Prison psychiatrist David Craig explains prescribing methods in new article

The psychiatrist at Newfoundland and Labrador's largest prison, who has often come under fire for taking inmates off their prescribed medications, has published an article about his practices in a Canadian medical journal.

• Prison psychiatrist doing nothing wrong, peer review says

In the Canadian Journal of Addiction released in December, Dr. David Craig said he "sought to reduce the unnecessary prescribing of psychotropic medications with abuse potential," citing medications like Valium, Ritalin and sleeping pills. 

In "Swimming against the Tide" Restricting Prescribing Practices in a Prison: A Personal Journey, Craig acknowledged that dealing with public criticism for his way of treating inmates has been "difficult."

Despite multiple complaints from inmates and their families, a peer review released in 2012 said Craig met the standards of care in the psychiatric services he provided to inmates at provincial correctional facilities.

Craig wrote that there has been positive impacts on the well-being of inmates — and on health care costs, by reducing "unnecessary prescribing rates of psychotropic drugs with abuse potential to prison inmates."

Decrease in prison violence

Craig explained he would assess the inmates and would taper them off benzodiazepines (Valium-like drugs) and HS sedatives (sleeping pills). 

Inmates were then allowed no more than one antidepressant and no more than one antipsychotic agent.

As a result of those methods, Craig said health staff noted overall improvement of an inmate's mental health, and prison staff reported a decrease in prison violence.

Craig said he first worked at Her Majesty's Penitentiary during his residency program in 1986 and was concerned over the practice of prescribing sleeping pills, despite the inmate's "abuse potential." 

In 1999, when Craig was asked to take over the psychiatric practice at HMP, he said he warned the director of adult corrections to expect complaints as his approach to prescribing medication was conservative. 

'Emotionally challenging' ordeal

Craig said that while the peer review approved of his methods, years of complaints and negative stories in the media have not been easy.

"Anybody who is facing a complaint to the licencing body, it's emotionally challenging," Craig told CBC News Wednesday.

"Somebody is basically saying that you're unethical or incompetent. So it is anxiety-inducing until the reports come back."

Craig said that perhaps the hardest part of the situation is that often when people would publicly criticise his work, he would not be allowed to respond to those accusations publicly.

"Basically, you're stuck. Something is said, and you have to live with it," he said. "I had a lot of times when I had nights where I had difficulty sleeping, and times when I wanted to say things."

Craig said there were several times when there were public calls for him to be fired, especially from Citizen's Representative Barry Fleming.

"I would argue that, ironically, the citizen's representative turned around and tried to tarnish my reputation — and in doing so he violated my rights," Craig said.

"I believe there was at least three times where he was in the media calling for my head, and saying I should be fired. Well, as it turned out the peer review said that I was doing a good job."