Some Canadian Prisons Are Denying Inmates Methadone, Putting War on Drugs Before Health
While illicit drugs are still making their way into prisons, the one proven way to get people off heroin is being denied to some prisoners.
In prisons all across Canada, there are inmates using methadone—an opiate that satisfies the cravings of those with opioid addictions without providing the signature high that comes along with drugs like heroin or oxycodone. It is considered one of the most effective treatments available to stop extreme withdrawals and curb addiction, but not every inmate has access to it, and some have even been pulled off it.
In 2014, Mike Bland, a man charged with trafficking drugs in the Yukon, filed a human rights complaint after he was denied methadone treatment during his remand while waiting for trial. Bland was on the drug consistently before being imprisoned, and was eventually put back on it when he got out on bail.
When Bland was finally sentenced in 2015, the Yukon Human Rights Commission (YHRC) raised concerns about whether he would be pulled off the drug when he returned to the correctional centre to serve his sentence. Lawyer Colleen Harrington argued that WCC, which has had a back-and-forth change in policy on methadone treatment for a number of years, was not sticking to its word in providing methadone to inmates who needed it. Bland was put back on the treatment when he finally went to prison in October.
WCC's most recent policy, an update of prison regulations from 2012, was put in place in June . The policy states that inmates who require methadone treatment will be assessed by the "physician of care" and will only be placed on the treatment if they have been on it in the past, not if they wanted to start it from within prison. According to Tyler Plaut, a communications spokesperson at the Yukon's Department of Justice, this is a policy the province stands by.
"There is a battery of checks and balances that need to be done and we believe this is an effective policy," Plaut told VICE.
But not everybody agrees—for starters, the World Health Organization (WHO) specifically states in their guidelines for inmate treatment that prisoners should have the same "access to the health services available in the country without discrimination on the grounds of their legal situation." Even the federal government recognizes the usefulness of methadone maintenance treatment (MMT) and gives inmates who request the drug ability to begin treatment with little limitation.
The treatment itself is usually considered lifelong. Like insulin for a diabetic or long-term antidepressants for someone with severe depression, MMT is something that can't simply be taken away or supplemented cold turkey. Due to the nature of how opioids establish long-lasting, uncontrollable cravings in the body that actually cause physiological responses when they are taken away—such the shakes, nausea, and erratic behaviour—it is a misconception to believe they are simply something someone can "get over." This is according to, Dr. Philip Berger, medical director of the Inner City Health Program at St. Michael's Hospital in Toronto.
"[Very few] people revert off methadone without going back to using hard drugs, so you don't just lower the dose," he told me." Sometimes people want to lower the dose and try to get off, but it just doesn't work. It has to be a lifetime treatment."
Berger said that when an inmate is pulled off of methadone abruptly, a number of things happen. First of all, they will experience a severe withdrawal that Berger says can be "like torture" to those who have serious opioid addictions. There will also be an increase in cravings, as well as extreme behavioural changes.
"What will happen to them is that they will go into acute withdrawal, which won't kill them but will completely agitate and aggravate them for three, four, five days, as well as establish long-term cravings. Both will produce an understandable change in behaviour towards authorities or other prisoners," he said. "Secondly, it will just provide a greater incentive to have heroin or another opioid prescription smuggled into the prison, because people are desperate for it, and therefore people will be taking it in an uncontrolled way."
While it's unclear how many opioids actually make it inside Canadian prisons, the use of opioids and presence of illicit street drugs is an undeniable problem. This is supported by both hard data and the numerous testimonials of inmates on the topic, which can be found in the widely-cited 2009 "Under the Skin" report. The report touches on the exchange of used needles and injection equipment in Canadian prisons through the first-hand accounts of current and former inmates.
In terms of data itself, a CBC News investigationturned up a 20 percent increase in the amount of contraband being smuggled into Canadian prisons in 2013-2014, and exact numbers given by the CSC paint a picture of 103 seizures of opiates, including drugs like heroin and oxycodone.
In the 2011 annual report from the Office of the Correctional Investigator, the importation of drugs into prisons was highlighted as a critical issue that needed to be addressed.
