Restricted care: prescription medicine and the construction of the ‘problem’ patient in prison

Background People in prison are entitled to the same healthcare that is provided in their wider community. However, despite the high healthcare needs of the prison population, the prison setting imposes constraints on prescribing practices due to concerns regarding misuse and diversion of medication.Methods The analysis is based on interviews with prison healthcare professionals (N = 11), people experiencing imprisonment (N = 39), and fieldnotes conducted in prison (N = 156 hours). The empirical data are explored in the theoretical framework of Lipsky (Citation2010 [1980]) about street-level bureaucrats and of Lorber (Citation1975) on categorisations of ‘problem’ patients.Results Prescribing decisions are shaped by perceptions of certain individuals as ‘problem’ patients, influencing access to medication. This perception fosters suspicion among healthcare staff, often resulting in deprescribing or the withdrawal of medication, which has a profound impact on the access to medication and the well-being of people in prison.Conclusion Healthcare professionals’ decision-making is affected by the prison setting, where security and risk considerations are significant. It is important to be aware of how the prison setting affects the opportunity to put patient’s need first and to consider how the consequences of being a ‘problem’ patient can be minimized.