My Lords, in moving Amendment 19 I shall speak also to Amendment 20. Amendment 19 should have been tabled in my name, but unfortunately due to an administrative error my name was not added to sit alongside those of my noble friends Lord Beecham and Lord Kennedy.
Clause 14 enables the Secretary of State to specify in prison rules and rules for other places of detention non-controlled drugs which can be tested for under the existing mandatory drug-testing programme. I generally support the intention behind Clause 14, but I would like to see greater clarity on two aspects: first, on what plans are being made to ensure that suitable provision is in place for people in prison to be able to take prescription drugs safely and so limit the scope for abuse; and secondly, on the incidence of drugs in prison and in particular the effectiveness of drug testing.
In tabling both of these amendments I should declare an interest as the former chair of the independent cross-ministerial committee on the review of drug treatment in prisons which resulted in the publication some years ago of The Patel Report. At the time we were very much focused on the development of the integrated drug treatment system in prisons which commenced in 2006. It has had a considerable and positive impact on reducing the use of heroin and illegal drugs in prison. However, we know that since that time, the demand for prescription and over-the-counter medication in prisons has been increasing, and we have also seen an increase in the use of
psychoactive substances, the so-called “legal highs”. We need to consider the use of legal highs alongside the problems around prescription drugs in our attempts to deal adequately with these issues. For that reason, I intend to address both issues together.
Amendment 19 requires the Secretary of State to lay a report before Parliament,
“describing his plans to ensure that safe and supervised places are provided in which prisoners can take medication which has been prescribed to them”.
Amendment 20 requires the Secretary of State:
“Within 12 months of section 14 coming into force … report to Parliament on the incidence of drugs in prisons and the effectiveness of drugs testing of prisoners in prisons”.
Let me first explain why these two amendments are important. Although accurate prescribing data for analgesics are unavailable, a report entitled Managing Persistent Pain in Secure Settings, published by Public Health England last year, gives some startling figures on the scale of analgesic prescribing. A snapshot of just two institutions with populations of 751 and 859 respectively suggested that between 55,000 and more than 350,000 analgesic tablets, excluding paracetamol and ibuprofen, were prescribed in just one month. The Chief Inspector of Prisons highlighted in his annual report last year that the diversion of prescription drugs, such as Tramadol, Gabapentin and Pregabalin was taking place in high security and vulnerable prisoner populations. I know from my own work with NHS England on conducting health needs assessments in a wide range of prisons just how serious an issue this is, and that the growing demand for and diversion of prescription drugs is viewed by both prison staff and the prisoners themselves as a major problem.
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We are also hearing more about the use of psychoactive substances in prisons. This is a serious problem because there are no data at the present time on these legal highs in prisons, as they do not show up on mandatory drug tests and so are difficult to detect and identify. Both these issues—the increasing demand for and potential abuse of prescription drugs and the use of psychoactive substances—present considerable challenges to the prison system and, in particular, to the safety and well-being of prisoners.
It is important that we understand why this is happening. Prisoners are likely to suffer from conditions such as insomnia, anxiety and pain that lead them to seek medicines that can lead to dependence. Some prisons have reported that part of the problem is that prisoners come into prison with prescribed medication that may be considered unnecessary by the prison GPs but has been prescribed by GPs in the community. In these cases, prisoners can be very reluctant to give up or to consider a reduction programme to bring them off these medications. We also have many more people coming into the prison system who are older and more likely to suffer from conditions that require complex medications, including adequate management for pain relief. There is no doubt that managing persistent pain in secure environments presents clinicians with a number of challenges surrounding diagnosis and the management of treatment.
The difficulty faced by GPs in prisons is to distinguish patients who need medication for pain from those who want to misuse it or trade it as a commodity, as diverted medication can result in problems such as drug debts, bullying and the risk of overdose. Some prisons have reported that prisoners can be demanding, and in some cases bullying of doctors and nurses can take place in their requests for painkillers. I was told in one prison that a GP had to press the alarm three times in the past 12 months due to prisoners bullying him for medication that he had refused, as he felt it was not clinically necessary. We also know that nursing staff have to spend large amounts of their time dispensing medications, many of which are controlled or deemed to be a high risk for abuse and/or diversion. Some of the measures they have to take involve random checking of prisoners’ mouths to make sure that they are swallowing their drugs and not holding or concealing them in their cheeks. To avoid this, in some cases, liquid medication, such as liquid Pregabalin, is dispensed instead of tablets. However, this is not always sufficient as we have heard examples of prisoners concealing sponges in their cheeks to absorb the liquid medication. In some prisons, crushed tablets are dispensed to prisoners to prevent them from trading them. Prison officers will also remain with nurses to ensure that medication that is dispensed is taken appropriately. However, in some prisons simply not enough staff are available during the dispensing of medication to prevent diversion and bullying of prisoners.
Noble Lords can understand how dispensing medication is time-consuming and can be stressful for the nurses, prison officers and prisoners. Of course, an easy solution would be to allow more prisoners to have their medication in possession, which means that they keep it in their cells in lockable cupboards. But unfortunately this too can leave them open to bullying. We have examples of greater use of technology to assist security of prescribing, such as the Methasoft iris recognition system, which is currently used to ensure that prescribed drugs are dispensed to the correct prisoner. But again, all these measures take time and resources, and many prisons are not equipped to deal sufficiently well with this increasing problem.
I hope that I have demonstrated just how important it is to have safe and supervised places with sufficient staff cover to ensure that prisoners can take medication that has been prescribed to them. However, having a safe space for the dispensing of medication alone will not resolve the problem. A number of prisons do not have a clear policy on this issue as yet. Some are starting to establish multidisciplinary team meetings to review and address the needs of people on long-term medication and to discuss how to deal with potentially difficult prisoners, and that should be acknowledged. Some prisons are commencing pain clinics in order to reduce the need and consequently the amount of painkillers prescribed. For example, I know of one prison where healthcare staff, including the GP, lead nurses, and the pharmacist, are working together with local hospital anaesthetists and physiotherapists to review all pain medication that is being prescribed and identify alternative ways by which prisoners may be helped to come off or reduce the need for this type of
medication. This is excellent work and we need to support more prisons in developing appropriate policies and approaches. That is the intention behind Amendment 19, which will require the Secretary of State to lay a report before Parliament, setting out clearly the plans for ensuring that prisons have sufficient safe places for providing prisoners with medications that have been prescribed for them.
As I hope I have made clear, extending the use of mandatory drug testing will go only part of the way to providing a solution. Many of the drugs that I have described as causing problems are prescribed in prison, so of course will show up on testing—but the use of psychoactive substances, or legal highs, will not, as many of these substances will not show up. Therefore, Amendment 20 seeks to ensure that we have sufficient information not only about the use of drugs in prison but about the effectiveness of the mandatory drug-testing system. Taken together, this review of effectiveness of mandatory testing and the scale of the problem of drug use in prisons, alongside clarification about the plans for provision on safe places for ensuring that prisoners can receive drugs that they need without the potential for abuse, will, I believe, provide us with greater confidence in the likely impact of Clause 14. The clause needs to address the range of complexities and potential solutions to these very challenging issues, and I very much hope much that the Minister will consider these amendments seriously. I beg to move.