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The prison is trying to crack down on prescription drug pregabalin, as inmates either remain addicted or use it as currency.

Illustration: Joe Watson-Price

A large number of inmates at HMP Bristol are addicted to prescription drug pregabalin, despite a “crackdown” on prescriptions at the prison, the Cable can reveal.

An employee at HMP Bristol told the Cable that pregabalin was “highly addictive” and the “most tradable” prescription drug at the men’s prison in Horfield.

Pregabalin is prescribed for anxiety, nerve pain and epilepsy, but its addictive potential as well as a growing black market have prompted the government to propose reclassifying it as a class C drug.

“I couldn’t say how many people are on them but it’s a lot – too many people are getting addicted”

The drug is increasingly being taken recreationally alongside other substances, and there has been a sharp rise in overdose deaths where pregabalin has been taken – 111 deaths in 2016, compared with four in 2011.

“I couldn’t say how many people are on them but it’s a lot – too many people are getting addicted,” the employee told the Cable.

“It’s a currency and it’s being abused. It’s highly addictive and probably not that effective either for anxiety in the long term.”

These misuse problems come despite an attempted crackdown on prescriptions by GPs within the prison, as they battle with inmates to get them off the drug.

Illustration: Joe Watson-Price

Another prison worker claimed there was a “massive black market” where inmates “get it prescribed when they don’t need it by blagging GPs”. They also claimed that inmates on a high dose were routinely assaulted until they gave it away.

Pregabalin is at its most dangerous when taken with other substances, especially heroin or other opioids, because it has a similar depressive effect on someone’s breathing. This is particularly problematic for the considerable number of inmates on methadone, a heroin substitute.

Opioid users have reported that pregabalin reinforces the effects of opioids and reduces the undesirable effects of withdrawal symptoms, making it widely sought after for misuse.

The drug causes drowsiness and dizziness, and those who come off it can experience chronic withdrawal symptoms. While there is little research into the long-term harms of the drug, it is certainly a safer option compared to Spice, which the Cable revealed as the most problematic drug at HMP Bristol.

“Prisoners like pregabalin because it’s legitimised substance misuse, they get a prescription for it and then they have a currency- something you can trade in the prison environment”

This is part of the appeal of the drug, according to Dr Tim Williams, clinical director for drug and alcohol services at Avon and Wiltshire Mental Health Partnership, who oversees healthcare at the prison.

“Pregabalin misuse is a problem in the prison estate,” he told the Cable. “The number one reason why prisoners take drugs is boredom, and with pregabalin your ills will be smoothed away but you won’t have the levels of intoxication of Spice.”

However, some inmates are so dependant on the drug that they have been known to avoid GP appointments in order to stay on it, according to the prison workers.

“They are very resistant. When the conversation comes up about getting them off it or switching to an alternative, people are incredibly resistant to it and will dig their heels in,” the prison employee said.

A tool, a currency

Although some inmates are taking or are even addicted to the pregabalin they are being prescribed, others sell it on because it has become a commodity.

Williams said: “Prisoners like pregabalin because it’s legitimised substance misuse, they get a prescription for it and then they have a tool, a currency. If you’re on a script, you have something you can trade in the prison environment.”

“It’s extremely tradable, so you get some people who are on it who probably never take it. It’s currency that people sell on,” said the HMP Bristol employee.

A report by HM Prison Inspectorate on the national picture in 2017 found that “poor management of the prescribing of tradeable medication and poor officer supervision of medication administration queues in a significant minority of prisons continued to give too many opportunities for bullying and the diversion of medication.”

“They are trying to crack down on that so you have to show the nurses before and after taking it, but people hide it in the roof of their mouth and spit it out once the nurse is gone so they can sell it on,” the prison worker added.

A crackdown on prescriptions

As with community GPs, there has been an attempt to restrict the prescribing of pregabalin in recent months in order to reduce misuse.

“The prison environment itself is set up to push people towards substance using, so we have to recognise that,” said Williams.

“The prison population are vulnerable to substance dependence in the first place, so we have always tried to support primary care practitioners in prisons across the south west to try to restrict prescriptions of pregabalin and gabapentin,” he said.

“Even though they want to get people off pregabalin, they have to be a bit careful with stopping people’s medication straight away because you could have withdrawal from it”

However, the power of prison GPs appears to be limited. “The secret is to get prescribed it before you come, because it’s almost impossible to get prescribed it in prison,” according to the prison employee.

Inmates who are prescribed it in the community and go into prisons can get it automatically prescribed once confirmation comes in from their community GP.

“Even though they want to get people off pregabalin, they have to be a bit careful with stopping people’s medication straight away because you could have withdrawal from it,” he said.

“What they’re trying to do now is to be a lot hotter about getting people off it, but some inmates put a good case across. People say ‘It’s changed my life and it’s brilliant so if I come off it I’m definitely going to kill myself’, so GPs are put in a difficult position.”

A spokesperson for InspireBetterHealth partnership, which provides healthcare at HMP Bristol, and Bristol’s other prisons, Eastwood Park, Ashield, Leyhill and Erlestoke, said: “GPs prescribe drugs in accordance with their clinical judgement of patient need. Clinicians are all aware that some drugs can be misused: staff are always vigilant regarding potential drug misuse and act appropriately if they become aware of it.

“Staff receive training on this issue and drugs which have the potential for misuse are not held in possession by prisoners, but dispensed at a daily medication round which clinicians manage,” they added.

“We also constantly review the need to use certain medications within the prisons, including the use of pregabalin and gabapentin.“

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