Coronavirus (COVID-19) opioid substitution treatment in prisons - evaluation: patient experience follow-up report

Key findings

• On May 1^st, 2020, the Scottish Government requested that all daily oral Opioid Substitution Treatment (OST) patients in custody, who were currently serving a sentence of six months or longer, were offered the opportunity to transfer onto Buvidal, a type of Prolonged Release Buprenorphine, where clinically appropriate^[1]. This was intended as a contingency measure in prisons to respond to COVID-19. The report Coronavirus (COVID-19) - Opioid Substitution Treatment (OST) in prisons: process evaluation highlighted that by August 2020, one tenth of the estimated total prison population on OST and with more than six months left in custody had moved over onto Buvidal. In addition, it found that daily OST places a considerable burden on prison operations and healthcare services and that there were a host of anticipated benefits arising from the introduction of Buvidal as treatment option for prison regimes (e.g. freeing up staff time for increased case management work), healthcare services (e.g. allow for more patient focussed activities), and patients, such as increasing engagement with purposeful activities and reductions in drug seeking behaviours.
• The use of Buvidal as an Opioid Substitution Treatment (OST) in Scotland's prisons could have transformative potential that might lead to improvements in the health and wellbeing of OST patients, prison safety and security, and improve through-care outcomes once people are released.
• The numbers of Buvidal patients in Scotland's prisons has increased – although the rate at which people switching over appears to have been influenced by uncertainty around funding for the treatment, with patients less willing to switching when healthcare staff were unsure about the longevity of the scheme.
• High levels of satisfaction about Buvidal were reported by almost all patients and healthcare staff continued to be enthusiastic about the positive impact Buvidal can have on patients' lives.
• The desire to come off methadone was a strong motivation for most Buvidal patients, who reported that they did not like how it made them feel and that methadone was a stigmatising treatment. A further motivation tied to wanting to come off methadone was that changing to Buvidal would prevent people from having to attend a community pharmacy on a daily basis after their release from prison – a setting where they felt at risk of relapse.
• Buvidal appears to alleviate cravings and reduce drug seeking behaviour, which combine to drastically reduce illicit drug use among Buvidal patients.
• Buvidal had positive effects on patients' health and wellbeing – patients and healthcare staff reported sometimes drastic changes to peoples' emotional wellbeing; in some cases this led to positive lifestyle changes, such as people re-engaging with purposeful activities and going to the gym.
• Buvidal may offer a route for people to escape being bullied to divert their OST prescription in prison, which has harmful impacts on patient health and safety and prison security.
• Given these findings, there is now evidence to suggest that more patients would benefit from being prescribed Buvidal, if it was offered as a treatment option to everyone entering prison with a history of opioid use
• Once people have left prison, Buvidal offers the potential for them to take greater control of their lives, free from a daily medication regime, which may allow them to source and hold down employment and take part in other positive activities, such as going on holiday, more easily.
• Buvidal, however, may not be suitable for all OST patients – concerns were raised about how some may cope with the increased cognitive clarity Buvidal patients experience compared to methadone, particularly if their drug use is tied to suppressing or coping with previous trauma. Some degree of patient discomfort should be expected when they change their OST prescription and close attention should be paid to the transition period when parents are switching from high doses of methadone.
• This study also suggests that patients mostly become stable on Buvidal after they have been given their second monthly dose. While it is currently only OST patients with a minimum of 6 months remaining on their sentence that can change their prescription to Buvidal, findings from this research suggests that this period could be shortened to potentially include people with only 3 months left on their sentence.
• From a healthcare service perspective, increasing the number of Buvidal patients would likely free up resources within prison health centres to be able to offer other services to patients, including those more focused on recovery.
• While this report noted a lack of clarity surrounding the future of Buvidal, and that this may have been a factor in patient decision making about changing their OST, the Scottish Government has since allocated £4 million for the 2021/22 financial year to encourage services that people with drug issues engage with to make Buvidal more available in prisons and the community. In addition, an expert group has been established to support this work which includes doctors, pharmacists, drug addiction specialists and lived experience members. The group is being chaired by the Interim DCMO. One of the main aims of the expert group is to work to remove existing barriers across health and social care to expedite the use of prolonged-release buprenorphine across Scotland.