Resources for Secure Environments

Substance misuse

National Institute for Health and Care Excellence (NICE) Guidance

 NHS England

 Public Health England

The Home Office

Project NEPTUNE

The European Monitoring Centre for Drugs and Drug Addiction

Regional Medicines Optimisation Committee (RMOC)

  • Position Statement. Oral Vitamin B supplementation in alcoholism (Nov 2019) (PDF): The RMOC has issued a position statement on oral Vitamin B supplementation in chronic alcoholism (parenteral supplementation is not covered). Vitamin B complex preparations are no longer recommended for prevention of Wernicke’s Encephalopathy in alcoholism however they may be prescribed on a short-term basis (10 days) for patients at risk of refeeding syndrome (see NICE CG32 Box 1 below). Vitamin B complex (as Vitamin B compound strong) may also be prescribed in rare cases e.g. medically diagnosed deficiency or chronic malabsorption.

Oral thiamine should continue to be prescribed (see NICE CG100) 200-300mg daily in divided doses for the prevention of Wernicke’s Encephalopathy to harmful or dependent drinkers who are malnourished (or at risk or malnourishment), have decompensated liver disease, acute withdrawal, before and during planned medically assisted alcohol withdrawal. Following successful alcohol withdrawal, thiamine should be continued for 6 weeks, providing patients have regained an adequate nutritional status.

  • RMOC Buprenorphine Long Acting Injection Guidance (April 2021): The RMOC has produced guidance on the use of long-acting Buprenorphine injection opioid substitution treatment in community settings and secure environments (e.g. prisons, immigration removal centres, children and young people secure estates) in England. The guidance is aimed at substance misuse service providers, commissioners, community pharmacies and acute NHS Trusts in England. It includes topics such as practical considerations in different care settings, starting treatment and transferring care. It provides recommendations, clinical scenarios and a Buvidal® cost calculator to provide guidance to organisations/commissioners on the potential financial impact of Buvidal® implementation for a local population.

NICE Guidelines for Assessment, diagnosis and management of Physical and Mental Health in prisons

NICE CG32: Box 1 - Criteria for determining people at high risk of developing refeeding problems 

Patient has one or more of the following:

  • BMI less than 16 kg/m2
  • unintentional weight loss greater than 15% within the last 3–6 months
  • little or no nutritional intake for more than 10 days
  • low levels of potassium, phosphate or magnesium prior to feeding.

Or patient has two or more of the following:

  • BMI less than 18.5 kg/m2
  • unintentional weight loss greater than 10% within the last three to six months
  • little or no nutritional intake for more than 5 days
  • a history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics.

Prescriber

Courses

  • Drugs: Management of Drug Misuse (Level 1): This is an online course which provides introductory learning on evidence-based treatment of substance misuse in primary care, including the role of opiate substitution therapies (OST). It is a useful starting point for staff working in secure environments.

Addiction Professionals: Registration body and network (formerly known as SMMGP and FDAP)

The SMMGP (Substance Misuse Management in General Practice) – FDAP (Federation of Drug and Alcohol Practitioners partnership has changed its name to Addiction Professionals. It is a network for people from a wide range of professional backgrounds including GPs, psychiatrists, counsellors, key workers, pharmacists, psychologists, social workers, nurses and mentors, who work in the field of addictions treatment, including alcohol, other drugs and behavioural addictions. The organisation offers training and support for members and provides quality assurance through registration and professional accreditation. It runs ongoing professional development courses and provides free resources, which include a range of webinars and published guidance, pertinent to managing substance misuse in prison.

Webinars (published by SMMGP)