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Prison Drug Store. Mohsen Saadat , D.O., F.A.C.P Medical Director San Joaquin County, Correctional Health Care Facility. Financial Disclosures. None. Three Focus areas. 1. Epidemic of Drug Abuse 2. Medicat i on Abuse by Inmates, Psychotropic Medications

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Prison Drug Store

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Prison drug store

Prison Drug Store

Mohsen saadat d o f a c p medical director san joaquin county correctional health care facility

MohsenSaadat, D.O., F.A.C.P

Medical Director

San Joaquin County, Correctional Health Care Facility

Financial disclosures

Financial Disclosures

  • None

Three focus areas

Three Focus areas

1. Epidemic of Drug Abuse

2. Medication Abuse by Inmates, Psychotropic


3. Essential Pearls in dealing with Jail Medicine

Prison drug store

Prescription Drug Abuse: Insight Into the Epidemic

Michael Boticelli, Deputy Director of the White House Office of National Drug Control Policy, announced that the abuse of prescribed drugs has been classified as an epidemic by the Centers for Disease Control.

Prison drug store

Prescription Drug Abuse: Insight Into the Epidemic

  • Joseph Rannazzisi, from the Drug Enforcement Agency provided the following information:

  • Deaths in 2010 caused by accidental overdose of prescription opiates exceeded the combined rate from all other drug deaths, including heroin and cocaine combined.

  • Deaths from accidental drug overdoses exceeded all other causes of accidental deaths, including vehicle accidents.

Prison drug store

Prescription Drug Abuse: Insight Into the Epidemic

Prison drug store

Prescription Drug Abuse: Insight Into the Epidemic

Prison drug store

Prescription Drug Abuse: Insight Into the Epidemic

  • United States has 4.6 percent of the world’s population, but consumes 80 percent of the world’s opiates and 99 percent of the entire world production of hydrocodone.

  • For every death by opiate, there are 130 individuals abusing the drug chronically.

  • Pain in the rest of the world is managed with far fewer opiates than in U.S. Alternatives include NSAIDs, acetaminophen, physical therapy, herbal remedies and supportive care.

Prison drug store

Correlating the General Population Data with the subset of the Population Residing in the State Hospitals and Prisons

Medication abuse by inmates

Medication Abuse by Inmates

Medication abuse by inmates1

Medication Abuse by Inmates

Medication abuse by inmates2

Medication Abuse by Inmates

From deinstitutionalization to trans institutionalization

From Deinstitutionalization to Trans-institutionalization

Psychotropic medication abuse in correctional facilities

Psychotropic Medication Abuse in Correctional Facilities

  • 20% of the 2.1 million Americans in county jails and state prisons are seriously mentally ill.

  • Only 80,000 in mental hospitals.

  • 72% of inmates with mental illness have substance abuse/dependence.

Psychotropic medications abuse by inmates

Psychotropic Medications: Abuse by Inmates

Concerns in treating the incarcerated psychiatric patient

Concerns in Treating the Incarcerated Psychiatric Patient

1) Compromised Care for Those Who Need It

2) The Malingering Patient

3) Inmates Creativity factors

Care compromise

Care Compromise

  • These individuals may be bullied, abused, have their medications taken from them by other inmates.

  • Paradoxically, there are prisoners who would benefit from psychiatric agents but fear treatment will make them vulnerable to other inmates. “ You can’t make me a zombie.”

The malingering patient

The Malingering Patient

  • Those desperate to escape the larger prison community out of fear: “Just to get some sleep”, “Just to get away from the noise”, “I want a little peace”, “ A little Privacy”.

  • Those who want to trick the system into providing psychotropic drugs.

The creativity factor

The Creativity Factor

  • Sliding the white pill into the empty socket of a missing tooth.

  • Using denture adhesive on the roof of the mouth to hide the pills.

  • For crushed meds and powders, pretend to swallow but would leave the powder on the back of the tongue. Then scrape the powder off the tongue and mix it with saliva to make a paste, then dry the paste and sell it to the other inmates.

Lessons to be learned

Lessons to be learned

  • Apart from the initial “Ewww”, it shows how desperate some inmates are for the drugs and how far they go to get anything that alter consciousness.

