by Tom Cox MRPharmS, Lead Prison Pharmacist.
Medicines optimisation in prison – the challenge
It’s long been recognised within prison populations that there’s a high prevalence of substance use disorder in connection with prescription medicines. This is often found alongside problematic polypharmacy situations.[i] My main objective as a Lead Prison Pharmacist is to optimise medicines and resolve problematic polypharmacy, to try and rehabilitate people held in custody.
Medicines optimisation within a prison takes many forms, just as it does in other areas of health care. It starts with comprehensive medicines reconciliation when people arrive at the prison. Compared with the general population, people in custody have often lived chaotic lifestyles, either on the outside of prison, or perhaps in other prisons, so the first step is to understand what they have been taking, and how they have or have not been managing their medicines.
A particular problem we encounter during medicines reconciliation is that when a person arrives in prison, they often have other people’s prescription medicines in their possession, as well as their own. This forms important evidence for any resulting medicines optimisation.