The Scottish Model - Practical Steps

The aim of the prison naloxone programme is to train prisoners in overdose prevention, intervention and naloxone during their sentence and to provide them with naloxone-on-release. It is delivered by NHS staff and peers, facilitated by the Scottish Prison Service.

There are many steps along the ‘prisoner journey’ through their sentence where they have access to training. The steps below describe some of the potential barriers and solutions to each phase.

I. Reception

This is where the prisoner is checked in when they arrive at the prison and a drug test will be taken by health care staff. If they have a positive test for opiates they should be informed of the naloxone programme and their interest noted in their file. If the person declines, they will be approached again at a later date.

Barriers:

This is not always the best time to introduce an intervention that will only be available on release. The person will undoubtedly have mainly other things on his mind.
There is a change that they are not informed of the programme, it is not recorded or that they are not followed up.

Solution:

Ensure there are multiple opportunities for training throughout their sentence.

II. Induction

The induction programme is offered to all prisoners within the first few days of their sentence. In some establishments, it is also peer-delivered and in many, the naloxone programme is included in this information session. Interest in the training is again noted at this point by staff or peers.

Barriers:

Induction is not mandatory so people may not attend. Their interest in the training may not be noted.

Solution:

Ensure there are multiple opportunities for training throughout their sentence.

III. Training

This is often delivered 6 weeks prior to liberation, in combination with other pre-release programmes.

Barriers:

These programmes are not mandatory so people may not attend. They also may be released earlier than expected and therefore miss this opportunity.

Solutions:

Ensure there are multiple opportunities for training throughout their sentence (the length of time prior to release is not the most important factor).

Referrals

During the person’s sentence, they can also self-refer for training at any point – they may have seen a poster, read a leaflet, been told about it by a peer or by a family member/friend at a visit. 

IV. Training delivery

Initially, this was designed to be delivered in a group setting by two staff members.

Barriers:

Organizing trainers and participants to be in the same place at the same time was problematic.

Prisoners had competing priorities – work, gym, visits etc.

Prison officers were required to escort people to training which reportedly did not always happen due to prisoners refusing on the day.

Staff shortages or availability was an issue.

Groups are not always suitable in a prison environment, particularly with the subject of overdose which can be emotive and the environment can be intimidating.

Solutions:

Training is now mostly delivered as a brief intervention over 10-15 minutes.

One member of staff or a naloxone peer trainer delivers this – can be done in clinics, as part of other appointments or on the halls.

The nursing staff then delivers the naloxone kit to the reception area to be placed in the person’s valuable property (with their mobile phone etc.).

Barriers:

The timing for this training can be problematic – if someone is trained a year before they are released, the kit needs to be put in their valuable property nearer that time. People are often released early from a court before there has been a chance to put the kit in their valuables.

Reception staff are not always informed of what naloxone is and may not realize the importance of ensuring the kit is put in the valuables.

Solutions:

It is imperative that prison officers are given awareness sessions on naloxone. Not only so that they know what it is themselves but also so that they are able to answer questions from prisoners and encourage them to leave with it.

Find a mechanism to ensure that the kit is placed in the valuables in plenty of time prior to court appearances, early release etc.

V. Release day

The person collects their valuable property as they leave the prison.

Barriers:

The kit has not been placed in the valuables. The person is unlikely to wait until it can be delivered at this point.

Unnecessary attention is drawn to the kit by the staff and the person refuses to take it. This may be because the person has said they will no longer be using drugs and taking naloxone may be seen as contradictory. Or they may not wish to be seen as someone who uses drugs by other people in the vicinity.

Solutions:

Ensure the kit is securely in the valuable property prior to release.

Involve peers at this stage – a great example was in one of the Scottish prisons where naloxone peers were given a job that involved being at the reception area to ensure people left with their kits.

The overwhelming majority of barriers have been operational. Systems and standard operating procedures should be put in place to minimize these types of barriers.