SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Discharge from prison on Friday pm and an interesting way to transfer to buprenorphine? (May 2006)

During the afternoon surgery the receptionist buzzed through and asked me if I would take a collect call from the local prison. I said yes and a patient of mine, Harry, came on the line. He said he was sorry to bother me but he was getting out tomorrow (Friday) and could he have an appointment! I agreed willingly and gave him a time to come in.

I knew he had only been in for a couple of months for a traffic offence and I had discussed with the prison about continuing his methadone maintenance, to which they had agreed. I was so "delighted" when he arrived as he said he remembered my "nagging" him about the risk of overdose when tolerance was lost after detoxification or prison, and he had made the surgery the first stop post discharge! He had also watched the excellent DVD "Going over" several times and now handed it on to others (Ref 1).

However I was slightly confused why his methadone had been stopped in prison. He explained that he had received it for two weeks but on the 12th day he had had a urine test which showed amphetamines as well as methadone. His maintenance was immediately stopped and he was detoxified from 120mg of methadone over a few days. He explained, as stated so many times before, that it was easier to get drugs inside than out and Harry had accepted the amphetamines to help with the boredom. It always seems slightly odd to me that drug users are punished for using drugs, whether in prison or out in the community - would asthmatics have their inhalers removed for smoking? Although I realise the situation is slightly different in prison, the futility of detoxing someone because they use drugs on top of their script is, I feel, ridiculous and solves no problems at all!

Anyhow he explained that he had "discovered" buprenorphine in prison since his methadone was stopped and he felt well on it and would like to continue with it. I agreed and so far four weeks on he is doing well on 28mg of buprenorphine. An interesting way to transfer to buprenorphine from high dose methadone, but not one I would completely recommend!

For me one of the many advantages of general practice treatment is that Harry could restart his treatment immediately he was out of prison, avoiding that risky period waiting for his reassessment appointment to re-enter drug services. As he was about to leave with his buprenorphine prescription in his hand he asked "Do you mind seeing my mate who was also released today and whose drug service can't see him for about two weeks?" Could I possibly have said anything else but yes?

We need much clearer pathways between prison and community and community and prison to avoid completely preventable deaths. (This also needs to happen if people are discharged early from rehab, again because of the high risk relapse.) People who require prescribing need to be able to enter directly into a safe prescribing service.

- Dr Chris Ford


1. Going over 4 overdose stories told by the people who were there DH and Exchange supplies 2002