Exploring medication safety in prisons: a scoping review

Drug-related problems (DRPs), which encompass medication errors (MEs), adverse drug reactions and adverse drug events (ADEs), represent significant challenges in healthcare settings. While medication safety has been extensively studied in hospitals and primary care settings leading to development of improvement strategies, there is limited understanding of these issues within prison healthcare environments. This knowledge gap is concerning given that prisoners often have complex medication needs due to higher rates of chronic physical and mental ill health and substance use disorders compared with the general population. Time in prison presents an opportunity to provide treatment for this socially disadvantaged group, making it an important setting to optimise medication management. This scoping review aimed to understand the nature and frequency of medication safety incidents, their contributory factors and evaluate strategies for enhancing medication safety within prison healthcare environments, where unique institutional constraints and security requirements may impact safe medication use.

This study conducted a systematic search across six databases to appraise the published literature from 2000 to 2023 (Embase, Medline, PsycINFO, CINAHL Plus, Cochrane and Web of Science), with reporting according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review guidelines. Data extraction was completed by one author, with validation of a sample by the other authors. The review included quantitative, qualitative and mixed-methods studies examining DRPs in prison healthcare.

The review included 42 studies on medication safety in prison healthcare, comprising epidemiological perspectives (52.4%, n=22/42), aetiological exploration of DRPs (45.2%, n=19/42) and intervention evaluation (11.9%, n=5/42). Studies were predominantly from the USA (30.9%, n=13/42) and the UK (26.1%, n=11/42). Most studies focused on infectious disease management (52.3%, n=22/42), particularly HIV treatments (42.8%, n=18/42), followed by mental health medications (23.8%, n=10/42). Non-adherence emerged as the most commonly studied DRP, reported in both epidemiological (68.1%, n=15/22) and aetiological studies (68.4%, n=13/19). Contributing factors included medication delivery problems, psychosocial factors, accessibility challenges and conflicts between healthcare delivery and security requirements. Five intervention studies were identified, with two from the USA (40%, n=2/5). These interventions included those addressing medication non-adherence (40%, n=2/5) and potentially inappropriate prescribing (20%, n=1/5), and highlighted the potential efficacy of multidisciplinary and pharmacist-led approaches in addressing medication safety challenges within prison healthcare settings.

This represents the first comprehensive study to present a narrative report on the existing evidence regarding the epidemiology, aetiology and interventions for medication safety events in prison healthcare. While intervention studies demonstrate promising findings from multidisciplinary and pharmacist-led initiatives, further evidence is needed to address DRPs beyond medication non-adherence, guided by a deeper understanding of their contributory factors. Future studies should target preventable MEs and ADEs, as well as wider health conditions to broaden our understanding of prison-specific contributory factors to develop targeted interventions for this vulnerable population.