Newly admitted federal inmates can be denied prescription medication for 30 days or more while they wait for an assessment from time-strapped prison doctors, a dangerous practice with potentially far-reaching health consequences, especially for prisoners dealing with mental-health issues.
The revelation is contained in an unreleased prison ombudsman investigation that identifies a series of flaws in Correctional Service Canada's (CSC) drug plan.
The report, conducted by federal Correctional investigator Howard Sapers and obtained through Access to Information legislation, comes at a time when the agency faces unprecedented scrutiny in how it deals with inmates facing mental-health issues, a segment of the offender population that has increased by 60 to 70 per cent since 1997.
CSC's own physicians told investigators that they have insufficient time "to meet and assess all new admissions to federal custody," sometimes leaving offenders to wait a month or more for an admitting physician to approve prescriptions. During that wait, CSC regularly discontinues an inmate's outside prescriptions, according to the investigation.
"This practice effectively introduces interruptions in care and may be particularly inappropriate or unsafe for first time federal offenders with a mental health condition," states the report, which recommends a maximum waiting time of 72 hours before new offenders should receive an initial assessment.
In a consultant's report appended to the investigation, psychiatrist Olivier Farmer calls the practice of halting and substituting medications "dangerous in some cases."
That blunt conclusion squares with what researchers have observed at both provincial and federal institutions across the country. "People, for the most part, are started on a medication because they need it," said Fiona Kouyoumdjian, a post-doctoral fellow at the Centre for Research on Inner City Health at St. Michael's Hospital. "I think it's appropriate to reassess a person's medications to make sure it's in their best interests. But to hold back a medication without having a consultation is, especially for 30 days, problematic for that patient."
As an example, Dr. Kouyoumdjian points to clozapine, used to treat schizophrenia and prescribed to federal inmates only under tight restrictions. Suspending such a prescription, she said, "could have serious consequences for a patient's mental health."
In an e-mailed statement, CSC spokeswoman Esther Mailhot insisted that medication reconciliation is a priority for the agency and must take place within 24 hours of admission.
Another tendril of the investigation identified a dearth of treatments for attention deficit hyperactivity disorder, chronic pain and other select ailments. CSC physicians reported that such limitations "significantly restrict their professional autonomy and clinical judgment."
Ms. Mailhot, however, explained that "certain medications at high risk of abuse and diversion may not be listed or have greater restrictions in order to maintain offender and staff safety."
That emphasis on the illicit potential for many prescriptions, especially painkillers, deprives inmates of badly needed medication, according to Seth Clarke, who works with inmates regularly as federal community development co-ordinator for the Prisoners with HIV/AIDS Support Action Network. "It's not unusual to see a quite aggressive tapering off of some pain medications for the reason that the institution considers it a security risk," Mr. Clarke said. "And if you're not on top of pain, that can have some very negative impacts on you, and in some cases, these people end up turning to illicit drugs inside."
The consultant, Dr. Farmer, found that several common ADHD treatments don't exist in the CSC formulary at all: Concerta, Adderall XR and dexamphetamine.
Prison physicians can't prescribe a number of common psychiatric drugs – Abilify, clozapine, Seroquel or Wellbutrin – without permission from a regional pharmacist. Such restrictions upend the normal power balance between physicians and pharmacists, according to Dr. Farmer, and "administratively obstructs a physician's professional autonomy."
The findings accord with what prisoner advocacy organizations have been saying for years.
"These are all concerns we would share and we have certainly raised these complaints with CSC on a regular basis," said Kim Pate, executive director of the Canadian Association of Elizabeth Fry Societies. "But I wasn't aware their own doctors were raising these internally as well, and I think that underscores the seriousness of the concerns."