“Swimming against the Tide” Restricting Prescribing Practices in a Prison: A Personal Journey
Bibliographic record
Abstract
Objectives: I sought to reduce the unnecessary prescribing of psychotropic medications with abuse potential, chiefly benzodiazepines (Valium-like drugs), HS sedatives (“sleeping pills”) and psychostimulants (e.g. methylphenidate [Ritalin]) in prison settings. Method: After each patient/inmate was assessed, benzodiazepines and HS sedatives were tapered and stopped. Patients/inmates were restricted to no more than one antidepressant and no more than one antipsychotic agent; prescriptions for psychostimulants were also restricted. Results: Other health care staff consistently reported that the overall mental health of inmates improved soon after these changes were implemented. Prison staff reported that incidents of “strong-arming” of inmates for medications decreased as did levels of prison violence. Prescription drug costs dropped substantially and psychiatrist visits dropped by approximately 75%. Drug-seeking behaviors included complaints to the media, which was sympathetic, and to the College of Physicians and Surgeons of Newfoundland and Labrador, and eventually to a widely publicized peer review which, fortunately, endorsed my practices. Conclusions: Reducing unnecessary prescribing rates of psychotropic drugs with abuse potential to prison inmates has beneficial effects on both health care costs and inmate well-being. However, dealing with public criticism for doing so is difficult. Objectifs: J'ai cherché à réduire la prescription inutile de médicaments psychotropes avec un potentiel d'abus, principalement les benzodiazépines (médicaments comme le Valium), les sédatifs HS (“sleeping pills”), et les psychostimulants (ex.: méthylphénidate [Ritalin]) en milieu carcéral. Méthodologie: Suivant l’évaluation de chaque patient/détenu, les doses de benzodiazépines et sédatifs HS étaient progressivement diminuées jusqu’à l'arrêt. Les patients/détenus étaient limités à un antidépresseur et une substance antipsychotique; les prescriptions de psychostimulants étaient aussi limitées. Résultats: Le personnel médical signalait régulièrement que la santé mentale globale des détenus s'améliorait peu après que les changements soient mis en place. Le personnel carcéral a signalé une diminution des incidents impliquant la force avec d'autres détenus pour obtenir des médicaments et de la violence en prison. Les coûts liés à la prescription de médicaments ont diminué substantiellement et les visites en psychiatrie ont diminué d'environ 75%. Les comportements toxicomaniaques incluaient des plaintes aux médias, qui étaient favorables, et au Collège des médecins et chirurgiens de Terre-Neuve et Labrador, puis à un examen par les pairs largement publicisé, qui ont approuvé ma pratique. Conclusions: La diminution de prescription inutile de médicaments psychotropes avec un potentiel d'abus parmi les détenus a des effets positifs à la fois sur les coûts de soins de santé et le bien-être des détenus. Toutefois, faire face à la critique du public pour avoir agi ainsi est difficile.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.022 | 0.015 |
| Scholarly communication | 0.012 | 0.010 |
| Open science | 0.003 | 0.011 |
| Research integrity | 0.012 | 0.020 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".