Smoke Free Prisons: What Does A Post-Implementation Smoking Cessation Service Look Like?

Background

All prisons in England and Wales are commissioned to provide stop smoking services in partnerships with relevant health providers.

Nearly 2 years have passed since many (closed) prisons in England and Wales transitioned to becoming smoke free. In January 2019, the MOJ published the Smoke Free Policy Framework in addition to the NHS England Minimum Service Offer that was already in place.

With this in mind, what makes for an effective smoking cessation service?

Post Implemention Prisons

Access to Nicotine Replacement Therapy (NRT), with patches and lozenges being the most often provided, are all too often prone to being abused or misused. Both patches and lozenges are being traded as a form of currency, whereas the boiling and smoking of patches in not an uncommon practice. In the Post Implementation Smoke Free prison estate, those who are serving their sentences have made their choices to vape or use e-cigarettes or not smoke at all.

The challenges lie for those prisoners who arrive on remand, who are smokers. Being a new reception on remand and with some much going on in their lives, e.g pending court case, trying to maintain external relationships, or perhaps some financial worries etc. smoking (to a smoker) would be a reassuring coping mechanism for so many. Being a new reception in prison would most certainly not be the time/place to decree “I’m going to give up smoking!”

Smoking cessation becomes more a matter of something best described as a “Nicotine Maintenance Programme” for those on remand or perhaps serving very short sentences. That is until at least they are released when they can then return to tobacco smoking or vaping, if they so wish.

As prisons are now fully smoke-free, and at the post implementation stage, there will continue to be a need for ongoing stop smoking support and relapse prevention. This is at a very different level to pre-implementation.

A harm reduction option will be more suitable than a programme of cessation for patients transferring into smoke-free accommodation, who intend to return to smoking on transfer or release. All prisoners who are on sentences of less than 8 weeks should initially be offered a harm reduction intervention, to help them manage their addiction whilst in prison.

Those prisoners in a reception or local prison should be offered harm reduction interventions as a first line treatment, with full cessation being offered at the point of sentence or on transfer to another prison, whether that is to another place of detention, or to the community.

Points to consider when delivering an effective service:

  • Smokers identified as vulnerable and at risk of self-harm or suicide due to smoke free policy will have safer custody processes applied to support them whilst in custody.
  • Smokers must be seen by a stop smoking adviser within 48 hours of arrival into custody. Prisoners will be referred to a smoking cessation programme if they wish to participate.
  • Providing a prison regime that encourages and supports abstinence from smoking.
  • Provision of a range of stop smoking support, including harm minimisation approaches, to assist prisoners to abstain from smoking.
  • Developing strategies to address continued smoking seeking behaviour including misuse of Nicotine Replacement Products.
  • Recent popularity of electronic cigarettes (e-cigarettes) and more so vapes, has demonstrated that many smokers are interested in using these as less harmful sources of nicotine.

This level of ongoing need will also be dependent on prisoner movement and turnover within the establishment, whether prisoners are received from smoking or smokefree establishments and consideration should be given to what is required in a reception prison with comparatively high turnover as compared to a training prison with a more stable population.

Conclusion

All this condenses down to 3 simple actions to take when delivering an effective smoking cessation service:

  • For all new reception prisoners, provide access to e-cigarettes or vapes as part of first night reception packs.
  • For all new reception prisoners who are sentenced to more than 8 weeks, see within 48hrs and offer smoking cessation services to all those who’ve not opted to use e-cigarettes or vapes.
  • For all new reception prisoners who are on remand of sentenced to less than 8 weeks, promote harm reduction options.

References/Links:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/773041/smoke-free-policy-framework.pdf

https://www.england.nhs.uk/publication/minimum-offer-for-stop-smoking-services-and-support-in-custody/

Photo by Dev Asangbam at Unsplash

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