Corrections Community

Hi all,

   Happy "day after" July 4th!

   We are looking at changing our practices related to verification of pain medication and psychotropics.  At present, we allow inmates to provide their pharmacy name for current Rx and continue active Rx's. 

This leads the mental health staff, as well as medical,  to question the why's of some Rx's; esp. if person is assessed with substance use disorders and the Rx is for a benzo or narcotic; or for even high doses pain meds for an injury when they were children.  We believe these suspect RX’s contributes to out 95-100K pharmacy bill for the 25% of our 1400 inmates on prescribed meds.

    Our thinking is to begin limiting RX verification for psychotropics and pain meds to the prescribing physician's office... and possibly asking for a non-addictive/less addictive [aka less contraband] substitution.

    Any experience with -- or thoughts-- on this problems?  Other solutions?

Thanks. JJ Larson

Mental Health Administrator

Greenville County Detention Center

Greenville, SC

864-467-2384

I made this change several years ago in a much smaller jail with the help of our medical director.  We allowed them to continue their current perscriptions until they had their intial appointment with our "Doc."  He would then consult with their perscribing doctor and develop a plan based on our approved medication list.  In the intial phase the inmates grieved the process.  It did reduce our med costs, I also think it prevented some med swaping, we were not able to quantify the contaband issue but the perception was that it was less of a problem.

I have been a substance abuse therapist for ten years and have worked with criminal justice, and dual diagnosed clients for the last seven years. Messing with an inmates medications can result in serious problems. Questions that need to be addressed before would be (1) what is the nature of the injury or disorder for which the medication is prescribed? (2) what kind of physician is prescribing? (3) how long have they been on the medication? (4) What were the qualifications of the individual that made the diagnoses of substance abuse,? (5) what instrument did they use and is it a screening or assessment tool? (5) is the addiction diagnosis related to the medication of concern.

The importance of asking these questions are related to the basic rights to receive services for legitimate illness. I will give examples. I injured my back in 1990 and after the initial treatment have been basically medication free. I was placed on muscle relaxers for 6-months after a strain by a pain management doctor 2-years ago and underwent physical therapy. 3-months ago I had a fall and reinjured the same area. I am now on a high does of opioid medication, without it I do not sleep, if I do not sleep I do not function. The prescribing doctor is a family practice doctor. I am a recovering addict with 26-years recovery, my drug of choice- benzos- if assessed to day by any of the individuals doing assessments for criminal justice I would be deemed one of two things an active addict or no history of addiction based on the instrument used. I see the latter all the time. Addiction diagnosis can only be made on criteria met within the last 12 months. If the ASI or MAST are used the diagnoses is not based on an instrument designed for assessment but screening. The only assessment instrument I am familiar with is the GAIN developed and publish by Lighthouse, Decatur IL.

Lv