An important new report published today (14 January) by the Independent Advisory Panel on Deaths in Custody and the Royal College of General Practitioners Secure Environments Group says that the prevention of deaths in and after custody must be central to all work on substance misuse in the criminal justice system. The report “Protecting lives: a cross-system approach to addressing alcohol and drug-related deaths within the criminal justice system” can be found here. It highlights the need for a whole-systems approach to tackle substance misuse in the criminal justice system – in order to prevent drug and alcohol-related deaths amongst prisoners and those released back into the community.
The report brings together cross-sector expert advice through a literature review, analysis of findings by criminal justice scrutiny bodies, an expert roundtable event and interviews with cross-sector experts.
The scale of drug and alcohol misuse in the criminal justice system is significant and both directly and indirectly leads to deaths in custody. The COVID-19 pandemic, which means that people in prison are spending up to 23 hours locked in their cell to prevent transmission of the virus, exacerbates feelings of the hopelessness, boredom and desperation which lead to drug use, and presents a threat to life.
Opportunities to divert those with substance misuse issues are being missed, with only 6% of all community orders made with alcohol and drug treatment requirements.
Greater use of harm-reduction initiatives and improved investigatory processes are required, including the need to take into account clinical factors leading to a death and the importance of commissioning skilled independent clinical reviewers.
The report demonstrates that people are at particular risk of a substance misuse-related death when they are in transition between prison and the community. It shares the considerable evidence which suggests that people who have recently left prison are at a higher risk of death. One study suggested that male prisoners are 29 times more likely to die in the first week after release when compared to the general population, while another suggested the risk of dying in the first two weeks following release was eight times higher for former prisoners who use drugs compared to those who do not. Such deaths could occur following release owing to lower tolerance, a lack of awareness of the strength of drugs recently introduced to the community and an element of ‘celebration’ of having been released
Just over 60% of individuals who leave prison with an appointment for treatment fail to attend or engage, despite heightened relapse risks.
The report makes a number of key recommendations including:
- Improving our data collection and understanding of the numbers and circumstances of substance misuse-related deaths in the criminal justice system.
- Increasing the number of people receiving help in the community via Community Sentence Treatment Requirements.
- A more holistic approach to drug treatment and recovery.
- More use of the newly available formulation of prolonged-release buprenorphine as an opioid substitution therapy, (given as a weekly or monthly injection), would help to reduce risk and improve the continuity of treatment to service users as they move between community and prisons.
- Expanding the use of naloxone to prevent fatal overdoses.
- A particular focus on helping drug users during the initial post-release period which is a high risk period.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here.