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Misused medications in a prison

From a lipstick blotted tissue to a metal can lid, everything is for sale inside a prison

By Joe Bouchard and Lorry Schoenly

One of the laws of contraband is that everything has a price. From a lipstick blotted tissue to a metal can lid, everything is for sale. Though scarcity and potential use dictate worth, a market is usually not difficult to find behind the walls.

Size means little in the world of contraband. Dependent upon the use, tiny items can fetch lucrative trade value or can score a coveted service. For example, certain medications could literally be worth their weight in gold if the supply is low or the effect is strongly desired.

Perhaps the irony is not lost as most corrections professionals ponder this. Medication is supposed to help certain offenders, yet is widely abused. Some will trade their beneficial medicine for unrelated goods and services.

The misuse of personal medication is widespread in corrections. Inmates develop new and creative uses for these substances regularly. A review of recent practices in facilities reveals the following novel applications:

• Female inmates crushing and inhaling the antihypertensive Clonodine to ‘get high.’

• Cascara sagrada in solution (constipation medication) is obtained and used. It has a fairly high alcohol content.

• Misuse of asthma inhalers by young inmates before exercise who mistakenly think it increases endurance.

• Misuse of nutritional supplements like Ensure by young inmates in order to ‘bulk up’ when muscle-building.

• Use of HIV medication with the unfounded and erroneous belief that the medication will prevent HIV and treat it as well.

More obvious medication diversion and misuse include nicotine patches and pain medications. When narcotics are not available in the environment, other pain medications such as Tramadol (Ultram) may be utilized. Tramadol, for some reason, was not classified as a controlled substance when approved by the FDA in the 1970s.

However, prison systems should consider it as a narcotic and limit inmate access as it has opiate properties and has high potential for abuse.

Reducing medical contraband
Below are some tips to help you reduce contraband in your facility:

• Work with health care staff to continually identify high-value medical contraband in your setting.

• Be particularly mindful of the medications that can be KOP (keep on person) in your facility.

• Institute a rigorous medication check program if your facility uses a KOP process. Inmates should only have in their possession medications still in identifiable cards with their name on it.

• Help new medical staff learn the ropes quickly. When doctors and nurses enter the system from the outside, they typically are not used to viewing medication, medical equipment and treatment supplies as potential contraband. New physicians, in particular, will be tested by the inmate population on how easily they can be maneuvered into ordering valued medications, medication exemptions (low bunks, special shoes) or unnecessary treatment materials (special creams or nutritionals).

A contraband item does not necessarily need to be a weapon in order for it to be dangerous to offenders and staff.

Certainly, the trade of medications is less directly perilous than a ten-inch-shank. But the exchange of goods and services that surround medication is staggering.

Many offenders go to great lengths to protect their illicit commerce. As the old saying goes, little things mean a lot. In the world of illegal trade in medicine, little things are often of significant worth and spawn many battles.

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