Clinical Management of Substance Misuse Dave Marteau Prison

Clinical Management of Substance Misuse Dave Marteau Prison Health David. marteau@dh. gsi. gov. uk

Drug-motivated offences are estimated to comprise around a third of the total cost of crime Cost of drug-motivated crimes* £ 58 bn £ 19 bn** * Includes: security expenditure, property stolen, emotional impact on victim, lost output and expenditure on criminal justice system ** This is an estimate within a range of £ 14 -20 bn Source: Team analysis, based on NEW ADAM survey of arrestees 1999 -2002, ‘Economic and social costs of crime’

Many high harm causing users enter prison each year, and most leave again within a year High harm causing users in prison, entering prison and leaving prison during a year 50, 000 15, 000 49, 000 • Nearly a quarter of high harm causing users are in prison at one point during any year • Their average sentence length is around 4 months 16, 000 Source: Team analysis, based on Prison statistics 2001, NEW ADAM, ONS Psychiatric Morbidity of Prisoners 1998, Criminality Survey 2000

Characteristics of Injecting Drug Users (Matthews 2005) Entrenched (in their habits) Treatment resistant Poor physical & mental health Challenging behaviours High suicide and self-harm risk Very high post-release mortality risk Stigma Rewards for success

A 33 year follow-up of narcotic addicts (Hser et al. , 2001) N Age 581 24. 5 (3. 9) 439 36. 8 (5. 4) 354 47. 6 (5. 1) 242 57. 4 (4. 0)

National Confidential Inquiry study of 172 prison suicides 1999/2000

Death Rates in First Year of Liberty (v national mean average)

Follow-up study of mortality (Dole et al 2003) Probability of survival MMT non-MMT months

Re- incarceration up to May 2002 Continuous Mean total weeks in prison Methadone Non- Continuous Methadone n=45 n= 216 41 67 p . 007 (sd) Source: Dolan, K

Methadone maintenance treatment [MMT] at 12 months after release from prison [Johnson van de Ven & Grant 2001]

% of released prisoners returning to same prison over 3. 5 years [n = 3, 606] (Levasseur et al, 1997)

Number of prisoners on methadone maintenance programmes in Spain

Incidence of AIDS cases per thousand prisoners in Spain (Pallas 2004)

Clinical Management of Drug Dependence Plan Individual assessments Care plans based on need Closer Integration of clinical & CARAT [DIP] teams Increased maintenance prescribing Aiming to Reduce Early suicides in prison Deaths on release Blood-borne virus transmission Re-Offending

Projected Clinical Interventions Total (red) and maintenance (blue)