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A substitute for prison drugs policy?

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Mark Easton | 21:24 UK time, Tuesday, 8 December 2009

One of the government's former drug "tsars" has told me how a battle between two Whitehall departments is undermining efforts to get prisoners off heroin.

methadoneMike Trace, who currently heads a charity which runs drug rehab programmes in jails, says that the Ministry of Justice and the Department of Health are "fighting each other about who runs treatment in prisons".

The result, he says, is that last year a record 20,000 English prisoners were prescribed the addictive heroin substitute methadone instead of being encouraged to use their time inside to get drug-free.

"It is madness," he says. Mr Trace claims the reason health ministers agreed to spend £40m on drug services in prisons is "not because they love methadone, it's because they want to take control of prison drug treatment".

Methadone can be an effective tool in helping heroin addicts conquer addiction but critics argue that too often drug services use it as an easy option and are not ambitious enough in getting users "clean".

In a rehab centre in Burton-upon-Trent recently, I met many former prisoners all telling a similar story - that prison doctors are "doling out" heroin substitutes and making it less likely they will get off drugs. Only now, after their release, have they been able to get help to give up all drugs for good.

Barry JonesOne ex-con, Barry Jones, told me that prisons now use methadone as a way of "keeping the roof on" - to control prisoners. "I was never even asked why you do it. Just given a dose, told to get my head down. Don't kick your door. Don't kick off."

Another, David Bywater, said:

"Things can get difficult if you are shoplifting or whatever you are doing. So you think, I will go to a prison for a bit of a rest period. You know you are going to get your drugs, methadone and what have you, so you are better off inside."

Andrew Whalley was recently released after spending 10 years behind bars for a drug-related robbery with a firearm. In jail, he told me, methadone was the most certain way of ensuring he remained an addict and a criminal.

"We don't want to get stabilised, get maintained," he told me. "I'm an addict, so if you give me free methadone, free drugs, keep me in active addiction, then release me out of prison, then surely when I come out of prison I've got to commit crime to keep me there."

He listed all the prescription drugs he had been given by doctors while in jail: methadone, diazepam, subutex, sleeping pills. "Was he ever offered rehab?" he was asked. "The last course I was offered was a safer injecting course," he replied.

In a joint statement tonight, the Department of Health and the Ministry of Justice said:

"It is categorically untrue to say methadone is used as any sort of control mechanism. Decisions regarding treatment are clinically based.

"The programme includes abstinence, but all treatments are aimed at getting the person off drugs. The rise in prisoners getting methadone treatment means more prisoners are getting the treatment they need and there has been significant investment in prison clinical drug treatment to help this happen. Most prison methadone prescribing is for detoxification not maintenance purposes... with the goal of becoming drug free."

Mike TraceThe government commitment to do more to help English prisoners deal with their addiction problems is to be welcomed. But Mike Trace argues the Department of Health's determination to wrestle control of treatment budgets from the Justice Ministry is undermining efforts to get inmates off drugs:

"The budget for supporting methadone and health care in prisons sits with the Department of Health and the budget for drug free programmes sits with the Ministry of Justice. Each department pushes its preferred solution.

"The mechanism for those two departments to agree on a balanced strategy is clearly too weak at the moment. We have two different departments pushing two different strategies in prisons."

He explained to me that when a heroin-addicted prisoner arrives at a jail, among the first people they meet is a health worker who, he claims, almost routinely offers them methadone:

"We do see, to quite a worrying extent, that when they see the health professional sometimes the only choice they are offered is a prescription of some type - which means their motivation to remain drug-free can be undermined, and we see that regularly on a week-by-week basis."

The Conservative Shadow Minister of Justice, David Burrowes, says the Tories would change the philosophy if elected. Pointing to a policy paper entitled Prison with a Purpose, Mr Burrowes told me tonight:

"The public would rightly expect that at the very least prison is a place where drug-free conditions exist and there would be an expectation that drug-free rehabilitation would be available."

The policy paper published last year says that "across the entire prison estate there are just four abstinence-based therapeutic communities, and only 300 prisoners entered such programmes in 2006/7".

It says that "the reality for the majority of those going into local and remand prisons is 'clinical services' to manage substance misuse. These comprise detoxification and maintenance prescribing programmes which are meant to be a prelude to broader based drug treatment interventions. In the main they are not."

The prisoners at the Burton rehab centre explained that methadone has a high value behind bars and most inmates will jump at the chance to get what they describe as "free drugs". Some criminals, however, are desperate to get off drugs and yet are still put on methadone.

Darren HoltDarren Holt has spent three of the last five years in jail for drug-related offences and during his last sentence decided enough was enough. He told prison medical staff he wanted to get clean but, he says, they refused to listen.

"I was desperate to get off the methadone they was giving me. I asked them to take me off the methadone programme which they declined. I ended up having to spit it out."
"You actually detoxed yourself?"
"I detoxed myself."

A few weeks ago, the Ministry of Justice revealed how the number of prisoners put on methadone has increased 57% in a year.

Such are the numbers now being prescribed it in jail, that the government has recently spent £4m on biometric methadone dispensing machines in jails. This, I believe, is the first published image of these devices, which are located in prison medical departments.

Biometic methadone dispensing machine. Courtesy: NECNoreen Oliver who runs the Burton Addiction Centre believes voters would be shocked by how few prisoners are given the chance to get off drugs:

"I think what the public wants is their money getting people off drugs, back contributing to society and out of the benefits system. At the moment, that's only happening for 850 prisoners out of 60,000, that's crazy figures, who are actually given the chance to become drug-free."

Methadone, incidentally, can rot your teeth - which has led to a poignant joke doing the rounds in the prison system:

Q: What's got three teeth and a hundred legs?
A: A methadone queue in jail.


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