Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK.
Department of Emergency Medicine, Ysbyty Gwynedd, Bangor, Wales, UK.
Crim Behav Ment Health. 2021 Apr;31(2):131-142. doi: 10.1002/cbm.2187. Epub 2020 Dec 11.
The widespread use of drugs in prisons leads to avoidable deaths, poorer health and a poor living environment. The contribution of psychoactive prescription drugs to this problem has received little attention in prison policy or at individual prescriber level.
To determine the extent of unsafe and inappropriate prescribing of psychoactive medications in one UK prison using a newly developed medicines optimisation framework.
A medicines optimisation framework was developed based on principles of good prescribing. It was initiated on the opening of a new prison-HMP Berwyn-in February 2017. During the study period, all prisoners at HMP Berwyn were transferred from other prisons. The safety and appropriateness of psychoactive medications were evaluated de novo on reception at HMP Berwyn and during follow up, using the medicines optimisation framework.
About 1941 sentenced men arrived at HMP Berwyn between February 2017 and November 2018. Nearly one-third (634, 33%) were on a prescribed psychoactive medication. Seventy-five percent of these (474/634) required a prescription change due to appropriateness or safety concerns. Nearly half (295, 46.5%) received changes at reception despite having already undergone medicines reconciliation at their previous prison. Forty-three percent (275/634) received changes at follow up, most commonly those who had no prior risks identified at reception.
Inappropriate and unsafe prescribing of psychoactive medications is occurring in prisons despite mandatory medication reviews. Ongoing monitoring is required to reduce the risk from these medications. A medicines optimisation framework such as this could be adopted across other prisons, worldwide, to help contribute to risk reduction from drug use in prisons. Appropriately modified, a similar framework might help reduce inappropriate and harmful prescribing in hospitals and in the community.
监狱中药物的广泛使用导致了不必要的死亡、健康状况恶化和恶劣的生活环境。然而，在监狱政策或个人处方层面上，人们对精神活性处方药物对此问题的影响关注甚少。
使用新开发的药物优化框架，确定英国一所监狱中精神活性药物不安全和不适当处方的程度。
基于良好处方原则，开发了一个药物优化框架。该框架于 2017 年 2 月新监狱 HMP Berwyn 启用时启动。在研究期间，所有在 HMP Berwyn 的囚犯都从其他监狱转移过来。在 HMP Berwyn 接收时以及随访期间，使用药物优化框架，对精神活性药物的安全性和适当性进行重新评估。
2017 年 2 月至 2018 年 11 月期间，约有 1941 名被判有罪的男性抵达 HMP Berwyn。其中近三分之一（634 人，33%）正在服用规定的精神活性药物。由于适当性或安全性问题，其中 75%（474/634）需要更改处方。尽管在之前的监狱已经进行了药物重整，但近一半（295 人，46.5%）在接收时就进行了更改。43%（275/634）在随访时进行了更改，最常见的是那些在接收时没有发现先前风险的人。
尽管强制进行药物审查，但监狱中仍存在精神活性药物的不适当和不安全处方。需要进行持续监测，以降低这些药物带来的风险。像这样的药物优化框架可以在全球其他监狱中采用，有助于降低监狱内药物使用带来的风险。经过适当修改，类似的框架可能有助于减少医院和社区中不适当和有害的处方。
