About medicines in prisons
Prison healthcare delivery is a primary care service so the patient experience should reflect the community setting wherever possible and mirror that of community pharmacy.
Standards and expectations
HMIP Expectations (2012) defined the standard that prisoners are cared for by a health service that assesses and meets their health needs while in prison and which promotes continuity of health and social care on release. The standard of health service provided is equivalent to that which prisoners could expect to receive elsewhere in the community.
A Pharmacy Service for Prisoners (June 2003) includes recommendations about stock versus individually labelled medicines. Recommendation 7 states that the drug and therapeutics committee should ensure medicines are generally supplied in patient packs.
Professional Standards for optimising medicines for people in secure environments, RPS (2017) states people are supplied with, or receive medicines from, individually dispensed and labelled prescriptions or over-labelled supplies when they receive a medicine via a patient group direction, or supply against a prescription. Administration of doses from bulk stock is reserved for urgent, short-term supply and for specific Controlled Drugs.
Supplying medicines in prisons
Following a risk assessment, a prisoner may have medication supplied in the following ways:
In-possession (IP)
The prisoner is in possession of their individually labelled supply of medicine and accepts responsibility for its secure storage.
Non in-possession (NIP)
These are medicines that that are stored centrally, away from the prisoner.
The use of individually labelled patient packs is still recommended for NIPs for the following reasons.
Safe storage
Using individually labelled medicines for each prisoner, both IP and NIP medicines, means they can be stored together in baskets or individual medicine bags, which mirrors the community pharmacy model.
Transfer and discharge
Individually labelled NIP medicines can be used to supply the prisoner with medicines on transfer or discharge in line with the requirement for continuity of medicines stated within national prison pharmacy guidance.
Audit
It is important that the amount of and supply of medicines to prisoners, especially for high risk medicines for diversion, can be audited. If a prison uses stock supplies for all NIP medication, then it is very difficult to detect whether stock has gone missing or to confirm a claim from the patient that they haven’t received a dose
Safer administration
Administration of medicines using labelled stock is safer than administering from a stock supply. This is because additional checks are possible at the point of supply using the label on the medicine (prisoner name, medicine name, dose, etc.).
Mis-selection error reduction
Individually labelled NIP medicines reduce the risk of a mis-selection error from stock in the high pressure environment of administering supervised/NIP doses of medicines to prisoners.
Efficient supply
Improved efficiency of supply in instances where a NIP is changed to an IP for clinical reasons or as part of the prisoner’s rehabilitation. Having a labelled medicine means it can be supplied to the prisoner rather than having to wait for a new dispensed supply.
Stock medicines
Individually labelled medicines are preferable to using stock medicines. However, there are occasions when the use of stock medicines as a stop-gap is appropriate.
A limited range of common NIP medicines stock could be held in treatment rooms to enable NIP doses to be given until the prisoner’s supply or new prescription can be supplied. As volumes of stock held on the wing will be low and used less often, stock reconciliation and management are achievable and would detect anomalies/missing stock.
Substance misuse services
The medicines for opiate substitution and alcohol detoxification are Controlled Drugs (CD) (schedules 2,3 and 4) and these are never held IP in any prison. Every prison is expected to host patients needing these treatments and all prisons will hold these medicines so using a stock supply is the safest and most reasonable system.
For releases both planned and unplanned, national substance misuse guidance states the need for ensuring continuity of supply via short term discharge supplies or FP10 use with access to community services.
Note that tramadol, gabapentin and pregabalin are expected to be labelled for individual patients and are stored along with the patient’s other medicines and not in the CD cupboard. These medicines are all NIP with the exception of category D open prisons where, following a risk assessment, they can be held as 7-day IP.