Methadone maintenance treatment (MMT) became available through the Irish Prison Service in 2002. Wheatfield prison is a closed, medium-secure prison for men, with an official capacity of 700. On 3 October 2011, of the 664 prisoners in the prison, 119 (18%) were receiving MMT. The authors undertook a descriptive study of all 119 prisoners on MMT on that date, from the electronic medical records.1 The main characteristics are summarised below.
- Mean age was 33 years (range 21 to 58 years).
- 78% were classified as either medium or full security risk.
- Mean sentence length was four years (range 1 month to 15 years); 2% were on remand; 44% were serving a sentence of one month to two years; and 34% were serving a sentence of three to six years.
- Mean methadone dose was 55mg (range 4 mg to 180 mg), and 62% were on 60mg or less.
- 7% were HIV positive, and 7/8 of those who were HIV positive were on antiretroviral therapy.
- 38% were hepatitis C positive, and none were on hepatitis C treatment at the time of the study.
- 1% were hepatitis B positive; 7% were recorded as having a hepatitis B vaccination.
- 2% were being treated for active tuberculosis.
- 50% were prescribed other psychotropic medication – 24% anti-depressants, 18% anti-psychotics, 7% hypnotics, and 1% mood stabiliser.
- 16% were attending addiction counselling services.
The profile of the prisoners on MMT in Wheatfield – their drug use prevalence, demographic data, sentencing details, medical and psychiatric history – was similar to the profile of prisoners who participated in other studies on this topic.
Given that 18% of the population of Wheatfield prison were on MMT the day of the study, the authors concluded that MMT is now a significant medical undertaking in the IPS. They highlighted several issues in the management of MMT in Irish prisons:
- Viral screening: there were gaps in documentation of prisoner status with regard to HIV (33%), hepatitis C (29%), and hepatitis B (73%). Using only information on documented hepatitis C status, the authors found that 54% (45/84) of prisoners on MMT were hepatitis C positive. They highlighted the need for improved viral screening for this high-risk group.
- Methadone dosages: the authors explained the wide range in methadone dosages as being probably due to an older population, on extended sentences, who had stabilised their opiate use, often through an agreed gradually reduced methadone regime. The highest dosages were explained by well recognised pharmacokinetic interactions with TB medication, which necessitated higher dosages.
- Extended aftercare: the authors recommended extended aftercare for prisoners who voluntarily worked to reduce their methadone dosage in order reduce the risk of overdose. They highlighted the need for
- Take-home naloxone: The authors highlighted the need take-home naloxone for prisoners when released, to reduce the risk of fatal overdose and also to fast-track prisoners back into MMT where necessary.
1 Galander T, Rosalim J, Betts-Symonds G and Scully M (2014) A survey of patients on methadone programmes in Wheatfield Prison, Dublin, Ireland. Heroin Addiction and Related Clinical Problems 16(2): 17–22. http://www.drugsandalcohol.ie/23736/
