Multidisciplinary Chronic Pain Medicines Management in the Secure Environment (2022)

Kent Community Health NHS Trust

Project Summary

Many patients admitted to prison are taking a complex mix of medications for the management of chronic pain. These frequently include a high-risk combination of Gabapentinoids and opioids together with other classes of medications. They frequently have a complex history of past trauma and abuse and there is a very high proportion of substance misuse. The widespread availability of non-prescribed or illicit substances increases the risk to individual patients, in addition to issues of bullying for tradeable medications.

Chronic pain is complex and hard to assess objectively. The Community Chronic Pain Service have been delivering pain clinics in local prisons for a number of years. It became apparent that a high proportion of patients seen were either in receipt of high-risk medications or actively seeking the prescription of such from multiple clinicians. When working alone GP's can feel threatened or intimidated into increasing or prescribing according to demand and therefore a Multidisciplinary Clinic (MDT) consisting of GP, Pain Specialist and Pharmacist was created.

The MDT approach enabled all practitioners working in the prison to inform patients that the only route to obtain high risk medications was through the MDT. A pilot MDT was successfully run in the local Cat B clinic with successful outcomes in terms of deprescribing high risk medications where not clinically indicated. This clinic continues to run, and prescribing rates for Pregabalin/Gabapentin are approximately 2% of the entire population.

In 2019 the MDT was commissioned for the neighbouring Cat B/C remand prison using the same format. The population of this prison includes many patients on remand and as such it is a more mobile, changing population. Nevertheless, significant deprescribing has taken place. The MDT format also serves as a 'one stop shop' where many other health needs can be identified and addressed. This approach has served to reduce the pressure on the GPs and other clinicians as they can clearly state to their patients they are prevented from initiating any prescriptions without MDT approval.

The service has now been commissioned in additional secure environments in the local area. It was referred to as a 'notable practice point' in the recent CQC inspection of the Cat B/C prison.