Resources for Secure Environments
Providing healthcare in secure environments such as prisons, secure hospitals, young offender institutions and immigration removal centres presents unique challenges for GPs and primary care professional.
Prescribing
- The RCGP. Safer Prescribing in Prisons. Guidance for Clinicians. 2nd edition (770 KB, PDF) provides practical prescribing guidance for clinicians working in prison medicine.
- NHS England. Pain Management Formulary for Prisons: The formulary for acute, persistent and neuropathic pain. Second Edition: October 2017 and Implementation guide: December 2015 :There are two parts to this resource. The formulary provides a list of recommended medicines along with advice and clinical guidance links and the implementation guide covers scope and use of the formulary, prescribing and reviewing pain medicines in prison, self-management and optimising patient safety.
- Opioids Aware: This resource is for patients and healthcare professionals. It was produced by the Faculty of Pain Medicine of the Royal College of Anaesthetists in collaboration with PHE. It has five key messages which cover when opioids are useful (acute pain and end of life), when their benefit is limited (persistent pain), the increased risks of high dose opioids (equivalent to >120mg/d oral morphine), when to stop opioids and the importance of collaboration and planning when tapering and stopping.
- NHSE. Health and Justice mental health services: Safer use of mental health medicines (2017): This document provides a background to prescribing and mental health medicines in secure environments with clarification on the prescribing responsibility for initiating, continuing, reviewing or repeat prescribing of mental health medicines by specialist mental health prescribers.
- RCGP Top Ten Tips: Dependence Forming Medications. 2019: This brief guidance provides advice about patients safety and support and good clinical practice in relation to DFMs.
- NHS England Guidance for the handling of Tramadol in health and justice residential sites (2014) (PDF): From 10th June 2014, changes were made to the Misuse of Drugs Act (1971) to reclassify tramadol to a Schedule 3 Controlled Drug, exempted from safe custody requirements. This NHSE guidance provides information on the handling of Tramadol in health and justice settings as a result of the changes.
- PHE Dependence and withdrawal associated with some prescribed medicines: An evidence review (2019) (PDF): This important review by Public Health England was commissioned by the minister for public health and primary care. It sets out the scale, distribution and causes of prescription drug dependence in adults (aged 18 and over), and what might be done to address it. The review covers five classes of medicines: benzodiazepines; z-drugs; gabapentinoids; opioids for chronic non-cancer pain; antidepressants.