottom bunk.

He has less than a week left, try not to worry (as hard as that is) x

Thank you for answering, and for acknowledging that there are people out there who use opiates responsibly.

I just believe there are exceptions to every rule - maybe 9,999 out of 10,000 people who are in prison and take certain medication are addicts, but what about the one person who has been under a pain clinic and used the medication responsibly for 15 years... then is imprisoned for a minor offence and dies in horrible pain because their medication is stopped? Does anyone care about that one person who slips through the net, or is he/she just collateral damage? Does the system prefer to uphold the view that 100% of prisoners on medication must be addicts, full stop, no questions asked, ever?