Drug and Alcohol Research Centre, Middlesex University, The Burroughs, London, NW4 4BT, United Kingdom.
Drug and Alcohol Research Centre, Middlesex University, The Burroughs, London, NW4 4BT, United Kingdom.
Int J Drug Policy. 2022 Feb;100:103515. doi: 10.1016/j.drugpo.2021.103515. Epub 2021 Nov 16.
The non-medical use of prescription medication and risk of diversion have become policy and practice concerns within prison settings in the UK. These issues have been highlighted by the Advisory Council on the Misuse of Drugs, Her Majesty's Inspectorate of Prisons and Her Majesty's Prison and Probation Service (2019) prison drugs strategy. In 2019, new prescribing guidance was issued by the Royal College of General Practitioners for clinicians working within prison settings.
Informed by Bacchi's (2009) What's the problem represented to be? framework, the ways in which the 'problem' of prescribed medication in prisons have been represented is interrogated through an analysis of the prescribing guidance framework for clinicians working in prisons.
Restrictive prescribing practices are recommended as a solution to the 'problem' of diversion and misuse of prescribed medication. Prescribers are advised to consider de-prescribing, non-pharmacological treatments and alternative prescriptions with less diversionary potential. They are represented as responsible for the 'problems' that prescribed medication bring to prisons. The guidance is underpinned by the assumption that prescribers lack experience, knowledge and skills in prison settings. People serving prison sentences are assumed to be 'untrustworthy' and their symptoms treated with suspicion. This representation of the 'problem' has a number of effects including the possibility of increasing drug-related harm, damaging the patient-doctor relationship and disengagement from healthcare services.
The representation of prescribed medication as problems of diversion and prescribing practices inhibits alternative representations of the problem which would inform different policy directions including improvements to regime and healthcare provision and would include a range of practitioners in prison settings to address the 'problem' more holistically.
在英国的监狱环境中，非医疗用途的处方药物和药物转移风险已成为政策和实践关注的焦点。这些问题已被滥用毒品顾问委员会、英国监狱监察局和英国监狱和缓刑服务局（2019 年）监狱毒品战略强调。2019 年，皇家全科医生学院为在监狱环境中工作的临床医生发布了新的处方指南。
受 Bacchi（2009 年）的“问题被代表为是什么？”框架的启发，通过分析为在监狱工作的临床医生制定的处方指南框架，审查了监狱中规定药物的“问题”是如何被代表的。
建议限制处方实践，以解决药物转移和滥用的“问题”。建议开处方者考虑减少处方、非药物治疗和具有较少转移潜力的替代处方。他们被认为对监狱中规定药物带来的“问题”负责。该指南的基础是假设开处方者在监狱环境中缺乏经验、知识和技能。服刑人员被认为是“不可信”的，他们的症状受到怀疑。这种对“问题”的表述有多种影响，包括增加与药物相关的伤害的可能性、破坏医患关系和脱离医疗保健服务。
将规定药物表述为转移和处方实践的问题，阻碍了对该问题的替代表述，这些替代表述将为不同的政策方向提供信息，包括改善制度和医疗保健服务，并将包括监狱环境中的一系列从业者，以更全面地解决“问题”。
