‘Keeping a lid on it’: exploring ‘problematisations’ of prescribed medication in prisons in the UK

Background: The non-medical use of prescription medication and risk of diversion have become policy and practice concerns within prison settings in the UK. These issues have been highlighted by the Advisory Council on the Misuse of Drugs, Her Majesty’s Inspectorate of Prisons and Her Majesty’s Prison and Probation Service (2019) prison drugs strategy. In 2019, new prescribing guidance was issued by the Royal College of General Practitioners for clinicians working within prison settings. Methods: Informed by Bacchi's (2009) What's the problem represented to be? framework, the ways in which the ‘problem’ of prescribed medication in prisons have been represented is interrogated through an analysis of the prescribing guidance framework for clinicians working in prisons. Results: Restrictive prescribing practices are recommended as a solution to the ‘problem’ of diversion and misuse of prescribed medication. Prescribers are advised to consider de-prescribing, non-pharmacological treatments and alternative prescriptions with less diversionary potential. They are represented as responsible for the ‘problems’ that prescribed medication bring to prisons. The guidance is underpinned by the assumption that prescribers lack experience, knowledge and skills in prison settings. People serving prison sentences are assumed to be ‘untrustworthy’ and their symptoms treated with suspicion. This representation of the ‘problem’ has a number of effects including the possibility of increasing drug-related harm, damaging the patient-doctor relationship and disengagement from healthcare services. Conclusion: The representation of prescribed medication as problems of diversion and prescribing practices inhibits alternative representations of the problem which would inform different policy directions including improvements to regime and healthcare provision and would include a range of practitioners in prison settings to address the ‘problem’ more holistically