Coronavirus (COVID-19) - Opioid Substitution Treatment (OST) in prisons: process evaluation

Key Findings

• Buvidal makes logical sense as a response to a pandemic where prison operations, including Opiate Substitution Therapy (OST) provision, might be interrupted.
• It would likely have been challenging to implement Buvidal provision for the first time during a pandemic, particularly in prisons with large numbers of OST patients. Findings suggest that the timing of the request from the Scottish Government for prison health centres to switch clinically appropriate OST patients to Buvidal arrived when prison health centres had already implemented Covid-19 contingency plans, and uncertainty about some practical aspects also created challenges.
• For these reasons, alongside uncertainty about the future direction of the Buvidal programme, there has been low uptake of Buvidal among OST patients in prison, therefore there is limited evidence to assess any impact Buvidal has had on OST patients, prison operations or health services.
• By the time of writing, seven prisons in five Health Boards had started to move some of their eligible patients onto Buvidal. These prisons had accounted for just under half of the total prison population on OST in February 2020.
• 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.
• Despite small numbers, the proportion of patients still on Buvidal after one month was high.
• Few adverse effects had been recorded, aside from those which would be expected from withdrawal from some forms of oral OST.
• Whilst there is limited evidence, the anticipated outcomes from people switching to Buvidal highlight that it has considerable promise to deliver a host of benefits to patient outcomes.
• Patient experience should be a central focus of any future research and, where possible, should seek to follow patients over a period of time, perhaps using a qualitative longitudinal approach, and should seek to document the impact that Buvidal may have on patients' throughcare progress after liberation from custody.
• This research has demonstrated the current burden placed on prison operations and healthcare services when administering daily OST, which in some prisons is considerable and points to the significant benefits which Buvidal could bring.
• Further clarity is needed to increase clinical confidence to address concerns about whether or not patients exiting custody would be able to access Buvidal in their community.