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Introduction: In Her Majesty’s Prison and Probation Service (HMPPS) prescribing and administration of medication to prisoners falls under the jurisdiction of the healthcare service provider, who work in line with National Institute for Clinical Excellence (NICE) guidelines. Each prisoner receives an individual risk assessment upon induction and this determines the risk for each, no high risk drugs such as Opioid based medication is issued in-possession and most medication is issued in a controlled manner by qualified health professionals several times a day. Some medication however, such as antibiotics, can be issued up to a 28 days maximum and then reviewed. Prisoners usually keep their in-possession medication in a locker, or safe depending on if the cell is shared with another or not. HMP Hewell is currently undertaking a project to improve the rehabilitative environment of the prison. As part of this work the prison is reviewing its processes on issuing in-possession medication to ensure they fit with the prison’s rehabilitative ethos. To support this work they are looking for examples of good practice in this area.
1. Giving the drug to the prisoner is the starting point. It is always decided by a doctor from the Prison Health Care Unit. If the doctor deviates from this, the assessment must be made individually. CNS and narcotic drugs, as well as some other specific drugs separately (eg pregebalin and gabapentin), are not given to the prisoner but are always taken under supervision. The physician deciding on the possession of the medicinal product should weigh the risks associated with the possession of the medicinal product in the prison. For example, an insulin pen is not given to a suicidal prisoner because it is a high safety risk. Sometimes there may be a need for safety-based drug takeover.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
2. None. A prisoner keeps medicines in his his/her wardrobe. There are no special devices for this.
At arrival to a remand prison a nurse makes an initial health investigation and in this is included to make an assessment about the clients capability to manage his own medication. In such a case the securityofficer has to deside weather the client could keep the medication in his/her living space. Al persons in a remand prison has their own living space and of the about 5.500 inmates in the prisons 4.500 have their own living space. If the prisoner is allowed to keep the medication there will not be more than one weeks consumption. No pharmaceuticals classified as narcotics are allowed.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
No, but for the medication not kept in the living space, there is a locked cabinet to keep them in.
Depending on the effects of the medication and the specific situation of inmates, medication must be administrate in presence of the medical staff. The possibility of having medication in cells is also foreseen and regulated, but not for opioids, due to the risk of traffic and intoxication.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
Each prison has medical staff in charge of these procedures
The administration of medicines in the places of deprivation of liberty is in accordance with Ordinance № 2 / 22.0.3010 on the terms and conditions for medical care in places of imprisonment, issued by the Ministry of Health and the Ministry of Justice. The overall activity of the supply of medicines is managed and controlled by the directors of the medical establishments. Depending on the needs for medicines and medical devices, the directors of the medical establishments submit written requests to the head of the respective place of imprisonment. The receipt, storage and distribution of medicines are organized by the director of the respective medical institution. The medical specialists at the medical centres in the places of imprisonment may store medicinal products according to a list determined by the Minister of Health. Prisoners are provided with the necessary medicines. Their receipt is certified by the signature of the detainees in the outpatient book. Drugs with narcotic or narcotic effect are provided to those in need only within the prescribed daily dose. In case of need for treatment with expensive drugs under the Health Insurance Act, the director of the medical centre assists in providing the necessary documents. When prescribing drugs, medical devices and dietary foods for special medical purposes, which The National Health Insurance Fund pays in full or in part, the director of the medical centre notifies the director of The Regional Health Insurance Fund and justifies the need for them. The director of the medical centre fills out a prescription book for a chronically ill person. Prisoners may receive medicines from outside only with the knowledge and under the supervision of the doctor from the medical institution in the places of detention. These medicines are stored in the medical establishment and are provided for use in accordance with Ordinance № 2 / 22.0.3010 on the terms and conditions for medical care in places of deprivation of liberty.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
By order of the Minister of Justice, a list of permitted items and objects that detainees and detainees under the Criminal Procedure Code may receive, use and keep with them has been approved, according to which: medicines, orthopaedic devices are determined. , blood pressure monitor, glucometer with consumables, hearing aid, electric cooler bag with a capacity of up to 25 litres - by doctor's prescription.
When serving their sentence in prison, inmates can receive the medication they need in three possible ways described as follows: 1) Psychotropic medication for chronic treatments (e.g. diabetes): once a month the patient is provided with the required medication in order to properly comply with the treatment for the month ahead. The inmate keeps this medication in his/her cell without any particular security measure. The doctor will also inform the inmate on how to take this medication and the inmate will manage it as if s/he would be doing so outside the prison having to go to the pharmacist. 2) Non psychotropic medication for treatment of acute processes (e.g. treatment for an injury in the courtyard): the inmate will be provided with the medication the very day s/he has been injured, together with the instructions on how to take it and the length of the treatment. The patient will be managing this medication him/herself without any security measure. 3) Psychotropic medication: this is delivered by the medical staff on Directly Observed Treatment mode. The intake is prepared daily by the medical staff and it is administered personally in the morning, afternoon and night by the auxiliary nurses, who ensure that the patient is actually taking the medication. The patient does not manage nor keep the medication themselves due to the following reasons: -This type of medication is commonly subject to traffic in prison -Prevent vulnerable inmates from being extorted -Keep track of the adherence to treatment with a type of medication that is quite sensitive in the prison context.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
No, we do not use this type of equipment.
