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Heroin Addiction and Related Clinical Problems: 2016, 18, N4 (pages: 13 - 22)

Audit of Admission Urines in Two Scottish Prisons in Prisoners Self-Reporting Opiate Misuse

Campbell G.

Summary: Background: Illicit drug use is common in those who come into the criminal justice system. Opioid replacement therapy (ORT) improves outcome but these drugs can be diverted and misused. Aim: The primary aim was to assess the urines of new admissions to the prison service with regard to opiate misuse, the numbers on opioid replacement therapy (ORT) and estimate the extent of diversion of ORT in new prisoners who self-reported opiate misuse. Methods: We performed urinalysis for the presence of methadone, buprenorphine, opiates, cocaine, benzodiazepines and amphetamines on admission to HMP Barlinnie and HMP Low Moss, two large male prisons in Scotland. From Jan–April 2015, a supervised urine sample (50 ml) was collected from consecutive new prisoners who were receiving ORT or who gave a current history of opiate misuse. Results: 209 prisoners fulfilled the inclusion criteria. In total, 51.7% (108/209) reported receiving ORT at prison admission. 47.4% (99/209) tested positive for methadone. Of these, 88.9% (n=88/99) were in receipt of a methadone prescription (one of whom tested negative for methadone) and 12.1% (n=12/99) were without a prescription. 29% of prisoners (62/209) tested positive for buprenorphine, the majority of which (67.7%, 42/62) was not prescribed. Six patients prescribed methadone were positive for diverted buprenorphine. Thus, diverted ORT was detected in 25.8% of cases (54/209) and was significantly more likely to be buprenorphine than methadone (p<0.0001). Polydrug use was common; 69.4% (145/209) of prisoners were using at least two illicit substances, but there was significantly less use of three or more illicit drugs in those receiving ORT (16.7% vs. 41.6%, respectively, p<0.0001). Conclusions: An encouraging number of prisoners with a history of opiate misuse were receiving prescribed ORT. There were high levels of polysubstance misuse. We found evidence of diverted ORT in more than 25% of prisoners. Of those without a prescription for ORT taking buprenorphine, more than a quarter were opiate negative, perhaps indicating self-treatment.