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.

I said to my pain consultant once - am I doing opioids wrong, I've never got high on anything: if I take a higher than usual dose I just get dopey and sleepy. He said that for genuine pain the opioids relieve pain rather than euphoria - but also some people's DNA just doesn't respond to opioids in that way. I took pregabalin and gabapentin and never would have thought of them in any remotely recreational way - probably just as well I've never got a kick out of any of my meds, given there's few opioids I haven't taken therapeutically! I don't get any kind of buzz (and to my shame in my younger days I have taken recreational drugs and know what a buzz feels like!)

Thanks for the insight OP, very interesting

The other point to make is that genuine pain patients live in fear of presenting as a drug seeker. When my handbag was stolen along with approx 1 week of meds, I didn't dare ask the GP for an early refill, because that could raise a red flag. I had to take 2 weeks off work to try and eke out the meds I had until I could submit my repeat - my GP might have been fine about it as a one off, but I felt I couldn't take that risk of presenting as a drug seeker

Same with my dose. I've known for a while that my modified release dose has been insufficient and my pain ill controlled. But I didn't dare make a GP appointment to ask to discuss adjusting my dose, in case I was seen as presenting as a drug seeker. I struggled on until a routine medication review when I raised the issue, and she suggested it sounded like the dose did need adjusting, and referred me back to my pain consultant. We live in fear of being perceived to be drug seekers, because of the behaviour of addicts

So true banana. I don’t hold drug seekers responsible for my worry about being treated that way though, as it’s down to the professional to act professionally, treat me as an individual and work with me based on our individual relationship rather than apply their views from another patient onto me. I’m not saying you believe otherwise at all btw, just I’ve seen others on chronic pain management say things like ‘well blame addicts for giving us all a bad name’! If a clinician is doing their job properly they won’t do that. And it’s certainly not the fault of another person who is entirely separate to me who is struggling with addiction.

I had my meds stolen once from my car which was broken into. I was able to claim a new script for them no problem, as long as I provided the police crime number as evidence. My current GP is absolutely fab, I’m on oral liquid and once managed to knock a bottle over, I got in touch and they prescribed me a replacement with no issues. Probably as I’ve been a patient there for a while now with no issues so we have mutual trust, though I’m also aware I’m less likely to be stigmatised as a liar or drug seeker due to being a well educated middle-ish class professional working white woman.

Absolutely 100% agree - I absolutely didn't intend it to come across that way, and I'm in violent agreement

I'm sure my GP would have been fine! Again, I have the privilege of being a middle class, professional woman in my 30s with a long history of care under a pain clinic, so it's likely I would have been fine. But I fear not being able to risk it just in case

Being off all my meds when doing IVF / pregnant was so excruciating, and meant I was essentially unable to lead any kind of normal everyday life, means I cannot contemplate the prospect of being cut off. So I live in over cautious fear just in case, as I don't want one GP in the practice who doesn't know me to cover their arse and not give me the benefit of the doubt (and I'd understand why, because we're talking about controlled drugs!)

☺️

I really do know the feeling, it took me around five years of serious daily intense pain that was getting in the way of being able to work and have a relationship/life before I was even started in the pain clinic! And another four years past that/many operations and interventions etc before I was started on morphine, which has almost literally saved my life. To look at me you wouldn’t have a clue. I think we know what it’s like to live knowing your existence is only possible due to taking these meds, and knowing as they’re (rightly) gatekept by doctors, they could be taken away at any point and you’d be straight back to hell. It’s a relief to have them, but it’s frightening knowing without them your life would be unliveable, no matter how much others (who usually haven’t experienced the pain) say there are so many other interventions that can help (yep, and I’ve tried them all!).

