Drug treatment in prison: what the data show
Thanks to staff at the House of Commons Library, and the diligence of many parliamentarians, it has proved possible to investigate how well the prison’s Integrated Drug Treatment System is working.
Many whose questions elicited answers are listed at the end of this article, which aims to sum up what we have learned.
Members tracked expenditure by the Ministries of Health and Justice/Home Office on IDTS, on the number and names of prisons where IDTS had been implemented, how many prisoners had benefited from improved quality drug treatment, how IDTS outcomes compared with pre-set targets (if any), whether there had been a reduction in overdose deaths in the first fortnight after release from prison or on early release from prison (IDTS-related, or not), steps taken to reduce the supply of drugs into prisons and how effective they had been, different policies on methadone prescribing between IDTS and non-IDTS prisons, harm reduction strategies specifically in respect of class A drugs, and how harm reduction measures in respect of HIV and hepatitis C matched up between prisons and the outside community.
The above list is not exhaustive but long enough to testify to parliamentarians’ scrutiny, the breadth of their understanding of the issues around drugs and drug treatment in prisons, and their concern for prisoners’ health. What did they discover?
1. Anne Main noted that, whereas the Department of Health (DH) had intended £20m funding for the clinical element of IDTS in 2007/08 rising to £40m in 2008/09, these budgets were reduced to £12m and £12.7m respectively because of a wider review of DH spending (24 April 2007 answer to ).
2. Nonetheless, 44,000 prisoners were still expected to receive IDTS-treatment by March 2008 (22 March 2007 answer to ). By June 2007, the expectation was revised: “with £18.7m invested in 2007/08 (by DH and Justice/Home Office), around 24,500 prisoners annually will benefit from improved quality clinical treatment”.
3. Compare with Table below (based on yet other answers); and 1 September 2008 account which confirmed, presumably from different data-sources, that: “In 2007/08, 25,519 prison drug treatments were initiated in 53 IDTS prisons”.
4. DH’s spend on IDTS was between £11.5m and £12.7 millions in 2007/08, and so the average cost per “prison drug treatment initiated in IDTS prisons” was apparently between £450 and £500.
5. Spending on the psychosocial elements of IDTS was only expected to reach its allocation of £6 millions in 2008/09 having been £1.9m and £5.5m in 2006/07 and 2007/08 respectively.
6. On 6 June 2007 in answer to , Caroline Flint had acknowledged that the DH’s IDTS-investment was not ring-fenced. Also in June 2007, Edward Garnier had established that it cost £2,831 millions to run the prisons in England and Wales, of which only 2.73 per cent was spent on “custodial drug treatment” (including the 0.82 per cent spent on clinical services: about £23 millions). National Offender Management Service reckoned that, at any one time, prisons held 40,000 problem drug users and that, because of the churn of prisoners, at least 70,000 problem drug users entered the prison system in a year.
7. Table on IDTS costs and services delivered was compiled from answers to a range of parliamentary questions. Superficially, the cost per CARAT assessment in 2007/08 was £482 and per clinical treatment was £408.
8. Lynne Jones established that there was no routine data collection to establish how many overdose deaths occurred within two weeks of release from prison [answer to 207703]. (Scotland conducts a look-back into the prison antecedents of its drug-related deaths and UK a confidential inquiry into the prison antecedents of deaths by suicide.)
9. Mr. Llwyd discovered in July 2008 that hepatitis B vaccination was routinely offered not in all prisons in England and Wales but only in ‘over 100 prisons’; and Edward Garnier questioned why so few drugs finds in prisons (1,641/5,528 in 2007) were reported to the police. Nonetheless, the government had accepted all 10 recommendations in the Blakey Review (Disrupting the Supply of Illegal Drugs into Prisons) including that: ‘recognition be given to the need for national and coordinated intelligence processes as the most effective means of long-term disruption’.
10. When asked about trends in the availability of drugs in prisons or about the success of the drugs strategy in prisons, Ministers answered by reference to random Mandatory Drugs Testing (rMDT). For example on 20 January 2009 (column 1342): “Success of the drug strategy is illustrated by reduction of drug misuse in prisons, as measured by rMDT: positive rate has dropped from 24.4% in 1996-97 to 9.1% in 2007-08.”
So what can we conclude from these answers and from my analysis of the mandatory drug testing data, which has been reported daily this week on this website?
· The roll-out of funded-IDTS is proceeding too slowly, and variably between prisons in the same IDTS-wave to judge by the prevalence of prescribed methadone in rMDTs even three years after the first wave of IDTS-funding.
· There has been too little analysis, and hence too little learning, of how tMDTs are deployed in the detection of inside-use of specific drugs. Intelligence-led tMDT appears to perform better in prisons which elected against 5 per cent rMDT: typically, these are smaller prisons but may also differ in security rating.
· Inmates who receive prescribed methadone are an identifiable easy target for tMDT, but after two years or so, prisons seem to have concluded that they are not the right target.
· Cannabis positive rates in rMDT dropped dramatically after 2004/05+2005/06 not only in IDTS first wave (down from 72 to 42 per 1,000 rMDTs) and Tier 2 prisons (from 89 to 55 per 1,000 rMDTs) but also in the remaining prisons (from 69 to 34 per 1,000 rMDTs). The Ministry of Justice should explain how these major changes came about.
· The Ministry of Justice should also take into account that, by daily prescribing of methadone to inmates who would otherwise have been inside-users of heroin, prisons’ opiate positive rate in rMDT is bound to decrease. However, the prison’s background prevalence of opiate-dependent inmates will not necessarily have decreased.
· When comparing opiate positive rates in rMDT from before and after the introduction of methadone prescribing, an adjusted rMDT indicator has been proposed here for use after methadone prescribing was introduced, namely: opiate positive rate in rMDT + one third of the prescribed methadone positive rate in rMDT. When thus adjusted, the background opiate positive rate appears to have increased in prisons in the period since 2005/06.
· The most costly data are those that languish insufficiently analysed when they are eminently capable of being used to monitor the performance of prisons in their introduction of IDTS and to assess prisons’ intelligence gathering about inside-use of illicit drugs.
· Prisons’ inept rMDT performance indicator (percentage positive for any drug) is overdue for release.
· Expectations based on drugs science should guide the interpretation of both rMDTs and tMDTs in prisons. Otherwise, human rights as well as cost considerations should see an end to rMDTs in England and Wales – use them, or lose them! Competent analyses of the results of mandatory drugs testing of prisons should be regularly in the public domain, not hidden from outside scrutiny. Interpretation of analyses should be apolitical, not spun.
Thanks to the following parliamentarians whose questions made these revelations possible: b Andrew Pelling, Edward Garnier ,Jeremy Browne, John Bercow, David Burrowes, Baroness Corston, Jim Cunningham, David TC Davies, Paul Flynn, Lord Forsyth of Drumlean, Dominic Grieve, Stephen Hammond, Mark Hoban, Simon Hughes, Chris Huhne, Lynne Jones, Elfyn Llwyd, The Lord Bishop of Liverpool, Anne Main, Andrew Rosindell, Graham Stuart, and Dr. Whitehead..