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Focused Topics
in Prison Health:
Prescribing in
Prison
John Koehn, MD, CCFP
.
FMF 2013
Drugs in Prison
• Pharmaceuticals have value in prison
– Diversion to pay debts
– Bartering power
– Bullying/muscling
• Perception of value makes meds desirable
– Limited access compared to community
– Different formulations to limit abuse
• Gabapentin in liquid form
– Dispensing practice
• Daily witnessed ingestion for T#3 and gabapentin
Problematic Drug Classes
• Sedatives/hypnotics
– Safety risks with benzos, z-drugs
– Other options: trazadone, mirtazipine, quetiapine
• Analgesics
– Acute vs chronic pain
– Role of opioids for chronic pain - incr risk to prisoner population
– Barriers to care:
• Limited access to non-pharmacological adjuvant therapies for pain
• Stimulants
– Treating ADHD
– Difficulties assessing function
• Other:
– Gabapentin
– Bupropion
– Quetiapine
“Only in jail…”
• Drugs of abuse – really?!
– Metamucil
– Inhaled corticosteroids
– Dimenhydrinate
– Clonidine
– Fresh fruit
Adapting to an Institution
• Unfillable prescriptions/referrals:
– Massage therapy
• Acupuncture, naturopathy, dietician services, etc.
– Orthotics
• Can only purchase OTC insoles
– Jogging pants and mattresses
• “Not a health care issue anymore.”
– Melatonin!
Thanks