Recent Entries

Opioid Withdrawal Not Deadly? Wrong!

2018-11-12 14:55:22 jeffk2996
One thing I always tell practitioners who are beginning a jail medical practice: you're going to see a lot of withdrawal cases -- study up! In particular, since the opioid epidemic hit, the number of patients I've seen in my jails withdrawing from heroin and other opioids of all stripes has skyrocketed. I've seen enough patients withdrawing from opioids that I think I am reasonably knowledgeable on the topic. Because of this, I was quite surprised when I ran across this sentence in a recent edition of The Medical Letter: "Opioid withdrawal is not life-threatening." -- The Medical Letter The problem is that although this sentence seems quite self-assured, it is flat out wrong. In fact, it is not just wrong; it is also dangerous. People do die from opioid withdrawal. I know of several such cases from my work with jails. Opioid withdrawal needs to be recognized as a potentially life-threatening condition, just like alcohol withdrawal and benzodiazepine withdrawal.
Posted in: MedPage TodayStudiesUncategorizedWithdrawalWithdrawal SyndromesTagged in: clonidinecorrectional medicineevidence based medicineinmatesjail medicinejailsMedPage Todayopioid withdrawalprisons Read more... 3 comments

Sample Food Allergy Guideline

2018-11-01 12:27:26 jeffk2996
Today’s post is the second in a series of sample clinical guidelines.  All of these sample guidelines will be placed under the “Guidelines” tab (above) as they are published. I view these sample guidelines as a group effort!  If you have a suggestion, critique or simply a better way to phrase some concept, say so in comments. I wrote about food allergies previously on JailMedicine in "Food Allergies: Sorting Out Truth from Fiction" (found here). Since then, I have had more email requests for a Food Allergy guideline than all other sample guidelines put together.  It is clearly a BIG issue in corrections.
Posted in: AllergyGuidelineMedical PracticeUncategorizedTagged in: correctional medicineevidence based medicineFood allergyinmatesjail medicinejailsprisons Read more... 0 comments

Gabapentin in the News!

2018-10-05 15:49:11 jeffk2996
2018 has been a remarkable year for news and research into gabapentin, and the year is not even over yet! That is great news for those of us (myself included) who puzzle over the proper role of gabapentin within correctional medicine. On the one hand, if gabapentin is a useful drug for chronic pain, neuropathy, or any other medical condition, I want to use it properly. On the other hand, gabapentin is a ferociously abused drug within jails and prisons. It is both a sedating and euphoric drug that also can be hallucinogenic at high doses. When it is available within a prison, there is inevitably abuse of gabapentin (like snorting it), diversion of gabapentin (because it has large value within the correctional black market and so can be sold to others), and finally, there is inevitably coercion of weaker inmates by stronger inmates to acquire gabapentin prescriptions and give those prescriptions up to the strong.  Those of us in corrections have seen all of this and worse. So any news of gabapentin, whether good or bad, can change the balance of this deliberation. If gabapentin is proven to be more effective medically, it may be worth tolerating the abuse. If it is found to be ineffective, there is no reason to introduce this stressor into the system.  With this in mind, here is a sample of the 2018 news on gabapentin.
Posted in: Drug EvaluationsDrugs of AbusePharmacyPractice ManagementTagged in: correctional medicineevidence based medicinegabapentininmatesjailspharmacy practiceprisons Read more... 2 comments

My jail Is Safer Than Your ER! from MedPage Today

2018-09-17 13:24:56 jeffk2996
This article was first published here on MedPage Today. How safe is correctional medicine? People naturally assume that working in a jail or prison is dangerous. "Aren't you nervous about working there?" they ask me. What people have seen of jails on TV looks pretty rough! After all, that's where they put the violent criminals, right? The problem is, it just isn't so! Jails and prisons are not dangerous places to work; to assume so is just one of many misconceptions people have about correctional facilities. In fact, my jail medical clinics have been a much safer work environment than where I worked before.
Posted in: Jail cultureMed Page TodayRestraint Read more... 1 comment

Sample Clinical Guideline: Medical Approval of Personal Footwear

2018-08-20 15:23:04 jeffk2996
Today's post is the first in a series of sample clinical guidelines.  These will be placed under the "Guidelines" tab (above) as they are published.  These guidelines are open access; you may use them in whole or in part as you see fit.  I view these sample guidelines as a group effort!  If you have a suggestion, critique or simply a better way to phrase some concept, say so in comments. This particular clinical policy addresses a common problem in jails (less so in prisons). I addressed the issue of allowing personal shoes in jail previously in "A Quick-and-Easy Solution to those Pesky 'Own Shoes' Requests," (found here).  As a result of that post, I have had many email requests for a sample "Own Shoes" guideline.

Medical Approval of Personal Footwear in Jails

This clinical guideline is intended to be used as a template to help clinicians and administrators create their own policy on personal footwear. This sample guideline must be modified to make it applicable to each unique correctional facility. This guideline is not intended to apply to all patients. Practitioners should use their clinical judgement for individual patients.
Introduction. Inmates housed in county jails are provided footwear by security personnel. Occasionally, inmates will state that they have a medical condition that requires them to wear their own personal shoes. If an inmate asks medical personnel to authorize him to wear his own personal shoes, medical providers should re-frame the question as “does this patient have a legitimate medical need to wear his own personal shoes?” Inmates may desire to wear their own shoes for many non-medical reasons, such as convenience, as a sign of increased status among other inmates and as a way to smuggle contraband. This guideline addresses the question of when inmates have a medical need to wear their own personal shoes.
Posted in: Comfort itemsGuidelineUncategorizedTagged in: correctional medicineevidence based medicineFootwearinmatesjail medicinejailsorthoticsprisons Read more... 4 comments

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