Dear Sir Re: Regulation 28 Report Matthew David Hamilton deceased refer to your report dated 14 February 2019 concerning the death of Mr Hamilton who died as result of toxicity of morphine and his metabolites. You concluded that his was a related death: thank you for bringing to my attention the Matters of Concern arising from the inquest as follows: On being released from custody, some heroin users (andlor other drugs) are unaware of: the fact or extent to which abstinence during imprisonment is likely to have reduced their tolerance to heroin (andlor other substances): andlor that consumption of those substances, at levels which may have been normal for them prior to their period in custody, may prove immediately fatal afterwards. take note that in your opinion action should be taken by me and my organisation to prevent future deaths would to bring to your attention the steps have now taken to satisfy the Matters of Concern: The Drug and Alcohol Reduction Team (DART) have updated their guidance pack, which in future will be offered to all prisoners on their discharge from HMP Durham and notjust to those who had elected to engage with DART while in custody: The guidance pack is also offered to those with the potential of release from court. will be happy to supply a copy of the guidance pack should you wish to receive it. As part of a pilot scheme, prisoners who are identified as at risk of an opiate overdose can be offered Naloxone upon release The DART team have a trained prisoner (DART Mentor) to offer additional harm reduction advice to prisoners at the point of release. This includes information on community based support services, as well specific, harm reduction information am confident that these additional improvements t0 our processes will reduce the risk of drug related deaths following release and submit them for your considerations Yours etc Prison HM Prison & Tees & Wear Refor_ Probation Service Prisons Group drug like being ' drug

Prison Reform: "Naloxone is a drug which temporarily reverses the effects of opioids such as heroin, methadone and morphine. For years, naloxone has been used within emergency medical settings to reverse the etfects of opioid overdose and to prevent death: UK Guidelines on Clinical Management of Drug Misuse fully endorses the use of naloxone in overdose management and prevention: Prison HM Prison & Tees & Wear Reform Probation Service Prisons many Group