A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants

2019 ◽  
Vol 16 (1) ◽  
pp. 67-77
Author(s):  
Anju Soni ◽  
Pamela Walters
Keyword(s):  
Free Text ◽  
Snomed Ct ◽  
Content Type ◽  
Case File ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Case Files ◽  
Forensic Psychiatric ◽  
Male Prisoners ◽  
Practical Implications

Purpose Electronic medical case files of male prisoners in a category B prison in London were studied to establish a prevalence during an eight-month period of the use of and the reasons for prescribing gabapentinoids in prison and also to establish prescribing standards in prison and compliance with these. In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants, particularly tricyclic antidepressants such as amitriptyline, was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. The paper aims to discuss these issues. Design/methodology/approach A retrospective, SystmOne case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1,500 prisoners; Average turnover of prisoners up to 6,000 per year), to establish practice standards related to the prescription of Gabapentinoids in the prison and determine compliance with these. Findings In total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. In 51 cases (47 per cent) gabapentinoids were prescribed with an opioid substitute. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners. Practical implications The initiation of gabapentinoids in prison should be avoided. For prisoners who are also receiving opioid substitutes or are abusing opiates, it may be unsafe to continue on gabapentinoids. Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well. Social implications Risk of dependance on gabapentinoids including risk of mortality when taken with opioids and opioid substitutes. Originality/value This is an original study conducted at a category B prison in London.

scholarly journals A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S291-S292
Author(s):  
Anju Soni ◽  
Pamela Walters
Keyword(s):  
Free Text ◽  
Snomed Ct ◽  
Case File ◽  
Controlled Drugs ◽  
Increased Risk ◽  
Case Files ◽  
Potential Risks ◽  
Forensic Psychiatric ◽  
The Uk ◽  
Male Prisoners

AimsElectronic medical case files of male prisoners in a category B prison in London was studied to establish a prevalence during an 8-month period of the use of and the reasons for prescribing gabapentinoids in prison.In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination.MethodA retrospective, SystmOne electronic case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1500 prisoners; Average turnover of prisoners up to 6000 per year), including to establish practice standards related to the prescription of Gabapentinoids in the prison and determine the compliance with these.ResultIn total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. Half of the cases were co-prescribed gabapentinoids with an opioid substitute and 17% with antidepressants. Only in 22% of the cases there was documentation of discussion with the prisoner about the potential risks of co-prescribing with these medications. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.ConclusionFor those prescribed gabapentinoids in prison, the indications for such use especially if off label should be reviewed and their use minimised where relevant.The initiation of gabapentinoids in prison should be avoided.For patients who are also receiving antidepressants and opioid substitutes or are abusing opiates, consideration should be given as to whether it is safe to continue on gabapentinoids, given the risks of misuse and death.Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.From 1 April 2019, gabapentinoids have been classed as Class C controlled drugs in the UK.

Property investment: gearing and the equity rate of return

2019 ◽  
Vol 37 (3) ◽  
pp. 323-328 ◽  
Author(s):  
Nick French
Keyword(s):  
Design Methodology ◽  
Investment Project ◽  
Equity Returns ◽  
Rate Of Return ◽  
Content Type ◽  
Bank Rate ◽  
Increased Risk ◽  
Practical Implications ◽  
Different Levels

Purpose The purpose of this paper is to comment upon the relatively straightforward but often misunderstood role of gearing (or leverage) on the potential equity return of a property investment. Design/methodology/approach This education briefing is an explanation of the upside and downside risk of borrowing (at different levels) to successful investment. Findings The use of gearing can greatly enhance equity returns but at an increased risk. Practical implications The process of borrowing at a bank rate below the return rate on an investment project can increase the equity return of the project as long as all incomes and discount rate remain at appropriate levels. Originality/value This is a review of existing models.

