Monthly Archives: January 2014

Reader Question: Xanax Withdrawal

I am looking for a withdrawal protocol for benzos. I have patients that have been on Xanax 2mg for 3-5 years and now I need to detox them. We all know how difficult this is with people in the community let alone in the correctional setting. PLEASE HELP !!!!
Thank You, Doris

Well, Doris, you have come to the right place! I, and many other JailMedicine readers, are happy to share our strategies for dealing with benzodiazepine withdrawal. And this is a common dilemma in county jails. Believe it or not, Xanax is the single most-prescribed psychiatric drug in the United States. My experience is that Xanax is highly addictive and yet handed out like candy by some community practitioners. Some community prescribers I have talked to do not even realize that Xanax is addictive!  Strange but true.GABA-Production Continue reading

Essentials of Correctional Medicine . . . Final Agenda

logo idea 3.5I am excited to be part of the Essentials of Correctional Medicine conference! It is only five weeks away, February 19, 20 and 21.

Click here for more information!

Hilton South exterior

As it was last year, Essentials will be held at the Hilton Hotel in Downtown Salt Lake City, Utah.
Conference attendees will have a continental breakfast and full lunch each day of the conference. More important, though, will be the excellent quality of medical education.

Wednesday, February 19, 2014

SasserDavid Sasser, JD. Dave has specialized in correctional law throughout his career. I have worked with Dave for many years and I can tell you that he is a great speaker; both interesting and funny. Dave’s first talk is entitled “Legal Overview of Case Law in Correctional Medicine.” Don’t let the title intimidate you! Dave says most people who work in corrections do not know all of the safeguards built into the legal system to aid and protect them. After this talk, you will know how to walk among the landmines (so to speak).

The second of Dave’s presentations will be “A Review of Case Law in Correctional Medicine.” This will be a group discussion about actual lawsuits and their outcomes. Each of these cases is unique. Why was the jail sued? How could the lawsuit have been avoided? Was a mistake made medically? Was a mistake made legally? What was the outcome? I find malpractice cases fascinating, myself.
Do you have a lawsuit hanging over you right now? Bring it up! Let’s discuss it!

“Managing Those Surprising Drugs of Abuse in Corrections.” We will talk about gabapentin, amitriptyline, Wellbutrin, and many others. What other medications have you seen diverted and abused in your facility? Let’s talk about it!

Medications Behind Bars—the Most Common Mistakes.” Observations by a Correctional Pharmacist. Do you have questions for our panel of correctional pharmacists? Formulary? Storage of scheduled drugs? Bring it on!

Thursday, February 20, 2014

Gardner PhotoNoel Gardner, MD is a forensic psychiatrist who will speak on Wednesday about psychiatric malingering and symptom magnification. His first lecture, “Disease, Distress, Disguise or Deception,” lays the groundwork for understanding the dynamics behind deception.

Dr. Gardner’s second lecture is entitled “Malingering: The Psychodynamics of Medical Manipulation; How to Recognize It, and What to Do About It.” You will be taking copious notes because this is information that will be immediately useful to you in your home facility.


ScottEliasonDr. Scott Eliason will follow Dr. Gardner. Oftentimes, we correctly identify a patient in our facilities as malingering or exaggerating a psychiatric illness, but we cannot simply walk away—this is still our patient. What do we do now? Medication? Counselling? Behavioral Modification? Dr. Eliason will share his experience with these patients in his years of working in prisons and jails.

Brian Mecham, LCSW has been working as a mental health counselor in jails for many years. His assignment is to answer the question of “How to Manage Personality Disorders Without Drugs.”

BerlinFinally, Neelie Berlin, who has been a jail medical provider for years in addition to her other job as a dermatologist, will speak on “Dermatology Behind Bars.” Neelie, of course, will have lots of gnarly slides and will make your life simpler with many, many tips on how to deal with the weird rashes that always crop up behind bars. Do you have a rash in your facility that is kicking your butt? Bring a picture and Neelie will help.

Friday, February 21, 2013.

BickOur Keynote Speaker, Dr. Joseph Bick, will present “Correctional Medicine in a Malaysian Prison—Lessons for American Prisons.” There is a reason that we picked Dr. Bick to be our Keynote Speaker. Well, four reasons, really. One, he is a wonderful and interesting speaker. Second, he is an infectious disease expert, and infectious disease is always a timely topic for jails and prisons. Third, Dr. Bick has a fascinating story to tell. For the past year, Dr. Bick has worked as a correctional physician in a prison in Malaysia. You think you have it bad? You will feel a lot better about your work environment after hearing this talk. Finally, this is an uplifting and motivational talk that will send you back to work with a spring in your step.

Dr. Bick’s second talk is entitled “What’s new in HIV, Hepatitis C and TB.” Hepatitis C is especially timely because of the pressure to use the new, unbelievably expensive, protease inhibitors coming on the market.

Carl VanceDr. Carl Vance is an endocrinologist who has, for years, been my “Go-To” guy when I have a jail patient with a difficult endocrine problem. He has helped me (and many others) with his timely and practical advice. Carl has distilled many of his practical tips into his lecture: “Endocrine Potpourri.” This lecture receives rave reviews whenever it is given. Carl says that whenever he gives this lecture, he spends another half hour answering questions out in the hall—so please bring your diabetic and endocrine problems. We will allow plenty of time for questions and discussion!

JeffreyKellerThe final speaker of the conference will be me. My experience prior to corrections is as an Emergency Physician, so I am going to talk about “A Simplified Approach to Abdominal Pain and Chest Pain.” The final lecture of the conference will also be mine and is entitled “Interesting Cases in Correctional Medicine.” I am going to pick my weirdest and most interesting cases to present and discuss.

Although seats for this conference are filling up fast, there is still room.  Please register!

Click here to learn more!

Do Not Use Hydroxyzine for Alcohol Withdrawal!

We correctional practitioners get to see a wide range of medical practice as we review the medical histories of inmates arriving at our facilities. I myself have seen many prescribing practices that make me scratch my head. One example I have run into repeatedly is the practice at many jails of using hydroxyzine to treat alcohol withdrawal.  It turns out that many jails do this.  I am not talking about hydroxyzine as an adjunct or an add-on to the primary agent. I am talking about hydroxyzine being used as the primary treatment agent itself.

In my opinion, this is a mistake, and should be stopped.

Now I admit that there is room for dissention in medicine. Not all practitioners practice in the same way and there are many, many areas of medicine where there is no right answer. And it is true that hydroxyzine was used in the 1960’s to treat alcohol withdrawal. However, since then, medicine has discovered superior agents to treat this condition: the benzodiazepines. Today, hydroxyzine is the wrong agent for alcohol withdrawal. If your facility uses hydroxyzine as the primary treatment for alcohol withdrawal, you should change your protocol. There is no legitimate basis for this practice.images Continue reading

Top Posts from 2103 and New Year Resolutions

Thanks to everyone who has read JailMedicine this past year!  I have to admit that when I started writing JailMedicine, I never thought it would be as successful as it has been. Total readership should exceed 200,000 by the time of my second year anniversary later this month.  This just goes to show that Correctional Medicine is growing and, in my opinion, is poised to become medicine’s Next-Big-Thing!  I am especially grateful for the help and free advice that Lorry Schoenly has given me from the very outset.  Thanks, Lorry!

Today, I recap the Top-Five Most Read articles of 2013 and my resolutions for the New Year.20140101 Continue reading