Hi I received this e-mail from a GP today which I thought might be a good debating point.

"I am really incensed this morning regarding the coverage of the issue about prison inmates suing for effectively not getting harm reduction treatment that they should be.

Whilst I am not going to get too much into how much in damages they should be getting, I am appalled at the way the BBC this morning portrayed the issue.

Maybe if there were better health services within the HM Prison system specifically substance misuse services then Joe, Jane and Jaswinder Public might see Prison Really Working and recidivism going down.

Unfortunately we are hostage to the mob."


and if you want to know what the mob are thinking read this:

http://newsforums.bbc.co.uk/nol/thread.jspa?sortBy=1&th...113145455&#paginator

This message has been edited. Last edited by: Jim Barnard,

This was bound to happen. When I worked in the Prison service we had a daily mountain of solicitors letters quoting .....'Inhumane and degrading treatment'
Mostly it was about stopping someones co-proxamol or some other opiate based medication or benzo's. Some of the Doctors used to prescribe Paracetamol for drug withdrawals.
There was chronic lack of Nurses many left due to workload and stress. We were underfunded and overstretched.
The Govt. might make proper investment, maybe.

The lack of substitute prescribing is a big problem for us in Worcestershire. If our patients being prescribed MMT go into prison their evidence based harm reduction treatment usually ceases. So they have enforced withdrawal or at best enforced quick reduction. I suppose the real question is "why should this treatment cease when if they had lung disease or diabetes then their evidence based treatments are continued?". The prisons locally are providing more substitute medication than they used to but the doses are too small and are usually reduction regimens. Some provide none at all. The way the media has manipulated this into a typical sabre-rattle for the entitled tax-payers is a sad reflection. Is there any point in a reply from the forum to the website-the BBC may well follow the story up. James.

Prescribing in London prisons seems to be improving. Just last week one of ours was released and we had a letter asking us to continues the script on 50mls.

That is another issue, communication. It seems prisons very quickly want to know what a person is prescribed but for many on discharge we do not get the same courtesy.

In my view people should expect the same medical treatment in prison as outside. However my main fear is that this case will stir up loads of hostility to treatment, a bit like currently in Scotland, and that the short term apparent victory for users may lead to counterproductive results in the political medium term.

Jim,
You are right that is the problem. One of the GP's commented today that these claims will end up taking as long and costing as much as the mineworkers claims.

I too read this article and listened to R2 phone in and the negative responses from listeners was saddening. However, in my opinion I am not suprised that the gen pop react like this because drug users are and have been demonised more than previously by the current gov... my other view on this is, the lack of freedom or 'liberty' is the punishment given, this is like punishing people because they use drugs too.. I was saddened by a ministers response that "this could be a devastating precident"... perhaps because gov already knows the problem existed and it happens so frequently that the flood gates may be ripped off... paying out of court is a clear admission of guilt, that's the precident for me... if the gov knew they had done no wrong with this approach they would defend it... damage limitation maybe.. I can imagine solicitors may have a good christmas for the next few years off the back of this... but public reaction? Not suprised really...

Home office tend to settle out of court it's cheaper, but this won't be in the long run.
Oh dear, if things had been done right this needn't have happened.
I'm not saying I agree with the payouts.

My concern is what the money will get spent on. Over the years I have seen compensation, rightly given but wrongly used, do so much harm.

Is there any support group or organisation out there looking after the applicants that helped to bring this case in the first place? If so, i wonder if there is scope for them to help the those receiving compensation manage the money wisely, like they try do do with lottery winners?

Is there a suggestion that if they spent the money on drugs that this would be unwise?Many years ago I worked in an office where a fellw worker proudly displayed a poster proclaiming,
If I had all the money I spent on drink,I'd spend it on drink.
Does assisting people in maximising benefit,DLA for example create some of the same concerns? So many questions.

