Laura Shaver had a heroin habit for years. Sometimes that meant going into opiate withdrawal in a British Columbia jail: "You're in a four-by-four cement cell. It's way too hot or way too cold and you don't get a proper blanket. You don't know what's happening. You shit yourself, you puke yourself."
Plenty of other inmates were in the same fix: "You can hear people screaming," she said.
Methadone can treat this "dope sickness" and stem the needle sharing and overdoses that can be part of being locked up with a habit. But opiate substitution therapies like methadone or Suboxone can be hard to access on the inside. Every time Shaver got locked up, her methadone treatment was interrupted.
Today, some prisoners are taking their jailers to court, arguing that they've been effectively blocked from treatments available on the outside. A BC Corrections policy says prisoners can't be prescribed methadone or Suboxone unless they have a doctor in the community willing to take on their treatment when they get out. The case points to a rule that requires inmates to show they'll be in a provincial facility for at least three months in order to qualify for treatment. But many inside don't know their futures. To the inmate, the scheduling of sentencing, trial, court appearances, and transfers can be unpredictable, making it hard to say for sure where they'll be.
These practices restrict treatment for inmates like Shawn Gillam, 33, who says he never touched opiates before his first time in custody. He says he developed a big habit inside—smoking a gram and a half of fentanyl every day. Within a few hours of being arrested again last December, Gillam was sweating, vomiting, and sleepless. Withdrawal hit hard. He asked to start regular Suboxone treatment. But Gillam swore in an affidavit that all he heard at North Fraser Pretrial Center was: "We don't do that here."
Many fight the pain and cravings of withdrawal by turning to drugs that are smuggled in. At one point, Gillam recalls overdosing in his cell, still waiting on addiction treatment. Luckily, he was revived.
Troy Underhill has a similar story. Soon after getting locked up in the Prince George Regional Correction Center, Underhill became dope sick. He too sought treatment but was rebuffed, according to his affidavit.
Underhill and Gillam are part of a group of four prisoners who are arguing in the Supreme Court of British Columbia that this violates their Charter rights.
Brian Cooper, 27, is addicted to heroin. When he was taken into the Kamloops Regional Corrections Center, he began to go into withdrawal—nausea, diarrhea, vomiting, aches, sweats, and shivers. He says he's used drugs on the inside before and has been caught twice by guards while injecting heroin. In previous stints in custody, Cooper got on Suboxone, he says. But after rounds of doctor requests and trips to the counselor—who recommended treatment—he still couldn't get help this time.
Adrienne Smith, the lawyer representing the prisoners, says they are challenging "a prison policy that imposes different standards for drug treatment medication for people who are in jail than the community standard for the same medications."
Smith says that the focus of BC Corrections on stability and ongoing care after release is laudable, but it ends up being a barrier to access inside.
The prisoners are seeking an injunction to quash the policy and see doctors. The first hearing will be on March 31.
Shaver, who is not part of the case, had a methadone prescription when she was arrested. She managed to have the prescription filled in prison, but only after days spent sick and without medication.
Shaver has managed to stay away from jail for several years. She's president of the BC Association of People on Methadone (BCAPOM) and describes a pattern where methadone patients cycle in and out of jail for brief periods. Every time the cuffs are snapped on, their treatment is disrupted for several days and that comes with risks. Shaver wants seamless treatment between the inside and outside that reduces harm to the prisoner and to the community they are released into. (Full disclosure, I've worked with harm-reduction groups like BCAPOM for years, and I've seen firsthand the value of these treatments and the damage when people can't access them.)
Health care for inmates in BC prisons is provided by Chiron Health Services, a private, for-profit company. Chiron Health Services did not make anyone available for comment by publication time.
An emailed statement from BC Corrections to VICE says: "Medical staff can refer an inmate for either methadone or Suboxone treatment, or an inmate can request it." It says treatment established on the outside can be maintained in custody, and there is no "minimum timeframe or length of custodial sentence to initiate methadone or Suboxone treatment." Yet reports of disruptions and restrictions to treatment are not uncommon.
Dr. M-J Milloy is an infectious disease epidemiologist at the Urban Health Research Initiative of the BC Center for Excellence in HIV/AIDS. "Some people say 'going to prison is a chance for people to clean up,' but it's just not true," he said. "Drug use continues behind bars. HIV and Hep C is astronomically higher inside—transmission is happening inside prison walls."
Without treatment inside, the risks continue. "When released to the streets, their tolerance has changed," said Milloy. "They use the same amount and they die."
But he says it doesn't have to be this way: "If prison systems are not going to provide clean needles, you'd think they provide the next best thing—addictions treatment."
After lengthy delays, Gillam may soon be receiving Suboxone treatment. He wants the judge to know this: "I don't want to overdose again."
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