Supporting the management of substance misuse in patients

Replacing dependent substances

On average, a quarter of our patients who begin their residence at HMP Norwich have existing substance misuse issues and are receiving Opiate Substitute Treatment (OST) – a medical prescription to replace dependent substances.

A liquid form of methadone is commonly prescribed for OST as it’s difficult to conceal or divert. However, methadone can cause stigma within prisons as it’s predominantly used to treat heroin addiction and patients have a general ideology that it’s difficult to stop this medication when they are ready for recovery or abstinence.

Of those who receive methadone, most patients told us they would prefer to be prescribed long-acting buprenorphine due to its ability to be administered via injection.

This medication has been available in the community since 2019, but as we weren’t commissioned to prescribe this previously, patients who had traditionally received it in this form had to switch to oral administration instead.

Not only can this cause negative mental and physical impacts for some individuals, it also limits the number of patients who can be treated with injectable buprenorphine when starting OST.

Embedding a continuous treatment method

We worked with our community partners CGL (Change, Grow Live), who support patients following release from prison; our commissioners, NHS England to pilot a roll out of Buvidal (an injectable form of long-acting buprenorphine) to prevent a break in prescribed buprenorphine for patients entering prison and on release.

As well as providing our patients with an alternative treatment option within HMP Norwich, the pilot also aimed to reduce harm and death associated with substance misuse and illegal supply of diverted medications, encourage engagement and participation with OST and improve patient outcomes.

Following a successful proposal, we secured £69,000 of funding from NHS England to transition 25 eligible patients from methadone to Buvidal between December 2022 to December 2023.

Patients were selected based on eligibility to ensure they were suitable for treatment at HMP Norwich and continuation following release with CGL.

To ensure a seamless transition and continuity of care between HMP Norwich and CGL, the team developed two pathways: one for those in custody on release and another for those who had been prescribed Buvidal in the community prior to residing at HMP Norwich.

A positive future for patients upon release

85 percent of patients supported through the pilot reported they are now positive for their future and are grateful to have had the opportunity to try something different that will change their lives for the better.

One patient said: “I feel comfortable since starting Buvidal and not even thinking about using on release. I feel very confident I will not return to prison or to using heroin. I would like to thank all staff involved in me starting Buvidal as I think this will impact my life in a positive way and very much help me to stop using in the future.”

Another patient has seen a positive impact on his life since being prescribed Buvidal. Not only does he no longer require the medication, but he’s also started driving and is very settled with his wife and children.

So far, 100 percent of patients have had no issues or adverse side effects from taking Buvidal, with 93 per cent no longer craving or using heroin.

Following the positive change in patients who took part in the pilot, the team would like to expand the opportunity to another cohort of eligible patients in its neighbouring county, Suffolk.

The team have already had interest from 25 patients who do not currently meet the Buvidal criteria, which would be supported by community partners in Suffolk, Turning Point, who already prescribe the medication to patients upon release from prison.