I think a lot of the perception of and fear of being seen as a drug seeker is in my mind, because of this fear. As I’ve got older (entering my fifth year now on opiates, they still work brilliantly) I’ve learned to be okay with it more: these drugs are manufactured and developed to treat severe pain, which I have, and which millions of people have too. I don’t need to feel any shame or fear in it, and anyone who judges is lucky never to have had to make that choice between being on daily morphine and trying to survive without it. I actually have a great relationship with my doctor and the pharmacist I usually see and I’m pretty open about why I’m on it if asked, and I make a real effort not to cow my head when I walk in to collect it. If anything I find people’s perceptions of people who take morphine are changed when/if they find out I take it, as from the outside I look perfectly healthy, I’m thirty, Work full time, drive, receive no benefits, and I’m not terminally ill. I have had quite a few people say they didn’t realise it’s possible to be on it long term successfully and be able to function day to day fine with no psychoactive effects, as they only know it as a medicine given in hospital that sends people loopy!

I’m thinking about kids soon and terrified, will have to see a Pain gynae doc to get their advice on what to do re medication and pregnancy, I’m not sure how I could function at all getting and staying pregnant without pain relief. Especially as mine is all urethra/bladder focused.

I think it boils down to the fact that to even be given such meds in the first place, your quality of life has to be pretty terrible. So it’s difficult fearing that happening again. Obviously the points I’ve made on this thread are primarily from a professional perspective, but from my own as a Pain patient it does make it easier to empathise with/fear for the patients in prison who are in the same position as us health-wise but are in a situation where they’re powerless to stop their treatment being stopped, and (from my own experiences working in prisons) sometimes under the care of clinicians who really don’t understand or sometimes care about trying to provide parity of treatment with the community.

Do you feel one GP is enough for a prison? And that nursing led healthcare is adequate?

Yes, the prison doctor has the same ratio of patients as they would in a community. Between the hours of 8 and 6 prisoners can access healthcare with any urgent concerns they may have, and they will be seen immediately (unless there is a life threatening emergency taking place at the same time). Routine health problems are triaged within 2-3 days. If they need to see a doctor they will see one that evening for emergencies and within 2 weeks for a routine appointment.

Prison nurses undergo a huge amount of training to do their job, I'm trained to examine and diagnose ear nose and throat problems for example, I can also suture, manage long term health conditions etc. We are not doctors assistants - we are independent practitioners with the ability to examine, diagnose and treat.

I am appalled anyone would advocate decriminalising drugs

Prohibition doesn't work. Punishment doesn't work. If it did I would have been made redundant but our prisons are as full as ever.

What happens to people who detox off of heroin or crack cocaine?

Heroin withdrawals:

• agitation
• sweating
• shaking
• vomiting
• diarrhoea
• severe joint pain
• Hair proliferation

It's not pleasant!

Apologies for butting in but I’m also a general prison nurse and work among the main population of the prison who are either, not withdrawing from drugs/alcohol or who have been safely detoxed and are then stable enough to join the general population.

I work with many patients who have complex needs/long term conditions and those who are terminally ill.

For patients in situations like yours Lovemyjob, either our GPs or specialist nurses would liaise with the patient’s GP or consultant/specialist. We also have a specialist pain consultant who works in our local hospital but also runs clinics at the prison. As Fruitcider mentioned, we also have a physiotherapist and good relationships with local clinical nurse specialists.

Those with complex health histories, or medication regimes would not necessarily be detoxed from medications which have been used successfully long term.

The patients who Fruitcider cares for will often be using drugs illicitly (including morphine/bupronorphene/benzos etc) and often either have a prescription or their own GP will confirm that they have not collected their prescription for many weeks/months.

I’ve looked after patients who take regular morphine/pregablin but the usage has to be assessed and managed safely. Being on these drugs can make patients vulnerable to be bullied but they wouldn’t automatically be detoxed.

HTH.

What does withdrawal look like?

Is it the same for every drug or different?

Hair proliferation...? Do they suddenly sprout fur?

Hair proliferation

Quite clearly this was an auto correct for piloerection!

What does withdrawal look like?

Is it the same for every drug or different?

Its different, though GI symptoms, shaking and sweating are common. Seizures can occur from alcohol and (rarely) benzo withdrawals. Heroin withdrawals aren't particularly dangerous but the risk of suicide is high.

Toothy you are more than welcome to join in, it's nice to hear from general prison nurses as their experiences are different to mine

Do you think that prisons are more dangerous places to work in recent years with poor staffing levels? I remember there was quite a lot of press about it last year, but I can't remember the outcome.