  • Also, the effort we put into preventing checking is not always successful, inmates are just too creative.

  • Control is an important motivating factor for the inmates to give them a sense of independence and respect by other inmates.

Bridging medications

Bridging Medications

  • A lesser known phenomenon to use other prescription medications to minimize physiological withdrawal until individuals can obtain their next “chemical high” with their drug of choice.

Inappropriate drugs in jails and prisons

Inappropriate Drugs in Jails and Prisons

A list of pearls

A List of Pearls

The definition of a ‘pearl” is a bit of pithy and insightful information that can be communicated in a few sentences.

A list of pearls1

A List of Pearls

  • Seroquel; “Quell”, “susie Q”, “or “Baby Heroin”, “Q-ball” - when combination with cocaine. Crushed and snorted, injected, or inserted rectally. Hypnotic effects and Amnesia.

  • Risperdal; “ Orange Monster” 2-3 pills for sleep.

  • Zyprexa; used orally or intravenously, causing a “buzz”.

  • Gabapentin; “Nana”, if a meth addict can produce a high, if heroin addict can produce drowsiness, hallucination. Snorted with Wellbutrin to decrease the nasal irritation.

A list of pearls2

A List of Pearls

  • Artane; “ A’s”, take (3) 5 mg pills with a cup of coffee, or directly snort, effects similar to meth.

  • Wellbutrin; “ Welbys”, mix in coffee provides a high similar to meth. Can be snorted or injected. 3-4 pills are crushed and placed in a spoon with a drop of water, mix well and let the water evaporate.

A list of pearls3

A List of Pearls

  • Benadryl; 5-6 of 50 mg does can cause high similar to speed in some individuals.

  • Albuterol; can be used in rapid succession to promote one hour high. Can express into a plastic bag and huffed, 2-3 hour high. Can keep cap on and deployed until canister empty, then scrape residue off cap and sniff, ingest, or shoot.

A list of pearls4

A List of Pearls

  • Nasal Decongestants; 20-40 drops heat in a spoon and inhale the vapor. Effects appear in a few seconds and last for 2-4 hours. Feeling of “stimulation”, “excitation”, “strength”.

  • Dextromethorphan, common in OTC cough suppressant, used at much higher doses for its dissociative effects. “ robo-tripping” or “Triple Cs”.

A list of pearls5

A List of Pearls

  • Bupropion SR; reported as being crushed and snorted, most often as an adjuvant to gabapentin.

  • TCAs; multiple reports of hoarding and used to commit suicide.

  • Tramadol; synthetic codeine with weak mu receptor activity as an anxiolytic. Lowers threshold for seizure.

A list of pearls6

A List of Pearls

  • Pruno; Jail house wine, fruits such as oranges, soup noodles or potato flakes and 3-4 packages of sugar. Let ferment for 7-10 days. Many different recipes.

  • Wheat bread mashed with orange peels, place in a warm place for the mold to grow. Extract brown mold and inhale, causes hallucinations similar to LSD.

  • Metamucil; reports of it being dissolved after given to an inmate and solidified into a shank.

National strategy of quality improvement in health care national quality strategy three part aim

National Strategy of Quality Improvement in Health Care (National Quality Strategy) “Three Part Aim”

Better Health for the population

Better Care for Individuals

Lower Cost Through


The Medicare Quality Improvement of California

Medical board recommendations

Medical Board Recommendations

  • Document appropriate H&P.

  • Establish a Diagnosis and an objective measure of pain.

  • Obtain an opiate contract.

  • Perform periodic review of patient condition and effectiveness of therapy.

Medical board recommendations1

Medical Board Recommendations

  • Obtain further consultation from other specialties if pain is difficult to control.

  • Maintain accurate records.

  • Perform periodic review of the records.

  • Provide adequate and appropriate documentation of the NP/PA supervision.

Three reasonable criteria

Three Reasonable Criteria

  • The risk of abuse the medication has in this correctional setting.

  • The potential benefit the medication offers.

  • Whether a less problematic substitute is available for this setting.

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