Desistance from absconding: “You’ve got to have hope”

2020 ◽  
Vol 22 (4) ◽  
pp. 223-234
Author(s):  
Aliye Emirali ◽  
Rachel O'Rourke ◽  
Caroline Friendship
Keyword(s):  
Design Methodology ◽  
Sense Of Self ◽  
Future Research ◽  
Content Type ◽  
Factors Associated ◽  
Practical Support ◽  
Increased Risk ◽  
New Perspective ◽  
Stage 1 ◽  
Practical Implications

Purpose This paper explores absconding from a new perspective. Literature has tended to focus on the risk factors linked with absconding. This paper aims to consider desistance factors for absconding for prisoners at higher risk of absconding in open prisons. Design/methodology/approach Stage 1 used logistic regression to identify factors associated with increased risk of absconding. Stage 2 identified new receptions with increased risk and used thematic analysis to analyse interviews with prisoners that did not abscond after three months. Findings Stage 1 found that the total number of previous offences predicted absconding. Stage 2 found three themes linked to desistance in absconding: “support”, “ownership” and “sense of self”. Practical implications This study highlights the importance of ensuring prisoners in open prisons are offered the appropriate emotional and practical support. It also identifies the importance of hope amongst prisoners in open conditions. Future research should further explore this idea in more depth. Originality/value Previous literature has looked at absconding from a risk factor perspective. This research identifies the desistance factors associated with absconding for individuals who have been identified as high risk of absconding. Improvements in factors associated with desistance from absconding may support a reduction in absconding from open prisons.

Staff support procedures in a low-secure forensic service

2018 ◽  
Vol 20 (3) ◽  
pp. 191-201
Author(s):  
Sarah Cooper ◽  
Andy Colin Inett
Keyword(s):  
Service Evaluation ◽  
Structured Interviews ◽  
Staff Support ◽  
Missed Opportunities ◽  
Content Type ◽  
Increased Risk ◽  
Forensic Service ◽  
Inpatient Settings ◽  
The Uk ◽  
Practical Implications

PurposeStaff working in forensic inpatient settings are at increased risk of harm perpetrated by patients. Support offered in response to such incidents can have a significant impact on how staff recover. The purpose of this paper is to explore how staff support procedures implemented in one low-secure forensic service impacted on staff recovery.Design/methodology/approachIn total, 11 members of staff who had direct patient contact volunteered from an opportunity sample. Semi-structured interviews were conducted with each participant, asking about experiences of abuse at work and subsequent staff support procedures. Interviews were analysed using thematic analysis.FindingsFour overarching themes were identified; experiences of harm, supported recovery, missed opportunities and therapeutic relationships. This led to a better understanding of how staff coped with incidents of abuse at work and how support procedures impacted on their recovery.Research limitations/implicationsThe service evaluation was limited by transferability of the findings. The process of sampling may have meant there were biases in those who volunteered to take part. Further projects such as this are required to develop the themes identified.Practical implicationsFindings led to the development of a new integrated model of staff support.Originality/valueThis was one of the first studies in the UK to formally evaluate a staff support procedure in forensic low-secure services and include experiences of both clinical and non-clinical staff who are regularly exposed to potentially harmful events.

Improving police risk assessment and management of family violence through a collaboration between law enforcement, forensic mental health and academia

2017 ◽  
Vol 3 (2) ◽  
pp. 119-131 ◽  
Author(s):  
Troy E. McEwan ◽  
Stuart Bateson ◽  
Susanne Strand
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Law Enforcement ◽  
Family Violence ◽  
Assessment Instrument ◽  
Content Type ◽  
Risk Assessment Instrument ◽  
Increased Risk ◽  
Risk Assessment And Management ◽  
Practical Implications

