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Background
"Our aim is to provide offenders with access to the same quality and range of healthcare services as the general public receives from the NHS". ( http://www.dh.gov.uk/en/Healthcare/Offenderhealth/index.htm ). This is not mere aspirational rhetoric but a realistic aim set by the UK Department of Health. The offenders referred to above include the approximately 80,000 inmates in the 139 prisons across England and Wales, and the healthcare services referred to above encompass care of those prison inmates who misuse or are dependent on psychoactive drugs. Drug misuse is common in prisons in the UK, as has been shown in numerous research studies, 1 - 3 parliamentary debate ( http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080311/debtext/80311-0002.htm ) and media reports despite considerable improvement in the state of affairs over the past decade or so. It is clear that "many prisoners are still not getting the help they need". 4
As a community-based treatment provider for patients who are heroin dependant, around a third of our patients have served a prison sentence at some point and a significant proportion of our patients are regularly in and out of prison. Hence our interest in the treatment they receive in prisons, and also to ensure continuity of good quality care. It was during the assessment of one such patient who is regularly "in and out of prison" that this story came to light and it is in that context this case description should be interpreted. Our rationale for sharing this story with the addiction community and policymakers is not primarily to criticise the prison service, but instead to open up for debate the issue of drug misuse in prison which, despite some progress and well intentioned regulatory measures, continues to be far from ideal or even acceptable.
Here we narrate how a patient who is heroin dependant, who is attending our community drug and alcohol team for methadone maintenance treatment, smuggled methadone and heroin into prison (which was not picked up during the search and which he only disclosed during assessment), his reasons for doing that, his personal description of the extent of drug use in prisons and finally what can be done to stop it from treatment and policy perspectives.
Case presentation
The patient lives with his partner and their 6-year-old son in a...