Despite some of my best friends being solicitors, I am not generally in favour of expensive legal solutions to things which are much better sorted out over a cup of tea (I imagine the lawyers have claimed legal fees far higher than the payouts) , but in the medium term this can only be good for my patients, I think.

The local prisons do seem to have improved considerably with their CARAT drug workers, and developing links with DIP teams, although there is still a way to go and the new systems are like new shoes, not always a perfect fit.

I hope these compensations may provide some with a very much needed bit of assistance,hopefully doing more good than harm, and evidence that some parts of the System do care a bit. It certainly should focus a few minds to write a few better protocols and guidelines.

I am still fuming at the press distortion in reporting this, ('headlies' again) and the band wagon-jumping politicians who have risen to the bait. Perhaps the worse thing was reading the popular response and listening to some of the phone ins. When will people realise that the vast majority of those imprisoned as a result of drug misuse are victims as much as they are offenders, could be someone they know and love, are not aliens invading their cosy communities but are their own neighbours?

Many of the 190-odd prisoners that this related to were in treatment prior to being imprisoned and this treatment was then abruptly withdrawn due to the inadequacies that existed in the prison health system at the time. Some were remand prisoners, so not guilty of anything at that point. Settling out of court means the Home Office were on a loser and knew it, but the spin doctors have made it look like it was the fault of Human Rights legislation and greedy villians, supported by venal lawyers. So they have rubbished their legal opponents, Brussels and drug-users all in one go, whilst appearing to be defending the public purse. It has also given the press a free lunch and phone-in producers a dream topic. (No need to fill in time with DJ waffle)

What current restriction-on-bail client of the DIP will agree to taking high doses of methadone now if they think their script will be pulled if they are given a custodial? So less effective treatment, less effective crime reduction, increased harm of all kinds. The damage all round will take weeks to repair. I am not yet ready to just accept this as part of working in this field.........

It could take longer to repair the damage if there are loads more claims which seems possible. The tabloids, politicians and shock jocks could then turn this into something even nastier than it is now that could take years to repair. You could just see Cameron using this as an election vote winner, then labour changing the law on rights of prisoners to treatment in order to outflank him.

it could turn into a very unpleasant political football.

Actually its a real shame its been settled out of court, its stopped the case being properly debated in court and allowed ignorance to have the day.

It will be interesting to see how the 'Integrated' Drug Treatment System improves the quality of drug treatment in prisons. It seems already that there is going to be a post code (prison) lottery on whether you receive treatment or not. Also, is the HO going to allow appropriate substitute prescribing regimes? The last guidance I saw (admittedly 2 years ago) placed an artificial ceiling on the amount to be prescribed, 'because thet are in prison people do not need the same levels of substitute prescribing'?!

Just wondering...

I agree with Jim's last post confirming my opinions that the debate has been focussed by the media on the "junkies get it all and more" scenario. I posted 2 entries on the BBC website and neither was put on the site. I pointed out calmly the facts and was denied access. Meanwhile, hundreds of"this is outrageous-I pay my taxes and these druggies get all my money" posts. I promise I was VERY reserved with no opinions around the media distortion of the facts. The BBC are as bad as the rest of them-and I am a confirmed old fashioned radio 4 man. Sad times. James.

I think that the prison treatment of drug addiction has been awful over the past few years. In my experience however, many of my patients when confronted with an amount of cash (inheritence etc) have actually deteriorated medically, as they have tended to have the resistance of a wet mars bar when it comes to drugs, and the only folk to benefit have been the BMW with dark window wallahs.

Dr James, I have just had a thought regarding your lack of success on posting on the BBC. They may have filters to stop people using offensive words, these can include the names of drugs. I have tried to find 'heroin' and 'methadone' in the postings, no luck. It is possible that your considered argument was blocked by a robot because you used correct terminology. This of course allows more space for those who do not know a thing about the issues, even the names of the relevant drugs.

Good job this forum is not like that, or we could never say things like *** of *&?**.


Oh fcuk, it's messed up my message!