You mentioned a high proportion of prisoners and addicts suffered adverse childhood events. Do you see any improvements in the current generation of children being raised, or do you think there will be similar issues when they are adults?

Do you ever see any positive changes when your prisoners become parents?

What is a pilo erection? Even more intriguing

LoveMyJob I’m glad that the pain management strategies you have in place are giving you a decent level of pain control - I have been on long term opioid therapy for 17 years (not 19, as I prev wrote - typo!), and my tolerance has actually only risen moderately. I didn’t get on well with fentanyl patches because my tolerance did build very quickly - I was ending up needing breakthrough doses very rapidly: I think I didn’t get on well with transdermal also because it didn’t give me scope to take less on good days. The fentanyl was the only one I had physical withdrawal from - absolutely nothing in the league of what OP is describing WRT heroin withdrawal, it wasn’t like the Trainspotting cold turkey scene. But I did feel utterly dreadful - achey, shivery, anxious, agitated, beyond restless, wanted to crawl out of my own skin: no diarrhoea or vomiting, but I did feel pretty bloody awful. My own fault entirely for not stepping down as slowly as I should have done.

Tramadol I needed to step down from VERY slowly - not because of the opioid withdrawal, but because of the serotonin and noradrenaline effect, the anxiety and agitation of coming off it too quickly was not pleasant.

But I tolerate the oxycodone MR and IR very well. You never get immune to the constipating side effects, but Movicol sorts that out. The only benefit to being off all the meds during my (sadly unsuccessful) pregnancies was the joy of daily bowel movements!

I used to collect my prescriptions from a central London high st chemist near my office, and when I’d go in during my lunch break, I would not infrequently be in the queue with people who were waiting for the CDs cupboard to be unlocked in order to get their methadone (which of course they had to drink there and then). Because I could take my meds with me, I was told by the pharmacist to put them straight in my handbag and to go immediately back to the office - as they were concerned that I could be mugged for what was a large quantity of opioids.

I’m thinking about kids soon and terrified, will have to see a Pain gynae doc to get their advice on what to do re medication and pregnancy, I’m not sure how I could function at all getting and staying pregnant without pain relief. Especially as mine is all urethra/bladder focused.

I consulted both my pain consultant and my gynaecologist about this before starting TTC - my gynae recommended I see a colleague of his who quite literally wrote the book on prescribing in pregnancy. He is one of only a small handful of consultant obstetric physicians in the country - whereas OBGYN deal with pregnancies and babies, obstetric physicians deal with the management of maternal medical disorders in pregnancy. He was absolutely terrific, and was basically the authority on management of both my pain and my epilepsy in pregnancy (which turned out to be academic, as I’m infertile and could never make it beyond the first trimester in my pregnancies). The general gist from him was nothing whatsoever in the first tri, some opioids would be reasonable in the second tri, and third tri stepping down in order to be weaned off by the time of delivery, to avoid the baby suffering withdrawal.

There's no meaningful research done on any kind of prescribing in pregnancy due to ethical issues, so it really is based on professional experience . I would strongly recommend seeing him privately if you can - his name is Dr David Williams, and he is the top guy in the UK, you won’t get better advice tbh.

The specialist women’s physio I see for pelvic issues wouldn’t touch me during the first tri either, but said to come back after 12 weeks (again, sadly academic in my case)

I’d recommend pre-TTC counselling and go to the right people. My OBGYN said he would make recommendations cautiously based on his experience, but he wanted to refer me to Dr Williams as he said he was the go-to guy for any such issues.

Sorry for thread-derail OP! And thank you for your really insightful input too Toothy

I’m hoping I have no cause to ever end up in prison, though tbh if that happens I do think that my pain management may be the least of my issues were that to be the case! But reassuring to know that cases are managed on an individual basis

Hair piloerection - goosebumps!

Do you think that prisons are more dangerous places to work in recent years with poor staffing levels? I remember there was quite a lot of press about it last year, but I can't remember the outcome.