"As I reported to Parliament in October 2011, there is no doubt that the presence of illicit drugs and home-made alcohol ("brew") in federal prisons is a major safety and security challenge. The smuggling and trafficking of illicit substances and the diversion of legal drugs inside federal penitentiaries present inherent risks that ultimately jeopardize the safety and security of institutions and the people that live and work inside them," the report reads.
Berger notes that prisons are perhaps one of best settings for the treatment, as the flow of drugs and supplies in the prison should not only allow for a safe and controlled administration of the drug, but will require the inmate to cooperate with correctional staff. Berger tells me that both things are often ignored due to authorities viewing methadone as "just another drug."
When first treating somebody with methadone, the positive effects are not immediate. Rather, a patient on the drug is expected to lower their dose of hard narcotics at the same rate they increase their dose of methadone until they are considered "stable" and no longer using street drugs. Over time, MMT will start to create what Berger calls a "blockade" for drugs like heroin, which means that even if street drugs end up being used, the user will feel no effect of them while on methadone.
Berger tells me that methadone does produce a slight high, but that it's nothing compared to street drugs. As mentioned, however, it is highly addictive, and when you combine that with the "mild euphoria" that the drug gives off to users, Berger says that prisons have developed a strong apprehension toward its use as a medicine.
"About ten years ago, I had a call from a provincial jail health unit, begging me to ship methadone that they could pick up for a patient of mine that was in jail who had overdosed and almost died on heroin, which was [smuggled] in for him," he said.
"They didn't give him methadone because they were so freaked out by accidental overdose in the prison that they actually brought one on. It's considered an essential medication in the treatment of opioid addiction, and in my judgement, it's no different than withdrawing medication from, let's say, mental illness. Why not just let a schizophrenic hallucinate the whole time they're in jail?"
Access to MMT in prisons across the country varies. Since 2002, MMT has been widely available in federal prisons following a change by the Correctional Services of Canada (CSC) to their policy surrounding the drug. The current policy both allows for inmates to start or continue methadone treatment when serving time of two years or more—the requirement to end up in a federal prison.
Prior to the change, federal prisons had individual policies on how to prescribe the treatment, much like provinces do now. For example, in British Columbia, inmates are able to initiate treatment inside prison—a feature which is unique to the province. While all provinces allow for MMT in some capacity, many, like the Yukon, are stingy about how they determine if someone is eligible.
Richard Elliott, executive director at the Canadian HIV/AIDS Legal Network, says that the current treatment of MMT in Canada constitutes what can be seen as a human rights abuse and that ongoing litigations, like the inquest that's happening in the Yukon, will continue to happen until the country can come to a definitive solution on how prisons should implement the treatment.
"The big problem here is the specifications in how each province handles [the treatment]," he said. "There is obviously concern over how [prisons] should go about the process."
"More generally, the equality issue exists in that we shouldn't be denying methadone to people inside prison. It violates international human rights law."
Elliott and Berger both agree that introducing methadone access into prisons is not only a good idea for addicts, but also for public health. Studies have shown that methadone treatment lowers the chances of diseases like HIV and hepatitis due to addicts no longer risking the chance of using tainted needles or equipment when administering drugs, as methadone itself is most commonly taken orally by mixing it with a citric juice. Not being dependent on a street narcotic or susceptible to the chance of overdose also improves life expectancy drastically.
But legislative bodies have been unreceptive. In a letter drafted by Elliott and 19 other experts in the field of HIV, AIDS and public health to the Yukon's Minister of Health and Social Services and Minister of Justice in 2013, the group called for the legislators to reassess their stance on giving prisoner's access to methadone in prisoners, citing concerns of both infectious diseases and inhumane treatment of prisoners.
In a response letter, Ministers Mike Nixon and Doug Graham thanked the group for their concern, but held tough to their position that a forced detox of inmates is the "safest, most appropriate approach for addiction management."
"Our government believes it is in the best interest for both the community and the inmate for the inmate to be detoxed in a setting where supervision and medical supporters are available, such as a correctional centre," the letter reads. "Thank you for your correspondence on this matter."
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