‘Through-the-Gate’forms a key part of the government’s Transforming Rehabilitation strategy aimed at supporting a prisoner’s recovery from drugs and/or alcohol once released back in the community. The provision of take-home naloxone (THN) forms a vital component for this policy with one English region acting as a pilot for the initiative. THN is an opioid antagonist to prevent an opiate-related overdose with the aim of reducing the risk of drug-related death for individuals recently released from prison.
A series of qualitative studies, including a bespoke prisoner survey, were undertaken to look at the distribution of naloxone within prisons. The findings, due to be published in two academic journals, highlight the complexities and nuances associated with the distribution of THN. Prisoners were shown to be a target group that would benefit from access to this intervention, with high levels of reported overdoses (self or witnessed). Yet for both staff and prisoners, there were varied perceptions including a number of confused perspectives and ‘urban myths’attached to naloxone and for some the harm reduction message did not exist well within an abstinence-based service framework. For prisoners, the perceptions of using (and carrying the kits on their person) were influenced by a variety of subtle factors, including the possibility of further criminal justice sanctions if THN was found on their person once released.
Process issues also affected the distribution mechanisms within prisons, including the acceptance (which has recently changed) that only clinical staff can be the vehicles for the provision of THN kits. A number of system-wide challenges were identified in the paper including the need to ensure all prison staff, from the governor onwards, were involved in the distribution of Naloxone. The difficulties of tracking and managing prisoners potentially eligible for training were also noted.
WHAT CAN BE DONE?
The papers advocate a system-wide approach to the delivery of both training and provision of THN kits at the point of release. Enhanced support could consider widening the coverage of THN training. In addition, the studies offer a range of possible next steps:
• Addressing perceptions and ‘myths’ regarding the use of naloxone among prisoners and staff
• Enhancing the identification and engagement of prisoners throughout their journey in the prison system
• Improving prison processes for the distribution of THN kits prior to release
• Ensuring the involvemt and support of all senior prison staff
• Considering linkages with community services including community rehabilitation companies to reinforce key messages.
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