Background and methods

Pharmacotherapy is essential for the delivery of an equivalent standard of care in prison. However, prescribing can be challenging due to the complex health needs of prisoners and the risk of misuse of prescription drugs. Misuse, or non-medical use of prescription drugs, refers to the intentional repurposing of prescribed drugs outside of their intended indication. The drugs identified with the greatest potential for misuse are prescription opioids, benzodiazepines, Z-drugs, and gabapentinoids.1-3 Although there is widespread concern regarding the misuse of prescription drugs in prisons, few studies have examined prescribing trends of prescription drugs with potential for misuse in prison.

A 2023 study4 assessed prescribing trends in Irish prisons for drugs with potential for misuse over the period 2012–2020 and determined whether trends varied by gender and history of opioid use disorder (OUD). In this research, published in the journal BMC Psychiatry, prescribing rates per 1,000 prison population were calculated using electronic prescribing records from the Irish Prison Service, covering all prisons in the Republic of Ireland. Negative binomial (presented as adjusted rate ratios (ARRs) per year and 95% confidence intervals (Cls)) and joinpoint regressions were used to estimate time trends adjusting for gender and for gender-specific analyses of prescribing trends over time by history of OUD. The main findings from this study are discussed below.

Results

Between 2012 and 2020, a total of 10,371 individuals were prescribed opioid agonist treatment, opioids, benzodiazepines, Z-drugs or gabapentinoids. History of OUD was higher in women, with a median rate of 597 per 1,000 female prisoners, compared with 161 per 1,000 male prisoners. Women were also significantly more likely to have been prescribed benzodiazepines, Z-drugs, and gabapentinoids relative to men. Adjusting for gender, prescribing time trends showed that prescribing rates decreased over time for prescription opioids (ARR=0.82; 95% CI: 0.80–0.85), benzodiazepines (ARR=0.99; 95% CI: 0.98–0.999), and Z-drugs (ARR=0.90; 95% CI: 0.88–0.92), but increased for gabapentinoids (ARR=1.07; 95% CI: 1.05–1.08). Gender-specific analyses found that men with OUD, relative to men without, were more likely to be prescribed benzodiazepines (ARR=1.49; 95% CI: 1.41–1.58), Z-drugs (ARR=10.09; 95% CI: 9.0–11.31), and gabapentinoids (ARR=2.81; 95% CI: 2.66–2.97). For women, history of OUD was associated with reduced gabapentinoid prescribing (ARR=0.33; 95% CI: 0.28–0.39).

Conclusions

The authors noted that while the observed reductions in prescription opioid, benzodiazepine, and Z-drug prescribing over the period is consistent with guidance for safe prescribing in prisons, the increase in gabapentinoid (primarily pregabalin) prescribing and the high level of prescribing to women is concerning. They suggest that targeted interventions may be needed to address prescribing in women and men with a history of OUD.

1    Cremers S and Wright DFB (2021) Nonmedical use of prescription drugs. Br J Clin Pharmacol, 87(4): 1635–1636.

2    Wood DM and Dargan PI (2021) Regional, national and international datasets: how they improve our understanding of the acute harms associated with prescription medicine misuse. Br J Clin Pharmacol, 87(4): 1654–1659.

3    Marsden J, White M, Annand F, et al. (2019) Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England. Lancet Psychiatry, 6(11): 935–950.

4    Durand L, Keenan E, O’Reilly D, Bennett K, O’Hara A and Cousins G (2023) Prescription drugs with potential for misuse in Irish prisons: analysis of national prison prescribing trends, by gender and history of opioid use disorder, 2012 to 2020. BMC Psychiatry, 23: 725. Available from: https://www.drugsandalcohol.ie/39710/