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Cardiff Prison is a Victorian city centre establishment that opened in 1832. It has the operational capacity for up to 820 adult men (Wales has no women’s prisons) and is a category B local remand prison with training and resettlement functions. There is an on-site healthcare facility, with an outpatient clinic area and inpatient beds. Providing healthcare to an imprisoned population presents unique challenges, especially when managing a stigmatising and potentially life-threatening condition such as epilepsy. Prisoners are four times more likely to have seizures than the general population,1 yet they engage much less with healthcare.2 Mental health difficulties are certainly more common among prisoners,3 including learning disabilities and dissociative (non-epileptic) seizures. Substance misuse and drug addiction are prevalent within secure environments, leading to high levels of addiction, overdose, trading, bullying and manipulative self-harm. Abuse of prescription medications is also very common, especially of pregabalin, gabapentin, benzodiazepines, tramadol and sedating antidepressants, as well as methadone. The monetary street value of a 300 mg pregabalin tablet outside of prison is mostly between £1 and £7,4 but there are no formal price data from prison. Clinicians frequently feel pressured to prescribe these drugs, which can give an opiate-like euphoric high and can enhance the high when used alongside opiates. However, in overdose, they can cause sedation, ventilatory failure and death. A 30 min hospital appointment from prison is costly in time and resources, taking half a day for two escort officers, …