Lawyers, advocates question why some inmates denied medication

Lawyers and advocates in Nova Scotia are questioning why some inmates are being withheld medications in jail.

Stephanie Hillson, managing lawyer for the Nova Scotia legal aid office in Amherst, says she receives monthly complaints from clients about the hardships accessing prescriptions for mental health illnesses.

"From the perspective of a lawyer who's trying to get lucid instructions, it's very difficult to do that when you've got a client who is understandably agitated and upset about the fact they're not receiving their medications," she said.

Hillson represented Kesha Casey in 2014 in a case that prompted the judge to scold the Burnside jail where Casey was being held. 

Casey told her lawyer she was not able to get her medication for bipolar disorder or attention deficit hyperactivity disorder while at the institution. 

"After a month of her being in custody, the situation still hadn't been resolved, even after I made repeated phone calls on her behalf to Burnside as well," Hillson said.

Methadone restrictions

Other inmates claim they are being denied methadone to help with opioid addiction, or not offered treatment at all.
 
A CBC News investigation has found that inmates in New Brunswick file similar complaints. 

According to Cindy MacIsaac of methadone clinic Direction 180, the practice is "inhumane."

"We get calls from people, you know some are in tears, some are yelling, some are angry and upset, wondering can we help because their dose is being reduced," said MacIsaac.

She says if an inmate arrives at the jail on a methadone dose higher than 120 milligrams, they are drastically reduced. MacIsaac would like to see doses reduced more slowly in provincial jails.

Better to reduce the dosage in steps "so that it's not just a sudden jolt," she said.

Cold turkey for some

The clinical director for Nova Scotia's offender health services disagrees.

"There is no evidence that doses above 120 milligrams is of any effect to the addiction part of the dependent's part for opioids," said Dr. Risk Kronfli.

He says inmates previously on a methadone program will continue getting the drug if they don't abuse it. However, those who arrive at jail without a methadone prescription will be forced to go cold turkey.

"We haven't had a chance or the capacity to initiate methadone because we have no control over how long they're going to be with us to initiate a comprehensive program. We are looking at those possibilities, but that would require a lot more resources," said Kronfli.

Smuggling concerns

While methadone and mental health prescriptions appear to be two very different categories, Kronfli says there is a deeper drug culture at play. 

"The challenge is that a lot of the medication we use in psychiatric can be abused if you changed the method of administering it, so instead of swallowing it they inject it or snort it," Kronfli said.

In some cases, anxiety and smoking cessation medication can give a cocaine high, he said.

"I'm worried about the patient who needs the medication but is being threatened and muscled, and their families on the outside are muscled, to force them to 'cheek' the medication — to not take the medication, to pass it along to somebody else under duress," said Kronfli.

"This is an abuse that happens a lot in every correctional facility, and it happens in our facility despite the best intentions."

'These medications can help'

Hillson says while she sympathizes with the challenges of disciplining abuses within the system, she doesn't believe every inmate should be punished.

"Withholding those medications threatens their lives," she said. "We know there is a very high instance of suicides within prison systems and these medications can help that."

Kronfli denies that patients who need medication under his care are going without treatment.

"It has been in the past where there were complaints to the College [of Physicians and Surgeons] that they haven't been getting their medication when they have a psychiatric condition. I can safely say that this would trigger such an intense assessment and review of our policies, and this has not happened because it just simply cannot happen," he said.

The psychiatrist maintains that all inmates receive a thorough assessment within 48 to 72 hours, and emergency cases are reviewed in less than 24 hours.