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The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug overall. Yet little is known regarding how illicit buprenorphine is obtained in prison and what influences prisoners to use it. Qualitative research was used to explore prison drug using practices. Thirty men who were former prisoners with a history of injecting drug use were interviewed in depth about their illicit prison drug use, including buprenorphine. Interviews were conducted over 18 months, from August 2006 to January 2008 and were analysed using Framework. The misuse of Subutex by snorting emerged as a significant theme. Accounts suggested that the diversion of prison prescribed Subutex was widespread and prisoners used various tactics to obtain the medication. Various complex and interlinked reasons were given to explain why Subutex was snorted in prison. The main motivation for snorting was to experience a prolonged euphoric opiate effect, believed to help to combat the boredom of being in prison. The price of illicit Subutex in prison was linked to its availability, but it was generally cheaper than heroin, thus contributing to its use. Participants’narratives identified the belief that snorting Subutex in prison was not risk free, but risks were lower than continuing to use other drugs, particularly injecting illicit opiates. The implications of prison Subutex misuse for prisoners, prison medical services, commissioners, and prescribing policy and practice are discussed.

Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007 qualitative study aimed to explore the use of Subutex and its associated effects on 14 participants on detoxification programmes.

All participants were male, aged from 21 to 44 years with prison sentences ranging from a few months to life imprisonment. Buprenorphine was unavailable to female prisoners at the time of this study. Participants were recruited from seven Scottish prisons. All 14 participants were on detoxification programmes, each was prescribed Subutex, and each was selected from a larger investigation that included both those undergoing detoxification and maintenance (n=21). All participants had previously also used methadone on previous detoxification programmes.

It can be concluded that the majority of detoxification participants within this study indicated that Subutex was a more effective treatment than methadone as it helped reduce craving, eased the process of withdrawal and improved sleeping patterns. In addition, the majority of participants noted higher levels of motivation and the ability to set goals towards obtaining an improved quality of life.

This study provides an alternative perspective to the use of Subutex within prison settings, when compared with results from previous quantitative studies reported. The study also highlights inconsistencies drawn from studies in this area, which may be an artefact of study design. It is recommended that further qualitative studies be conducted to explore further this alternative perspective. Finally, the issue of methodological approach taken should be addressed within the context of a related, but independent, research forum.

The purpose of this paper is to examine whether it is possible to switch patients from heroin or methadone to buprenorphine without needing to experience symptoms of withdrawal?

Review of author’s experience in 1980s where three patients transferred to 4 mg buprenorphine from 40 ml (1mg/ml) methadone without symptoms of withdrawal. Review of literature where patients were transferred to buprenorphine without waiting for withdrawal symptoms to occur. Presentation of six case histories in author’s clinic.

Provided the buprenorphine is commenced at a very low dosage, is gradually increased and the heroin/methadone is reduced over a period of time, it is possible to change from heroin or methadone without inducing withdrawal symptoms. It is not necessary to stop the heroin/methadone and wait for withdrawal symptoms to occur.

Due to the author’s retirement in October 2015 further research into the production of a template which could be used universally has not yet been possible.

Transferring patients from heroin and methadone to buprenorphine has often been difficult. Waiting for withdrawal symptoms to occur has often resulted in treatment failure. The method described eliminates the problem for patients.

Patients find the method is more acceptable and allows normal functioning.

Confirmation that the findings of the original case histories from 1980s were valid. The value to the treatment service should be considerable in simplifying the prescribing practice.

The purpose of this paper is to evaluate some of the wider aims and potential consequences of maintaining remand and short-term prisoners on methadone, rather than providing them with a rapid detoxification on first reception into prison. Consideration is given to the effects of methadone prescribing on treatment engagement; drug-related violence; treatment choice, including detoxification, maintenance and reduction doses; recidivism; and through care.

The author draws on qualitative data gathered during a wider study involving drug-using prisoners and prison drug workers exploring the influence of the therapeutic working alliance on outcomes in prison-based drug treatment.

Whilst participants reported advantages to the prescribing of methadone in prisons, such as reduced levels of bullying and drug-related violence in the prisons, they were also critical of many aspects of methadone prescribing which were intended to increase treatment choice, but in practice, often restricted choice. Drug workers reported that some drug-using prisoners were harder to engage with treatment when they were maintained on methadone.

Data were gathered from two “local” prisons in the same geographical area, and as such, the findings may not be applicable across all prison service establishments. Nonetheless, they highlight important considerations and wider policy implications that could be applicable.

Some previously unreported consequences of methadone prescribing in prisons are discussed, including its potential to increase, rather than decrease heroin use and accompanying crime.

