Prisoners are ‘popping pills like there is no tomorrow’

Updated - Adds CCF's reaction

A man serving time for marijuana-related offences has described a prison system rife with prescription medicine use, with inmates given medication “morning, afternoon and evening”.

Going cold turkey was absolute hell, the mood swings were incredible

“You see people popping pills like there’s no tomorrow,” Daniel Holmes said.

“Antidepressants, tranquilisers, Valium and all that... many of them don’t even know what they’re taking. They just swill and down them,”

Reports of narcotics entering jail surface fairly regularly, but this is the first time a potential problem with legal drugs has been flagged up.

When contacted, prison board chairman Ivan Mifsud said that while the board sometimes received complaints from inmates alleging they were being made to pay for medication they should be receiving for free, “the problem of over-medication has never arisen” over the past three years.

He acknowledged the important role medical judgement played in the issue, adding that the prison board would happily take up any such cases brought to its attention.

Mr Holmes, 34, was given a 10-and-a-half year sentence last November, more than five years after he was first arrested and charged with cannabis possession, cultivation and trafficking.

He recalled being sent to Mount Carmel hospital for a drug rehabilitation programme soon after being arrested in 2006.

The course lasted for “a few months” and was also characterised by prescription medications.

Mr Holmes said: “The doctor at the rehab programme put me on [tranquiliser] Valium and [antidepressant] Paxetin. I took them as I was told. Then one day I had problems getting my yellow medication card, and the doctor just cut me off them completely.”

Debate over marijuana’s addictive qualities is politically charged but there is widespread consensus within the scientific community that it is less addictive than alcohol and nicotine, as well as antidepressants.

Suddenly stopping antidepressant use can be dangerous and goes against good medical practice.

Mr Holmes found going cold turkey hard. “It was absolute hell at first. My dad had to fly from the UK and care for me, the mood swings were incredible.

“But at least I got off them. I never want to go there again,” he told The Times. “There’s no way I’m going to start taking pills again in [prison].”

But other inmates have no such qualms, he said. “There’s a medicine round three times a day – morning, afternoon and evening – and it’s always quite lively then.”

Former prison board chairman Mario Felice said “it would not be surprising” if over-medication of prison inmates was a problem at Corradino Correctional Facility.

However, he made it clear such problems were “a documented challenge for prisons everywhere” and not just in Malta.

“What is always difficult to establish is cause or effect. Some countries have studied it but as far as I know there’s never been such an audit of the Maltese prison system.”

Mr Felice recalled doctors within CCF being pressured by inmates to prescribe them certain medicines.

“It can be hard for a doctor to resist such pressure, especially when faced with it constantly. It boils down to the individual doctor’s strength of character.”

One way to counter this was group medical practices and rotating different doctors, he explained.

“When we did that, doctors found it easier to resist inmates’ demands, knowing they wouldn’t be facing them again just a few days later.”

CCF'S REACTION

In a reaction, the Corradino Correctional Facility said the population of the Corradino Correctional Facility benefits from an in-house medical service that is available twenty four hours a day, seven days a week in order to see to the disparate medical exigencies of the whole CCF population.

"All medical treatment dispensed by in-house doctors is similar to that applied to patients in the wider community by medical GPs at large. Indeed, the conditions treated inside the CCF reflect those normally prevalent among the general population and range from hypertension and diabetes to depression and heart disease."

All inmates are given for free all treatment as outlined by the National Health System and does not require the use of the Schedule V (yellow) card, the CCF said. If and when medication is not included in the National Health System free medication service, inmates are given the opportunity to purchase the prescribed medication. Residents on treatment are regularly monitored by the same medical authorities and the treatment is modified or withdrawn accordingly.

Medication is dispensed and administered as prescribed and according to indications.

"Thus, while medication at CCF is dispensed three times a day, this by no means implies that all inmates on medication require treatment three times a day.  Furthermore, treatment/medication prescribed by medical authorities is carried out with the patient’s consent. Having said this, it is also not uncommon for patients to refuse treatment against medical advice"

With respect to Mr Holmes, the CCF said the prison authorities are bound by the Consent and Confidentiality Clause, signed by Mr Holmes himself, not to disclose any information pertaining to his medical file.

"However, this clause does not preclude the Prison Board of Visitors from accessing his file to ascertain or otherwise the claims put forward by Mr Holmes with regard to his treatment. This said, it is to be noted that in 2006 Mr Holmes was at CCF for eight days and therefore medical treatment provided by the CCF was limited to that short period of time. This also holds true for Mr. Holmes’s detention in preventive custody in connection with an earlier, unrelated, case"

With regard to educational provision offered at the prisons, the CCF stressed that class provision is subject to demand and availability.  Current subjects offered in-house are of a basic and general nature. 

"Inmates requesting specialised training have the opportunity to pursue such training in recognised training institutions in Malta, as long as they satisfy the requirements for prison release for education purposes. At present there are 93 inmates who are receiving in-house training at the CCF, with a further four inmates attending courses outside the prison boundaries while on approved prison leave. Mr. Holmes will be eligible for participation in such courses on prison leave after serving the first six months of his sentence in accordance with established regulations."