Health Care Standards
Health Care Standard 10
Clinical Management of Drug, Alcohol & Tobacco Dependency
Standard Statement
The provision of evidence-based substance misuse management and support by competent, qualified and supervised professionals.
10.1Health Care Standard 10 should be delivered taking account of Heath Care Standards 1, 5, 7, 8, 11, 12 & 13.
10.2 CRITERIA: Drug Dependency
10.2.1Prescribing in relation to drug misuse and dependence should be carried out in accordance with the national guidelines - ‘The Orange Book’, “Drug misuse and dependence: UK guidelines on clinical management” (2007) to reduce harm and promote recovery by adopting the following (10.2.1.1 – 10.2.1.8).
10.2.1.1On admissionprisoners reporting a history of substance misuse will provide a supervised sample of urine for drug analysis to aid treatment decisions.
10.2.1.2 Person-Centred Integrated Approach – Services are part of a coherent, planned package of care including access to wider addiction services and support utilising the Integrated Addiction Process (see appendix 1).
10.2.1.3 This integrated care plan should be recorded in the Health Care Record.
10.2.1.4Continuity of care – continuing community prescribing whereappropriate, both into and out of prison and include regular case review.
10.2.1.5Initiation of substitute treatment – prison can offer a period of stability, reflection and access to treatment not usually accessed by prisoners when in the community. Treatment should be offered where appropriate and where a community prescriber has been identified to continue treatment after release.Prisoners should neither receive higher priority for their treatment nor should their legal status deny them equivalence of care.
10.2.1.6Consistent prescribing – Prisoner groups should be treated consistently within prisons and on transfer between different prisons; treatment should not be withdrawn punitively in the event of relapse but should result in closer support and review by a multidisciplinary team.
10.2.1.7Safe Prescribing - Dispensing of controlled medication should follow the Standard Operating Procedure on Controlled Drugs referenced in HCS 8.
10.2.1.8Compliance monitoring – Clinical testing (urine dip testing) will be conducted regularly to confirm treatment compliance and monitor outcomes.
10.2.2Prisoners not in receipt of a substitute prescription on admission into prison should be assessed and offered detoxification, if appropriate, to manage withdrawal symptoms in accordance with SPS Operational Guidance (2010/11).
10.2.3Prisoners engaged in injecting behaviour will be confidentially and discreetly offered a Harm Reduction Pack service in accordance with the “Harm Reduction Pack protocol” (2008) as an initial step towards substitute treatment.
10.3 CRITERIA: Alcohol Dependency
10.3.1Alcohol dependant prisoners who have been assessed and in withdrawal on admission into prison should be offered alcohol detoxification treatment in accordance with the SPS Operational Guidance (2010/11).
10.3.2Prisoners who indicate they have an alcohol problem should be referred to Addiction Services and/or appropriate Links Centre services for support.
10.3.3Prisoners who disclose that alcohol was an influence at their index offence, or that they were intoxicated at the time, or that the notes and circumstances document such alcohol misuse, should be assessed as someone with an alcohol problem, and managed appropriately (pending aspecialist assessment or screening tool).
10.4 CRITERIA: Tobacco Dependency
10.4.1All prisoners should be offered Brief Advice by suitably trained staff.
10.4.216-18 year old prisoners, who are tobacco dependant but cannot purchase tobacco products, should be offered Nicotine Replacement Therapy free on prescription and access to smoking cessation services irrespective of sentence length.
10.4.3Eligible prisoners who aretobacco dependent and wish to stop smoking should be offered access to services as outlined in “Smoking Cessation Guidance” (2009)
10.5 CRITERIA: Staff Training
10.5.1Both Doctors and Addiction Nurses working in prisons will have completed (or be working towards completing) the RCGP certificate in Substance Misuse parts 1 & 2 or equivalent experience, and will maintain their expertise in Addictions Management as a core skill.
REFERENCES:
Drug Misuse and Dependence: UK Guidelines on clinical management. London. Department ofHealth (England), 2007
SPS Harm Reduction Protocol (2008) can be obtained from:
Smoking Cessation Guidance (2009) can be obtained from:
Changing Scotland’s Relationship with Alcohol: a framework for Action. Scottish Government, 2009
National Quality Standards for substance misuse services. Scottish Government, 2006
Reducing harm and promoting recovery: a report on methadone treatment for substance misuse in Scotland. SACDM Methadone Project Group. 2007
Review of Methadone in Drug Treatment: Prescribing Information and Practice. Scottish Government, 2007
Review of the role of methadone in the treatment of drug problems: Consultation response. Scottish Drugs Forum, 2007
Methadone and buprenorphine for managing opioid dependence. NICE Technology Appraisal. NHS, 2007
Essential Care: A Report on the Approach Required to Maximise Recovery from Problem Substance Use in Scotland.Scottish Advisory Committee on Drug Misuse: Integrated Care Project Group, 2008
Integrated Care Project Group-Integrated Care for Drug or Alcohol Users: Principles and Practice.Scottish Advisory Committee on Drug Misuse, 2008
The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem.The National Drug Strategy for Scotland Scottish Government, 2008
Scotland’s Future is Smoke Free: a Smoking Prevention Action Plan Scottish Government, 2008
Better Health, Better Care Scottish Government, 2007
SPS Operational Guidance (2010/11)
Appendix 1
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2010/11HCS10