The In possession Medication policy is a joint Scottish Prison Service/National Health Service policy. NHS will carry out a risk assessment of a prisoner to determine if they can have in possession medication. The risk assessment will be based on their ability to comply with taking their medication, risk of diversion and risk due to mood and behaviour. Some opiate based medications may be given in possession however, controlled drugs are not given in possession. NHS will carry out spot checks to assess for compliance. Where someone has too many or not enough medication, the NHS will review if they can still have in possession medications. Anyone assessed by NHS as not suitable for in possession medication will receive supervised medication. Depending on the type of medication and the risk assessment, a prisoner may be provided with a 7 day supply of medication or up to a 28 day supply.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
Most cells have lockable personal safes and prisoners are expected to keep any in possession medication in the safe at all times.
The valid internal procedures of the Central Prison Hospital stipulate that medication for somatic diseases may be issued to prisoners after signing the relevant documents and limiting the amount of the issued medication: to ensure the continuity of treatment for chronic diseases – for up to 1 month period, in case of an acute illness – for one cycle of treatment. Along with the medication, a prisoner is issued a Medical Certificate with the name of the medication, its amount, and frequency of use.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
Prisoners have no special equipment for storing their medication in their cell/room, they keep it in a cupboard, storage box, etc.
Medicines for inmates are provided by prison medical facilities that are organisational parts of each prison. The attending physician (prison staff member) instructs the inmate in the purpose, way of using, therapeutic dosage and eventual undesirable effects of the prescribed medicines. The attending physician determines the distribution way of medicines to the inmate; he/she considers the health condition of the inmate, type and application way of the medicines as well as the personal characteristics of the inmate. The inmate can have the prescribed medicines in the in-possession in the cell or room. There are following exceptions from this rule: - Psychotropic drugs and analgesics of opiate type, - Personality of the inmate (based on the decision of the doctor, the inmate is not capable to follow the prescribed dosing or there is a risk that he/she will exceed the prescribed dosing). If these exceptions exist, the medicines are distributed by prison staff.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
Each inmate has in the room or cell a lockbox at disposal.
Medication is generally distributed by prison staff. When inmates manage medication in the cell, the medication is marketed as selfmedication on the medical form in their journal. There is of course focus on whether it is safe to have medication in the cell in each case.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
We do not have specialist equipment such as personal safes to support inmates having their medication in their cell. Some medication is however stored in a refrigerator.
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Prisoners receive medication (incl. personal medication) only with the prescription of the medical practitioner. Medication is issued and a prisoner receives it in the presence of staff. Issue and receipt of medication for the provision of planned treatment: 1) in prison – a prisoner receives medication prescribed by the medical practitioner every day and uses it in the presence of staff. Medication is not stored in cells, except for the daily dose of medication in case of emergency care with the permission (written statement) of a doctor. 2) in open unit - the prescribed medication is issued for the treatment course and prisoners keep it in their living premises, in cupboards that cannot be locked. Upon issuing medication for the treatment course, a written statement is given to the prisoner indicating the amount of medication. 3) in Centre of Addicts – medication for the treatment course is kept in specific medication distribution boxes/cases, and is issued to the contact person for 7 days. Prisoners receive medication from the contact person for each use. Contact persons keep medication in a locker in closed premises. Issue and receipt of medication for emergency medical care: 1) In case of emergency medical care, the daily medication dose is issued to the prisoner personally as well as the written statement indicating the amount of the issued medication.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
See answer to Question 1.
It is not exceptional in our system that detainees are allowed to store medication in their cells, e.g. diabetics etc. We only allow this when we think the person is able to manage his medication himself and when there is no risk for fellow detainees if the person has cellmates. The pill organizers which the staff hand to the inmates can easily contain all the medication needed for one day. We only make exceptions when we believe that the person needs assistance. In the case of confined persons, the medication is usually distributed several times a day. Only one exception is made, i.e. for medication that has to be taken under supervision, which is taken in the infirmary or in the cell under the supervision of nursing staff.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
No safes or other storage containers are made available to detainees to store medication. Full track is kept of what medication has been given, in what amounts and at what time. Medication that has not yet been distributed, is stored under lock and key in the infirmary.
- Patients requiring insulin are given a lockable medication box, which is checked and refilled at regular intervals in the infirmary. This is also where the exchange of insulin syringes and needles takes place. - "Unproblematic" medications, such as blood pressure medication, are given to the pa-tient for self-administration in the cell. The number is controlled randomly on the basis of the inventory. - Antibiotics, psychotropic drugs and substitutes are dispensed daily by the infirmary under sight.Do you use any specialist equipment to support prisoners having their medication in their cell/room (e.g. personal safes)?
Please see answer above.