Purpose Police play an essential role in reducing harms associated with family violence by identifying people at increased risk of physical or mental health-related harm and linking them with support services. Yet police are often poorly trained and resourced to conduct the kind of assessments necessary to identify family violence cases presenting with increased risk. The paper aims to discuss this issue. Design/methodology/approach This paper describes a multi-project collaboration between law enforcement, forensic mental health, and academia that has over three years worked to improve risk assessment and management of family violence by police in Victoria, Australia. Findings Evaluation of existing risk assessment instruments used by the state-wide police force showed they were ineffective in predicting future police reports of family violence (AUC=0.54-0.56). However, the addition of forensic psychology expertise to specialist family violence teams increased the number of risk management strategies implemented by police, and suggested that the Brief Spousal Assault Form for the Evaluation of Risk assessment instrument may be appropriate for use by Australian police (AUC=0.63). Practical implications The practical implications of this study are as follows: police risk assessment procedures should be subject to independent evaluation to determine whether they are performing as intended; multidisciplinary collaboration within police units can improve police practice; drawing on expertise from agencies external to police offers a way to improve evidence-based policing, and structured professional judgement risk assessment can be used in policing contexts with appropriate training and support. Originality/value The paper describes an innovative collaboration between police, mental health, and academia that is leading to improved police practices in responding to family violence. It includes data from the first evaluation of an Australian risk assessment instrument for family violence, and describes methods of improving police systems for responding to family violence.

Injecting drug use in prison: prevalence and implications for needle exchange policy

2015 ◽  
Vol 11 (1) ◽  
pp. 17-29 ◽  
Author(s):  
Nat M.J. Wright ◽  
Charlotte N. E. Tompkins ◽  
Tracey M. Farragher
Keyword(s):  
Needle Exchange ◽  
Large Male ◽  
Content Type ◽  
Prison Setting ◽  
Drug Injecting ◽  
Exchange Policy ◽  
The Uk ◽  
Male Prisoners ◽  
Practical Implications ◽  
Exchange Programmes

Purpose – The purpose of this paper is to explore prison drug injecting prevalence, identify any changes in injecting prevalence and practice during imprisonment and explore views on prison needle exchange. Design/methodology/approach – An empirical prospective cohort survey conducted between 2006 and 2008. The study involved a random sample of 267 remand and sentenced prisoners from a large male category B prison in England where no prison needle exchange operates. Questionnaires were administered with prisoners on reception and, where possible, at one, three and six months during their sentence. Findings – In total, 64 per cent were injecting until admission into prison. The majority intended to stop injecting in prison (93 per cent), almost a quarter due to the lack of needle exchange (23 per cent). Yet when hypothetically asked if they would continue injecting in prison if needle exchange was freely available, a third of participants (33 per cent) believed that they would. Injecting cessation happened on prison entry and appeared to be maintained during the sentence. Research limitations/implications – Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of needle exchange programmes (NEPs) not being provided in the UK prison setting. Practical implications – Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of NEPs not being provided in the UK prison setting. Originality/value – This survey is the first to question specifically regarding the timing of injecting cessation amongst male prisoners and explore alongside intention to inject should needle exchange facilities be provided in prison.

scholarly journals Evaluation of a cognitive skills programme for male prisoners – exploring treatment effectiveness

2016 ◽  
Vol 2 (4) ◽  
pp. 244-249 ◽  
Author(s):  
Jane L. Ireland ◽  
Jackie Bates-Gaston ◽  
Kevin Markey ◽  
Leah Greenwood ◽  
Carol A. Ireland
Keyword(s):  
Treatment Outcome ◽  
Cognitive Skills ◽  
Treatment Effectiveness ◽  
Thinking Skills ◽  
Self Report ◽  
Content Type ◽  
Psychometric Measures ◽  
Male Prisoners ◽  
Practical Implications ◽  
Treatment Design

Purpose The purpose of this paper is to provide an evaluation of a cognitive skills programme (Enhanced Thinking Skills) with adult prisoners. Design/methodology/approach A pre- and post-treatment design with 171 male prisoners, using self-report psychometric measures. Findings Significant differences were found in the direction expected. Clinical recovery using stringent methods was not indicated, although improvement/partial response was across a number of domains. Practical implications Expectations for treatment outcome for short-term interventions should be more realistic; cognitive skills programmes may be best considered as precursors to longer term therapies; treatment outcome should focus on improvement and not recovery. Originality/value This study represents the first prison study to distinguish between levels of positive change. It questions previous interpretations of treatment outcome.

Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery

2001 ◽  
Vol 94 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Simone Wagner ◽  
Holger Schnippering ◽  
Alfred Aschoff ◽  
James A. Koziol ◽  
Stefan Schwab ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Maximum Diameter ◽  
Cerebral Lesions ◽  
Content Type ◽  
Associated Lesions ◽  
Risk Of Mortality ◽  
Malignant Infarction ◽  
Increased Risk ◽  
Fine Print

Object. The goal of this study was to determine the frequency of hemicraniectomy-associated lesions and their potential effect on the risk of mortality in patients suffering from malignant infarction of the middle cerebral artery (MCA). Methods. The authors evaluated serial computerized tomography scans obtained in 60 patients with complete infarction of the right MCA who were treated using hemicraniectomy. The maximum diameter of the hemicraniectomy was determined and the hemicraniectomy-associated lesions were classified as ischemic lesions or hemorrhages. The category of hemorrhages was composed of parenchymal, subdural, or epidural/subgaleal hematomas. Parenchymal hemorrhages and infarcts associated with hemicraniectomy occurred with frequency rates of 41.6% and 28.4%, respectively. The occurrence of hemicraniectomy-associated bleeding was related to the size of the hemicraniectomy performed; that is, the smaller the hemicraniectomy, the more often lesions occurred (p < 0.05). Hemicraniectomy-associated bleeding was also related to an increased risk of mortality. Conclusions. Hemicraniectomy is an effective therapy in patients with malignant infarction of the MCA. However, a hemicraniectomy that is too small in diameter may cause the formation of additional lesions and adversely affect the risk of mortality and the quality of survival. In addition, the size and shape of the edges of the bone defect are important factors relating to its efficacy.

Smoking cessation in male prisoners: a literature review

2015 ◽  
Vol 11 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Ashleigh Djachenko ◽  
Winsome St John ◽  
Creina Mitchell
Keyword(s):  
Smoking Cessation ◽  
Literature Review ◽  
English Language ◽  
Smoking Behaviour ◽  
Smoking Ban ◽  
Police Custody ◽  
Content Type ◽  
Language Studies ◽  
Male Prisoners ◽  
Practical Implications

Purpose – The purpose of this paper is to review the available literature relating to smoking cessation (SC) for the male prisoner population. Design/methodology/approach – Databases PubMed, CINAHL and MEDLINE were searched for English language studies from 1990 to 2012. The authors identified 12 papers examining SC in male prisoners. Full-text articles were analysed for inclusion. Findings – A total of 12 studies were identified for inclusion. Four studies focused on forced abstinence (a smoking ban) while the remainder looked at various combinations of nicotine replacement, pharmacology and behavioural techniques. No robust studies were found that examined nursing approaches to SC for the prisoner population. The evidence shows a strong “pro-smoking” culture in prison and that many prisoners continue to smoke irrespective of an enforced ban. However, SC strategies can be successful if implemented systematically and supported by consistent policies. Research limitations/implications – Female-only prisoner studies were excluded as females comprise just 7 per cent of the Australian prisoner population. The analysis does not differentiate between maximum- or minimum-security prisons, or length of prison sentence. Results cannot be generalised to other forms of detention such as police custody or immigration detention centres. Studies were not appraised for quality, as exclusion on that basis would render further exploration untenable. The analysis was presented in a narrative rather than meta-analytical format and may be subject to interpretation. Practical implications – This paper provides a foundation on which to build further research evidence into the smoking behaviour of prisoners. This information can be used to advocate for healthier public policy for a vulnerable and marginalised population. Originality/value – To the authors’ knowledge, this is the first literature review into SC interventions in prisons. The authors apply the findings of this literature review to the five strategies for health promotion to propose a population approach to smoking cessation in male prisoners. Recommendations specific to the correctional environment are outlined for consideration by correctional health professionals.