I’m not OP and don’t want to step on her toes. But I will say that in my experience of prison Work, the poor staffing absolutely did make the jail feel a far less safe place. We got emails each day updating us on issues in the prison and every single day, without exaggeration, there’d be reports of prisoner on prisoner assaults or prisoner on staff assaults. It wasn’t uncommon at all for the offenders to attack staff. The safe guidelines were to have three prison officers on each wing but there were usually only two. Safe restraint of someone requires three, according to the rule book, so wings were run basically on the goodwill of the prisoners, if they wanted to riot they would. They knew that there just weren’t enough staff to have any meaningful control over the wing.

Plus usually one of the POs would be off doing something else (taking an ACT file somewhere, attending to something) so there’d be just the one PO there. It wasn’t uncommon for me to walk onto a wing during association (all cells open and the offenders just milling around), walk to the opposite end of the wing shouting someone’s name, until I realised halfway or the entire way across there wasn’t a PO in sight and I was alone on the wing with all ninety guys out. I’d turn around and casually walk back to the exit!

Poor staffing means the job is much harder and more dangerous so staff leave for pastures new and the prison can’t retain experience staff, which just continues to make the problem worse. Experienced staff are very valuable as it takes time to understand what’s called ‘prison craft’: just understanding how the system works, how to read body language and negotiate with people in distress, How to intervene in fights or spot bullying, how to talk to someone who is suicidal, how to read the room to see if something is afoot (restlessness, you can get a feel for whether trouble is going to break out), and most importantly how to strike a balance between treating the guys like human beings while also demanding and receiving respect. The prisons I worked in couldn’t retain staff so they had well meaning but inexperienced and naive young guys and women, paid barely above minimum wage, who didn’t last long and didn’t have any guidance as there were no experienced staff to show them.

I certainly never felt safe in an understaffed prison as there was nobody around if you needed them and as a drugs worker you just walk around on your own freely, you obviously aren’t accompanied by anyone. But have no radio or any kind of weapon.

In other prisons which were well staffed it was a different story and I rarely felt threatened at all, though you can never get comfortable.

It’s a difficult place to work, I found I was having to basically suppress my survival instincts every day to function as situations that would normally send your fight or flight into overdrive have to be attended to so you can do your job: in your personal life if you were to have to walk through a small corridor with fifty known violent men hanging around you just wouldn’t do it if you could help it. But in this job you have to just swallow the fear, pretend to be fine, do it anyway. It’s quite draining, my heart is pounding a little just typing this!

I’m very glad I left but have plans to return as a volunteer in the future. It’s a brilliant experience going in for a few hours per week to do some good, knowing it’s your choice. But forty hours per week to pay your rent feels different and of course you’re there more often so there’s more chance of something going wrong.

Also the sexual harassment was horrible and hourly. If a guy did it to your face it was fine as you could see who it was, respond, and implement consequences. But most of it was just in the background and so often you couldn’t actually do anything about it. If you were walking past the yard where half of the wing were out exercising, any of them could shout anything at you and you didn’t know who it was, so the only thing you can really do is just pretend you’ve not heard it and keep walking. But it really goes against your own self respect to have to tolerate that, it’s an inescapable part of being a woman working in a male prison (I was 24-26 at the time) no matter how much you try to dress to avoid attention. It felt degrading to be walking around at work doing my job (to help people), and getting ‘Show us your tits’ all the damn time. I wouldn’t tolerate that outside of work so it was a tough thing to accept inside work.

With fewer staff around, there are fewer people to have your back, support you in implementing consequences, you just feel very at the mercy of the offenders.

Thanks for the thread, OP - no questions as they've all been answered, but I've always felt nosy when I see your posts

Thanks also to PP for sharing their experiences with prison nursing.

A completely fascinating thread, thanks so much OP. Sharing your knowledge has been so valuable.

Keep on keeping on

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.

What a vile and hideous attitude.

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.

Yes, alcoholics are given replacement medication, because going cold turkey from an alcohol addiction can kill somebody quite easily.

This money is spent because a human being doesn’t stop being a human being with rights and the entitlement to respect and dignity once they pass the prison walls.