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A person being released from Pentonville prison
ACMD report on Custody-Community Transitions highlights increasing drug-related harms in prison and increased risk of death by overdose on release.

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Last week (12 June 2019), the government’s independent Advisory Council on the Misuse of Drugs (ACMD) published a new report on Custody-Community Transitions.

The report highlights a number of key concerns, most of them well known to those working in the field:

  • High incidence of homelessness. Many prisoners under supervision from the National Probation Service or Community Rehabilitation Companies are discharged to unsettled or unknown accommodation on their first night of release. This increases the risk of relapse and reoffending.
  • Adults serving sentences of less than 12 months in England and Wales had a reoffending rate of 64.4% between April and June 2017, with rates likely to be even higher among those with a drug problem.
  • Increased risk of death. Death rates among those on post-release supervision, are many times higher than in the general population. The first few weeks immediately following release to the community is the highest risk period.
  • Custody as an opportunity to reduce drug problems and offending was often squandered by failure to provide support on release.

As already stated, these issues are well known and the ACMD points out that there has also been a lack of systematic follow-up on and the fragmentation of responsibility for implementing previous recommendations. Previous reports had highlighted continuity of care as being critical. However, the latest data from PHE suggest that only 32.1% of people assessed as needing treatment when they leave prison enter treatment in the community within 21 days of release.

In theory, the prison service and the NHS are aiming for equivalence of care between custody and the community. Current policy outside prisons is to maximise access to naloxone (the medicine that reverses opioid overdose). Despite this, only 12% of prisoners who were previously heroin-dependent left an English prison with naloxone in 2017/18. This is particularly galling since the numbers for prisoners given naloxone when being released from Scottish and Welsh prisons are much better.

© Andy Aitchison


The ACMD makes a number of strong recommendations to address these concerns including:

  • That the Drug Strategy Board nominates one Minister who will have over-arching responsibility and accountability for the improvement of custody-community transitions for prisoners with complex health needs, including problems with drugs.
  • That this Minister prioritises:
    • Reducing the number of people who die in the first month after leaving custody and while under probation supervision, with these data collected separately and published.
    • Reducing the number of people released homeless.
    • Increasing the number of people continuing drug treatment on release.
    • Increasing the number of opioid using prisoners who are given naloxone on release.
  • Minimising the number of prisoners with complex needs released on Friday afternoons (see here for more details of the problems this causes).
  • Make it easier and quicker for released prisoners to access Universal Credit.


It is a depressing sign of the times that a number of systemic problems acknowledged for many years are not being actively addressed. Public Health England has made the issuing of naloxone to released prisoners a priority for several years without yet being able to make significant progress.

Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here.

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One Response

  1. These reports are all well and good but I don’t see much difference to how it was for me 30 years ago.
    I am 22years in recovery and my experience is if you aren’t considering the ACE Study in treatment you will continue to keep going over the same expensive reports that do very little and drug users will continue to die. These reports keep some jobs worth in employment and wastes tax payers money because after all these years they still refuse to look at the root cause of the problem. Shame on you all.

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