The safe implementation of a prison-based methadone maintenance programme: 7 year time-series analysis of primary care prescribing data

BACKGROUND: Internationally there is policy support for the introduction of methadone maintenance programmes into prison settings. Increasingly GPs are encouraged to undertake this work although concerns remain regarding the safety of such programmes. This study sought to evaluate the impact and safety of the introduction of a general practitioner with a special interest (GPsi) in substance misuse led methadone prescribing service into a UK prison between 2003 and 2010. METHODS: Time series analysis of secondary prescribing data pertaining to opiate maintenance therapies, opiate detoxification therapies and opiate related deaths for the time period 2003 to 2010. RESULTS: Results show that following introduction of a GPsi in substance misuse there was a statistically significant increase in both methadone maintenance and detoxification treatments. Over time the rate of methadone maintenance prescribing plateaued with a corresponding decrease in the rate of methadone detoxification prescribing. There were no methadone related deaths in prison over the study period. CONCLUSION: The phased introduction of opiate replacement therapies into a busy remand prison did not result in any deaths within the prison for which opiate replacement was identified as the cause. GPsi led opiate prescribing programmes can be introduced safely into secure environments.