Canada's prison watchdog has launched an investigation into the prescribing practices in federal prisons, after it was revealed that more than 60 per cent of female inmates across the country are receiving psychiatric medication.
In August 2013, of 591 female federal inmates in five correctional institutions, 370 were being prescribed at least one psychotropic medication, drugs that impact mood and behaviour.
When separated by region, the prescription rate jumps to almost 75 per cent in prisons such as the Nova Institution for Women in Nova Scotia, the Joliette Institution for Women in Quebec and the Fraser Valley Institution for Women in British Columbia, a joint investigation by The Canadian Press and CBC has learned.
That is a significant increase from 2001, when the prescription rate was 42 per cent, according to a study by Correctional Service Canada that raised concerns about what it called "over-prescribing and multiple prescribing of psychotropics" in some prisons.
The 2013 data was collected by Howard Sapers, the Correctional Investigator of Canada, who first looked into the issue last summer, after the CSC told The Canadian Press and CBC that the department did not keep records of medications prescribed to inmates.
Former prisoners and their advocates have been complaining for years about what they call the over-medication of inmates. They claim that quetiapine – an antipsychotic drug strictly recommended for the treatment of schizophrenia and bipolar disorder – is being prescribed to female prisoners as a sleeping aid.
When asked for comment, the CSC would only say that quetiapine – available in Canada under the brand name Seroquel – is prescribed to inmates solely for the treatment of schizophrenia and bipolar disorder, as per Health Canada's recommendations.
But an internal CSC memo, obtained through as Access to Information Request, shows there was a concern in 2011 that quetiapine was being prescribed for unapproved uses, often known as off-label uses.
"In an attempt to better control the circulation of quetiapine within CSC, the National Pharmacy and Therapeutics Committee has recommended that quetiapine be only funded for its official indications: schizophrenia and bipolar disorder," the memo reads.
"Gradual withdrawal over a period of at least one to two weeks is advisable. All planned discontinuations must be completed by June 30th, 2011."
An advocacy group whose regional workers visit women prisons every month says they have not been able to verify any decrease in the use of quetiapine, which can only be prescribed to inmates by a prison doctor.
"That would lead me to believe that there hasn't been a significant downtrend in the use of Seroquel," said Kim Pate, executive director of Elizabeth Fry Societies of Canada.
A former inmate of the Joliette Institution for Women from July 2009 to June 2011, who spoke on condition of anonymity, said she was prescribed Seroquel after complaining of having trouble sleeping.
"I heard a lot of my friends were on Seroquel because they had problems sleeping," she said.
Just a few days later, she requested to be taken off the drug.
"It was too strong for me. I [felt] that I wanted to eat all the time ... and I passed out right away...I don't want to be addicted to pills so I had to stop."
Another former inmate of the Grand Valley Institute for Women in Kitchener, Ont., who cannot be identified under the provisions of the Youth Criminal Justice Act, said prisoners thought of Seroquel as a sleeping pill.
She said she would get the drug from other inmates who were received their weekly supply of the drug in blister packs.
"I would ask for them to just sneak me one or two of their Seroquel pills and just take those so that I could sleep all day. And they were very powerful and very effective," she said.
"You just shut down. The eight hours would just melt away because I was either sleeping or just very, very tired and drowsy so not really aware of my surroundings so it's the perfect way to not have to care about something."
South of the border Seroquel is no longer being prescribed to prisoners in a number of states, including California, Ohio and New Jersey, after reports of widespread abuse of the drug by inmates.
The drug's manufacturer – AstraZeneca Pharmaceuticals LP – was ordered by the U.S. government to pay $520-million (U.S.) in April 2010 to resolve allegations that the company was illegally marketing the drug for uses not approved as safe and effective by the Food and Drug Administration.
Health Canada says it is not aware of allegations of "similar advertising tactics" taking place in Canada.
"However, should we become aware of [any] off-label promotion activities, necessary actions will be taken to protect the health and safety of Canadians," a spokeswoman said in an e-mail.
According to Health Canada, some of the drug's side effects could be fatal, including diabetes, hyperglycemia, constipation and intestinal obstruction and complications from blood clots.
"It's an antipsychotic drug and when it's used indiscriminately it can kill people," said Dr. David Juurlink, head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto.
"Even in the short-term people can become very restless, they can have abnormal body movements as a result of the drug, and in the long term they can develop features of Parkinson's disease, they can develop permanent movement disorders, they can experience fatal abnormalities of muscle and body temperature regulation."
As of last month, the total number of inmates in federal prisons was 15,276 – 610 of them women. Of the total number, 454 inmates were receiving Seroquel, according to the only data provided by the CSC.
The department was unable to provide a breakdown of the data by gender or by prison.
"CSC does not have these figures available nor do we have a system that allows us to readily track this information," a spokeswoman said in an e-mail.
Sapers said the lack of key data at the CSC presents "management challenges" that can have an impact on accountability and cost control.
"Health care in federal corrections is very expensive. Between $215-million and $220-million will be spent this year on the provision of health care to federally sentenced offenders inside institutions, and maybe a quarter of that will be spent on prescription drugs," he said in an interview.
"It's very hard for us to hold CSC accountable from making appropriate and safe and legal decisions about drug therapy unless we can see that information."
Prisoner advocates and experts say it is troubling that powerful psychotropic drugs are mostly prescribed to women.
"Oftentimes the biggest complaint we have from people working in the prisons, staff, is that women are very emotional, " said Pate of the Elizabeth Fry Societies.
"So if you dull down the emotions by medicating them, you end up with a situation where the chemical restraints keep them from being a challenge."
Jennifer Kilty, a criminology professor at the University of Ottawa who specializes in the treatment of incarcerated women, said the idea that the majority of women in prison – in some cases 75 per cent of them –are mentally ill to the point that they need some form of psychotropic medication is "absolutely outrageous."
Kilty, who has worked with female former inmates who were prescribed Seroquel, said the overmedication of women in prisons is nothing new.
"Seroquel is just the sort of wonder drug of today. If you went back 20 years, 30 years, you'd be looking at Valium," she said.
"There's also with women this really long history, particularly with criminalized women, of constructing them as somehow psychologically damaged...and it gives us a way to explain their criminality."
Sapers says CSC is co-operating with his office's investigation and he hopes to have some preliminary findings soon.
"Those preliminary findings will then help guide us in decisions about more in-depth investigations."