A painful situation: Access to medication in prisons

This is the second in a three-part series highlighting the critical need to consider policy and program reform in Canadian federal prisons. You can read the first post here.

When it comes to drugs in prisons, Canadian correctional officials are primarily concerned with keeping illicit drugs out. As a result, there’s insufficient attention given to in-prison use of and access to psychoactive medications prescribed for physical and mental health conditions. This neglect leads to gaps in our knowledge that negatively affect prisoner health and well-being. More research and improved policy that address prisoner access to medication are urgently needed.

Here’s brief context: Delivery of health services in federal prisons must conform to the Corrections and Conditional Release Act which states that every prisoner will be provided with “essential health care” and “reasonable access to non-essential mental health care” that contribute to successful rehabilitation and reintegration. The Correctional Service of Canada (CSC) has a Commissioner’s Directive plus other guidelines and procedures in place regarding the dispensing of medication, including a National Formulary  that all federal prisons must follow. The formulary lays out for physicians, pharmacists, and nursing staff which drugs are permissible inside prisons. Many psychoactive drugs are excluded from the formulary because they’re seen as having high potential for misuse and diversion (e.g., prisoners selling or being “muscled” for their meds). Psychoactive drugs that are on the formulary are subject to careful restrictions (e.g., only prescribed under certain circumstances, cannot be dispensed for longer than a week, must be taken by direct observation, etc.). Despite existing rules and regulations, people who work for external organizations and former CSC staff report a need for clearer policy and better practices.

People who enter the prison system are typically destabilized as soon as they arrive – they are completely taken off or tapered off whatever medications they were taking in the community. A variety of factors, including lack of communication between health care providers and security staff, and strict adherence or changes to the formulary, can contribute to a lengthy period before a prisoner can get back on or initiate a medication schedule. Clearly, this has implications for the prisoner’s physical and/or mental health.

System observers and former CSC staff report stories of prisoners experiencing severe mental health symptoms and getting, for example, involuntary transfers before or instead of receiving appropriate medication. For pain management, prison physicians face difficulty prescribing the few pain medications listed in the formulary. In some cases, prisoners experience interruptions to pain medication they were taking for years prior to incarceration. There are opportunities for community-based pain specialists to see prisoners and make recommendations to prison health care, but not necessarily in a timely or consistent manner. There is also a process to get exceptions to the formulary, but it’s an uncertain process with no guarantees. None of this is facilitated by the zero-tolerance setting inside federal prisons, where prisoners who request psychoactive medications for pain or other conditions often get labelled by staff as “drug-seeking” and are treated with suspicion.

It is crucial to note that certain groups are more likely to be prescribed or taking psychoactive medications (often self-medicating), and are thus disproportionately affected by lack of timely access to medication. These groups include: prisoners with mental health needs, and those with histories of trauma; women prisoners, particularly Indigenous women; prisoners living with physical pain, including some people living with HIV who experience a painful peripheral neuropathy; and aging or elderly prisoners. The Office of the Correctional Investigator has long acknowledged the need to better address the mental health needs of prisoners, including access to medication, and recently reported  that 63% of women in federal prisons receive psychotropic medication for mental health symptoms.

To ensure that prisoners receive the “essential health care” to which they are entitled, those of us who are researchers, service providers, and prison health advocates must ensure we continue to investigate this topic. If we strive for a compassionate society that considers prisoner health and well-being, we need to know a lot more about what is happening inside prisons regarding access to medication.

Tara Marie Watson

About Tara Marie Watson

Tara Marie Watson received her PhD from the Centre for Criminology and Sociolegal Studies, University of Toronto. She has longstanding interests in drug policy and correctional populations, and research experience related to public health programming for people who use drugs.

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