All medications have side effects and potential complications. Of course we all know this. Whether to prescribe and what to prescribe should involve a careful weighing of the expected benefits vs. the potential harm for each individual patient.  This math—risks vs. benefits—can change for many reasons.  For example, drug X may be great for most people but this patient has kidney disease and should not take drug X.  This patient does well on drug Y but that patient has no health insurance and cannot afford drug Y.

Being incarcerated changes the risk-benefit equation for many drugs.  This is especially true for drugs that are addictive or have the potential to be abused.  Some medications may be inappropriately used by inmates to continue or maintain their drug addiction while incarcerated. Such medications have value in the jail system and are commonly shared and sold.  Individuals taking these medications may be at risk from other inmates, who may coerce patients to “cheek” and share.  This additional extraordinary risk must be considered when prescribing medications in a correctional setting and for many drugs, the risks always (or almost always) outweigh any benefit a patient may derive from them. Continue reading →