The purpose of this paper is to critically regard the concept of recovery from the perspective of substance misusing offenders. It intended to understand how these individuals came to define recovery by asking “what does recovery mean to you?”

In total, 35 semi-structured interviews were undertaken with individuals with a history of heroin and crack cocaine use as well as convictions for a range of offences. Interviews took place in both prison and community settings, reflecting a spectrum of experience.

Whilst the constellation of recovery varied, it was at times made up of the same “stars” – and some re-occurring themes emerged; recovery was transient, fragile and unpredictable, it was ongoing, lacking a definitive end, it was more than abstinence and often involved a total psychological overhaul, recovery was about reintegrating with society and feeling “normal”.

Practitioners and services need to value the individual interpretations of recovery rather than being prescriptive around what it “should” look like. The components of recovery that were raised by participants permit specific recommendations for practice to be made.

This study sought the perspectives of those actually affected by and experiencing drug treatment in the Criminal Justice System. It allowed participants to tell their story without preconceived ideas or hypotheses, putting their voice at the centre of the stage. The study uses feedback from the ground to make informed recommendations for practice.

The purpose of this paper is to ascertain an awareness of the management of the drug misusing guidelines in Glasgow general hospitals.

A brief literature review was carried out to establish the available evidence for the guidelines. Additionally, a survey questionnaire was sent out to junior medical staff requesting their views on the drug misusing guidelines.

A paucity of evidence relating to drug misusing guidelines was found from the literature. The Glasgow Guidelines appear to be a welcome source of information that is both comprehensive and easily accessible for staff. Junior medical staffs have broadly welcomed the guidance but would appreciate additional support on the management of patients prescribed Suboxone.

There should be an increase in training and development for junior medical staff regarding the guideline.

The Glasgow Guidelines are aimed primarily at junior medical staff whose knowledge on drug misusing patients may be scarce. Increased training and awareness should improve the management of drug misusers in general hospitals. Consequently, patients should spent less time in hospital.

There is a strong political imperative to regard the prison as a key social setting for health promotion, but evidence indicates that drug misuse continues to be a significant issue for many prisoners. This paper aims to examine the social and environmental factors within the setting that influence individuals' drug taking.

Focus groups and interviews were conducted with prisoners and staff in three male training prisons in England. The sampling approach endeavoured to gain “maximum variation” so that a broad based understanding of the prison setting could be gathered. The data were analysed in accordance with Attride‐Stirling's thematic network approach.

The findings suggest a myriad of social and environmental factors influencing drug use. While staff recognised the scale of the drugs problem, they struggled to cope with creative inmates who were not perturbed by taking risks to gain their supplies. Fellow prisoners played a major role in individuals' decision making, as did the boredom of institutional life and Mandatory Drug Testing (MDT) policies within the institutions.

Drug treatment is an essential component of prison healthcare, but it only forms a small part of creating a health‐promoting setting. If the health‐promoting prison is to be fully realised, a more radical, upstream and holistic outlook is required.

The settings approach is an important theoretical and practical approach in health promotion. In comparison to other settings (such as schools), however, there has been limited research on the prison as a health‐promoting environment.

To many Europeans, Sweden is the odd member in the global effort to tackle drug problems. At a time when most countries stress a perspective of public health and almost entirely rely on harm reduction measures, Sweden almost exclusively directs its efforts towards abstinence. Carl Åke Farbring, a key policy maker, explains why abstinence is the driving force in Sweden, highlighting claims that it is the lowest drug‐using nation in the western world.

Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered in community settings. Fiftyone injecting drug users who had a history of imprisonment were interviewed. Interviews focused on the experiences of drug‐related care and treatment in prison. The interviews were analysed using the Framework method. Accounts of prison drug treatment experiences provided valuable insights into drug treatment in the English prison. The participants’ accounts provided a historical perspective, many of which reflected the different practices of different prisons and prison staff and the changes in policy and practice that have occurred in prison healthcare over recent decades. Positive and negative experiences of healthcare and drug treatment in prison were discussed. Issues that affected levels of drug use inside prisons and their receipt of care, support and treatment in prison included prescribing policies, illicit drug availability and prison staff and doctor attitudes. Whilst negative experiences of prison and drug treatment prevailed, users identified that recent policy and practice changes had positively influenced healthcare provision for drug users in prison, particularly the provision of opiate maintenance therapy. Drug users often saw prison as an opportunity to detoxify and contemplate their drug use. Further work needs to build on the positive experiences identified to ensure that prison drug treatment in England and Wales is consistent, effective and efficient in the future.