HIV Insight: Stakeholder Perceptions & Operational Barriers in the Training & Distribution of Take-Home Naloxone within Prisons in England

BACKGROUND:

The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England.

METHODS:

Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments (n = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques.

RESULTS:

The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement.

CONCLUSIONS:

The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed...

Since I’ve come to this jail, everyone [has been] banging on about getting myself sorted and off the drugs and everything you know. It’s taken a while and I’m in the right place to move forward for once, no more gear – nothing. I’m done with that life….. I’m clean now with no intention of using, so why do I need this? [Male prisoner, Prison 5]

What’ll happen is that I will leave here and as soon I get my feet on the ground the police will stop me, as always, and say…..’What’s this? You must be using again - you’re nicked [arrested]'. [Male prisoner, Prison 2]

Many of my staff understand what we are trying to do here which is get prisoners off drugs and abstinent by the time they leave here…if not abstinent entirely then at least in a positon to consider an abstinent life. For many staff, and it’s not just uniformed staff [prison officers], just handing out Naloxone give out the wrong message that says it’s alright now you can keep on using. I don’t agree with this view myself but I know they [staff] think it. [Healthcare Manager, Naloxone Action Group]

I am very concerned that Naloxone could be given out by prison officers or anyone else without healthcare input. The risks will be too great if something went wrong and the wrong person got hold of it. [Healthcare nurse, Naloxone Action Group]

Full article at: http://goo.gl/588N9e

By: Sondhi A1, Ryan G2, Day E3.

1Therapeutic Solutions (Addictions) Communications House, 26 York Street, London, W1U 6PZ, UK. arun.sondhi@therapeutic-solutions.org.uk.
2Public Health England, 2nd Floor Skipton House London Road Elephant & Castle, London, SE1 6LH, UK.
3Addiction Psychiatry, Addictions Department, National Addiction Centre, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8AF, UK.
Harm Reduct J. 2016 Feb 3;13(1):5. doi: 10.1186/s12954-016-0094-1.