DRUG charities have said they will be closely monitoring plans announced by the Scottish Government to switch some methadone users in prisons on to a weekly or monthly alternative, after raising concerns with officials.
The Scottish Recovery Consortium (SRC) and the Scottish Drugs Forum (SDF) told the Sunday National they were alarmed by a letter issued early this month by interim chief medical officer Dr Gregor Smith, revealing that Scottish ministers had agreed to a transition to “widescale” prescription of slow-release injectable heroin replacement Buvidal.
About one in four prisoners has a prescription for methadone, which is taken daily, while Buvidal is administered by a seven or 28-day injectable dose, making it “more pandemic-appropriate” according to the Scottish Government guidance.
But charities, who claim the drug needs careful supervision and is not suitable for all users, raised concerns with officials last week.
Users need to dramatically reduce the amount of methadone they are taking to move on to Budival. Though the offer of the more “clear headed” drug in Scotland has been widely welcomed as an alternative, users require additional psychosocial support to deal with methadone withdrawals and deal with trauma that may resurface as a result, it is claimed.
Jardine Simpson, chief executive of SRC, said he had told ministers that forcing people to switch their prescriptions could be considered to be a breach of human rights. “They way it was phrased suggested that this would be a universal transfer,” he said. “I was alarmed about that because it’s in complete contradiction with the government’s strategy of Rights, Respect and Recovery. The question I had was this an oversight or was it done because it could be seen to be justified in this emergency situation.”
After consideration ministers clarified prisoners would be allowed to opt out and agreed to write a clarifying letter, a move welcomed by Simpson.
“I do understand this is emergency contingency provision,” he added. “But I will be monitoring this process closely.” He said emergency provision must not become permanent policy by a back door.
Dave Liddell, chief executive of the SDF, confirmed that the organisation had been amongst those raising concerns last week. He said that he welcomed reassurances provided that Buvidal would not be offered as “a one size fits all approach”.
The proposal could improve the wellbeing of some prisoners, he added, as well as assisting in protecting staff and prisoners from Covid-19 infection.
But he warned: “It will not be suitable for everyone currently on methadone. Methadone and buprenorphine work in different ways and have different effects and side effects.
“It is likely that Buvidal will be unsuitable for people with significant mental health problems, particularly those related to trauma. It is also unsuitable for people with liver disease due to hepatitis C, which is significant in this group. There will also be people who have adverse reactions or discomfort after Buvidal administration who may want to opt out.”
Others have raised concerns about potential overdoses, with Health Secretary Jeane Freeman also widening the availability of the overdose reversal drug Narcan as a “precautionary measure” because access to drug support services had been affected by the pandemic.
Scottish prisons are currently on tight lockdown, with educational and other communal activities cancelled and visits suspended. Prisoners are confined to their cells for up to 23 hours a day, leading to escalating tensions. Last week a man recently released from HMP Barlinnie in Glasgow told the BBC the atmosphere in the jail was reaching boiling point.
It came as the Scottish Government approved the early release of up to 450 to take pressure off the system.
The letter from a Scottish Government official reads: “Please be assured that the approach is based on an emergency response to the current pandemic and has at its heart the need to ensure patient safety and continuity of care at a time of necessary social isolation and restricted movement within prisons.
“This has been developed to provide an appropriate and balanced option at a time when there is concern that a reduced workforce, along with the impact of social distancing and self-isolation measures, could risk disruption to the current administration of daily OST.” Consent for treatment should always be sought from prisoners, it adds.
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