scholarly journals Reward and threat in the adolescent brain: implications for leadership development

2017 ◽  
Vol 38 (4) ◽  
pp. 530-548 ◽  
Author(s):  
Patricia M. Riddell
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Risk Taking ◽  
Generational Differences ◽  
Content Type ◽  
Recent Advances ◽  
Increased Risk ◽  
Leadership Experiences ◽  
The Brain ◽  
Practical Implications

Purpose In the last 10 to 15 years, research studies have focused on the effects of differences across generations that result in differences in cultural expectations within the workplace (e.g. Arsenault, 2004). Different generations create shared attitudes to work and preferences for types of work which result in differences in their perception of, for instance, what makes a good leader or even the value of leadership within an organisation. While these generational differences are real, these analyses do not take into account differences that might result from the age, and therefore developmental stage, of the populations being assessed. The neuroscience literature clearly shows that there are maturational differences in the brain which are not complete until late teens to early 20s. It is therefore possible that some of the generational differences result from differences in processing ability resulting from structural immaturities in the brain. In particular, there are differences in the rate of maturation of areas of the brain related to reward sensitivity, threat sensitivity and regulation of behaviour which result in substantial differences in behaviour from adolescence through into adulthood. The purpose of this paper is to consider the effect of maturational changes in the brain on behaviours related to leadership and to outline ways in which these changes can be addressed in order to encourage young people to develop as leaders. This will include providing suitable experiences of leadership to encourage the faster development of the neural structures which underlie these capabilities. Design/methodology/approach Recent advances in neural imaging have resulted in a substantial increase in research investigating the development of the brain during adolescence. A literature review was conducted to find adolescent research that investigated decision making and risk taking. The data obtained were integrated and implications for leadership were drawn from an analysis of the resulting theoretical framework. Findings The research into decision-making processes in adolescents and younger adults points to a number of ways in which these differ from mature decision making. Younger people: (find it harder to inhibit behaviours) are more responsive to immediate reward; are more optimistic about the outcome of risky decisions; and are more responsive to social rewards (Jones et al., 2014). They also lack the experiences that adults use to distil the gist of a situation and therefore are more dependent on conscious, cost-benefit analysis of the outcome of decisions. Practical implications An understanding of the differences between adult and adolescent decision making points to the role of experience as a key factor in mature decision making. If adolescents are to make mature decisions, they have to be offered suitable challenges in safe environments from which they can gain expertise in leadership decision making. These can be designed to account for differences in sensitivity to reward and punishment in this group. In addition, young adults would benefit from learning the gist interpretations that have been extracted from situations by experienced leaders. This suggests that adolescents and adults would benefit from simulated leadership experiences and leadership mentoring. Social implications The Baby Boomer generation who currently hold many of the leadership positions in organisations are coming close to requirement. They will have to be replaced by members of Generation X and the Millennial Generation resulting in potentially younger leaders. In addition, flatter organisational structures that are currently being implemented in many organisations will require leadership at many more levels. Thus, we need to be able to develop leadership skills in a more diverse and younger section of society. Understanding how the brain develops can help us to design appropriate leadership experiences and training for this upcoming generation of young leaders. Originality/value Recent advances in neuroscience of adolescence provide a unique opportunity to bring new evidence to bear on our understanding of decision making in young adults. This provides practical implications for how to develop leadership within this group and to support them as they gain experience in this domain. The evidence also points to a benefit for the increased risk taking seen in adolescence since this leads to greater motivation to try new, and potentially risky, ventures. Through a better understanding of the differences in decision making, we can both help adolescents to develop more mature decision making faster while benefitting from the optimism of youth.

Sign in / Sign up

Export Citation Format

Share Document