Prison pharmacy can be seen to have an air of mystery. What actually happens behind the walls and iron bars? Is prison pharmacy anything like community or hospital pharmacy or is it totally different?
Just because people are in prison, this does not mean they receive any less of a quality of healthcare. Nor does it mean that their medical history can be forgotten and chronic illnesses ignored. This is one of the biggest challenges with new prisoners and their medicines. Dosages need to be maintained, accurate and dispensed in a timely manner, just as you would you expect in the community.
Patients can be imprisoned while terminally ill or become terminally ill in prison. External healthcare professionals may visit the prison to treat the patients. Certain prisoners may be granted, by the Governor, a licence (in exceptional cases) to allow them to return home or to a hospice to die.
Other prisoners may receive treatment like chemotherapy under strict supervision in a secondary care environment. Minor surgery, suspected paracetamol overdose and potential fractures are all dealt with at HMP Leeds. So, there needs to be a good medical reason for prisoners to be treated outside the prison.
HMP Leeds has a capacity of up to 1,500 prisoners. At any one time at least 350 of the prisoners are on substance misuse treatment. The supply of methadone can take a lot of the team’s time, with about 150 litres a week being dispensed. Approximately 100 boxes of Suboxone (buprenophrine and naloxone) are supplied weekly, not to mention the amounts of Subutex (buprenophrine) and diazepam that are also prescribed.
Prison pharmacists are like a combination of both community and hospital pharmacists. They deal with queries from doctors and dispense prescriptions. They also offer advice to prison staff on the wings, which include solutions about stock problems, how to control and supply certain high-risk medicines to prisoners, and information about minor ailments, as would be expected in the community.
At the same time, prison pharmacists are expected to perform duties similar to those of a hospital pharmacist, such as dealing with patients in a clinical manner would on a hospital wing and providing advice on any non-formulary or off-licence medicines that have been prescribed. A ward round is done once a week since the turnover of patients and their medicines is less than in a hospital.
Some pharmacists have a prescribing qualification and so run their own clinics. There are dermatology and substance misuse clinics within HMP Leeds. Other prisons may have other specialised pharmacists or nurses running various clinics. Prison GPs may also provide other services, such as hepatitis clinics.
HMP Leeds has a team of three pharmacists who rotate duties in the dispensary. Apart from the usual duties, they have to deal with a lot of administrative duties (eg, auditing, managerial paperwork and clinical governance).
Technicians either work on the prison wings or in the dispensary. They have a role similar to those working in a community or hospital pharmacy.
The wing technician role is varied because they deal directly with prisoners. The wing technicians and qualified nurses dispense medicines on the wings from the treatment rooms. From these rooms, prisoners will collect their medicines daily, weekly, fortnightly or monthly, depending on the type of medicine and if they have been risk assessed.
At HMP Leeds, Controlled Drugs are dispensed by technicians as long as the prescription has been clinically checked by a pharmacist.
It is the wing technician’s duty to ensure each prisoner provides identification in order to administer the correct medicine.
Security staff are based on the wings and assist the technicians by staying close to the treatment rooms. This restricts an inmate’s access to the area surrounding the rooms and, to a degree, provides protection to the staff, who may de dealing with aggressive prisoners.
There are different classifications for medicines in prison (eg, “never in possession”, “security hazard” and “harmful risk groups”). There are some drugs that have a high “value” to prisoners. They include opioids, sedatives and tricyclic antidepressants.
Drugs are also classified by a traffic light system by the level of harm they can cause in an overdose. For example, warfarin and digoxin are classed in the red category due to their toxicity in an overdose.
Drugs such as diazepam are kept in a Controlled Drugs cabinet and recorded in a register, even though it is not a legal requirement.
Another way the prison combats drug smuggling is to give prisoners medicines in liquid form followed by 200ml of water. This is common practice for drugs of abuse like diazepam and methadone.
Witnessing prison pharmacy has taught me how well the multidisciplinary team interacts and works together, with everyone’s roles appreciated by others. Keep an open mind about prison pharmacy as a potential career choice.
Acknowledgements The prison staff at HMP Leeds for their support, especially the pharmacy team