Prisoners’ access to psychoactive medications: The need for research and improved policy

Abstract

Access to psychoactive medications in prison does not garner as much research and policy attention as the use and trade of illicit drugs in these settings. Indeed, there is little published literature regarding how psychoactive medications are prescribed to prisoners, including studies of common practices and barriers (a few exceptions include Bowen, Rogers, & Shaw, 2009; Griffiths, Willis, & Spark, 2012; Nunn et al., 2009; see also Fazel, Zetterqvist, Larsson, Langstrom, & Lichtenstein, 2014 for some references about prescribing antipsychotic drugs and mood stabilizers to people with histories of criminal justice involvement). As in-prison access to pharmaceuticals has direct and important impacts on prisoner health and well-being, there is a pressing need for improved understanding and policy in this area. Compared to general populations, prisoners have worse physical and mental health, exhibit higher levels of substance use, and have had little contact with health service providers prior to entering prison (WHO, 2014). Among prisoners, certain subpopulations are~more likely to have been prescribed and/or taking psychoactive medications (often self-medicating to help cope with, for example, histories of trauma and abuse). These groups include: prisoners with mental health needs; prisoners who use drugs; women prisoners; Indigenous prisoners; people living with chronic pain, including some who are living with HIV; and elderly prisoners (e.g., Bowen et al., 2009; Office of the Correctional Investigator [OCI], 2014; WHO, 2014). There are international standards and recommendations that clearly state prisoners are entitled to a level of health care equivalent to that provided in the community (WHO, 2014). In practice, however, prisoners do not have equivalent access to psychoactive medications that may help alleviate or treat varieties of pain, mental health symptoms, and substance dependence. The subpopulations noted above are thus disproportionately vulnerable when it comes to interrupted access to medication. A notable example of unequal access, while clinically-supervised provision of methadone is an efficacious pharmacological treatment for opioid dependence, only just over half of prisons in the United States offer methadone maintenance (Ludwig & Peters, 2014; Nunn et al., 2009). In addition, many other psychoactive