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Canada’s prison agency to review treatment of inmates with opioid addictions

A letter sent to the Correctional Service Canada (CSC) on Monday – and shared with The Globe and Mail – summarized the experiences of 33 prisoners held in the federal jailer’s Pacific region who said they couldn’t access basic treatment for the highly addictive class of drugs that includes fentanyl and oxycodone.

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Canada's prison agency said it will review the way it treats inmates with opioid addictions in light of a series of accusations from B.C.-based prisoners.

A letter sent to the Correctional Service Canada (CSC) on Monday – and shared with The Globe and Mail – summarized the experiences of 33 prisoners held in the federal jailer's Pacific region who said they couldn't access basic treatment for the highly addictive class of drugs that includes fentanyl and oxycodone.

The Globe queried the CSC about the letter shortly after it was sent. The response was immediate: "The Correctional Service of Canada takes these allegations very seriously and will undertake a review of the application of opiate substitution therapy policy."

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Prisoners' Legal Services (PLS), a Vancouver-based law clinic devoted to prison issues, brought the inmates' concerns forward in the 14-page letter. Some prisoners reported waiting months and even years to receive opiate substitution therapy, which generally consists of methadone or Suboxone. "I'm very glad to hear that CSC is taking our concerns seriously and will be undertaking a review," said PLS legal advocate Nicole Kief. "We look forward to being consulted, and hope that CSC will also consult with prisoners who have been directly affected by these issues. And, given the urgency of the situation, we hope the review will happen immediately and will result in all prisoners who need treatment receiving it."

One prisoner, identified only as Joel, told PLS he was waiting three years on a waitlist for Suboxone to treat his heroin addiction. "He is set for release in mid-July and fears … becoming a victim in the fentanyl crisis," the letter states.

Others fortunate enough to receive the treatments say prison staff often cut them off cold-turkey, with devastating health effects. Austin Curtin, an inmate at Matsqui Institution, told PLS he was taking Suboxone successfully for three months when a nurse spotted something white in his mouth and suspected him of diverting his medication, a serious concern in prisons settings where prescription medications fetch inflated black-market prices and are often acquired by threat of violence. Mr. Curtin said the substance was not diverted Suboxone but a piece of a hard-boiled egg he'd eaten before seeing the nurse. His explanation did not allay the nurse's concerns, however, and his Suboxone regimen was terminated without any kind of tapering.

"Mr. Curtin reports that he experienced heavy sweats, cold shakes, diarrhea, stomach cramps, headaches, insomnia and restless arms and legs, but despite numerous healthcare requests, he received no help managing his withdrawal symptoms," the letter states.

Prisoners claim the decision to pull these medications is often based on flimsy evidence and inmates are given "no meaningful opportunity to defend themselves" – a violation of fundamental justice principles enshrined in the Charter, according to Ms. Kief.

In an e-mailed response, CSC spokeswoman Sara Parkes said involuntary tapering cannot be used as a form of discipline and must only be carried out where an inmate doesn't comply with the treatment program or presents a safety risk. "Diversion of methadone or Suboxone … even in very small amounts may lead to significant adverse effects, including respiratory depression and even death," Ms. Parkes wrote.

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Roughly 920 of the 14,639 inmates currently in CSC custody are receiving opiate substitution therapy, up from 779 in the 2015-16 fiscal year. In the 2014-15 fiscal year, the most recent period for which figures were available, there were six fatal overdoses in federal prisons, an increase from two deaths the previous year.

"It's a difficult issue," correctional ombudsman Ivan Zinger said. "I'm certainly of the view that there's an increased demand for methadone and Suboxone. CSC has increased access but it is probably insufficient to meet the demand."

In response to one inmate's grievance, a warden confirmed a supply shortage exists, according to the letter. It states that one inmate, who has been waiting a year for methadone, was informed the opiate substitution therapy program is "significantly beyond capacity."

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