Imagine this: You’re practicing medicine and a patient comes to you with an illness. You make the diagnosis and then say to the patient, “I can see that you are very sick. And there is a highly effective treatment for your condition that would make you feel a lot better. It’s simple and it isn’t even expensive. But, you know what? I’m not going to give it to you! You’re not sick enough. Come back tomorrow. If you’re sicker tomorrow—well, if you’re sick enough
—I will treat you then. But not right now.”
Crazy, right? We’d never do such a thing.
But . . . the problem is, we frequently do that exact thing with our heroin withdrawal patients. I’m not singling out correctional medicine practitioners here. I think that, in general, heroin withdrawal is treated better in correctional settings than it is in the community. Nevertheless, it is a fact that heroin withdrawal is often not properly treated in jails and prisons. I have seen it.
I believe that there are four main reasons that some facilities do not appropriately treat heroin (and other opioid) withdrawal.
Posted in: Drug EvaluationsDrugs of AbuseUncategorizedWithdrawalWithdrawal Syndromes
The practice of Correctional Medicine has many strange differences from medicine outside the walls. It took me a couple of years to get comfortable with the various aspects of providing medical care to incarcerated inmates. Of all of these differences, one that stands out in importance is the fact that many seemingly benign medications are abused in correctional settings.
Of course, the Drug Enforcement Agency (DEA) has established a list of drugs known to have potential for abuse and even addiction. The DEA even ranks these drugs according to the severity of this risk. Schedule I drugs carry the most risk, followed by Schedule II, and so on, all the way down to Schedule V, which are thought to have the least risk.
However, the drugs that we are talking about here are not on the DEA’s list. These are medications that are not abused (or, at least, not thought to be abused) in mainstream medical settings. But these drugs are, in fact, abused and diverted in jails and prisons.
The reasons for this are somewhat complex, but in my mind, it boils down to this: These are drugs that have psychoactive effects that mimic, to some degree, the effects of the drugs on the DEA Schedules. If you are addicted, or even if you just like to get high once in a while, and you can’t obtain your preferred drugs of abuse because you are incarcerated, these are the drugs that can serve as an alternative in a pinch.
It is critically important for medical professionals in corrections to know which seemingly benign drugs have the potential to be abused and diverted. Even if a particular inmate doesn’t care about getting high himself, he can still profit by selling these drugs to others who are. Vulnerable inmates can be (and are) bullied into obtaining these drugs for distribution--if we make them available.
Posted in: Drug EvaluationsDrugs of AbuseInmate issuesJail culturePharmacyUncategorized
One of the consequences of the heroin epidemic we all are experiencing is a marked increase in the number of skin abscesses presenting to the jail medical clinics. Jails have always had to deal with skin abscesses. In fact, the single most popular JailMedicine post has been the Photographic Tutorial on Abscess I&D (found here
). But since the heroin epidemic, the number of skin abscess we see has exploded. It is not unusual nowadays to lance an abscess every day!
The reason for this big increase in skin infections, of course, is that heroin users tend to share needles to shoot up, and these dirty needles leave behind the bugs that cause abscesses. And since shooting up causes the abscesses, they tend to be found where addicts commonly shoot up--like the inner elbow, the forearm and even overlying the jugular veins of the neck.
Fortunately, just in time for this onslaught of abscesses, my good friend Neelie Berlin PA taught me a new method of lancing simple abscesses that is quicker and easier—yet just as effective—as the method I had been using for my entire career. I’m going to call this new method of draining abscesses “The Berlin Method.”
Who says you can’t teach an old Doc new tricks? I have wholeheartedly gone over to the Berlin procedure. It is THE method I use now to drain simple abscesses.
Today’s JailMedicine post is a pictographic tutorial on how to do this new easier method of lancing simple abscesses.
Posted in: DermatologyInfectious DiseaseMedical PracticeProceduresUncategorized
The list of educational opportunities specifically geared towards correctional medicine is woefully short. We correctional specialists need to take advantage of as many of our own conferences as we can.
One excellent resource for several years has been the one day conference put on by the American College of Correctional Physicians (formally known as the Society of Correctional Physicians). Historically, this conference has always been held on the Sunday before the NCCHC National Conference held in October. These ACCP conferences have always been excellent, but only held then.
This year, however, is different. This year, the ACCP is also hosting a spring conference tied to yet another excellent educational opportunity in correctional medicine: the Academic Consortium on Criminal Justice Health. The Academic Consortium conference will be held this year in Atlanta on March 16th and 17th. ACCP's one day conference will be held immediately afterwards, on March 18th, a Saturday.
Posted in: Conference
I have a confession to make. Before I knew anything about Correctional Medicine, I had a bad opinion about it. I’m not proud of this. I even turned down my first opportunity to get into Correctional Medicine because of my preconceived prejudice. Thank goodness I got a second opportunity, because Correctional Medicine changed my life! Who knew that Correctional Medicine was such a great job and a great career?
Certainly not my colleagues. Back when I made the mid-life career change to jail medicine, my physician friends asked me, bewildered, “Why in the world would you want to work in a jail?” Without knowing anything about it, they had a preconceived notion of Correctional Medicine as being low skill and basically without redeeming features.
What a difference 15 years makes!
Posted in: Medical EconomicsMedical PracticeMental HealthPractice Management